Radiofrequency Ablation Vs.surgery For Solitary Hepatocellular Carcinoma(≤3cm):a Propensity Score Analyses

Background and Aim:The therapeutic outcomes of liver resection(LR)or radiofrequency ablation(RFA)for solitary hepatocellular carcinoma(HCC)(≤3cm)of BCLC stage 0-A are controversial.This study aimed to compare the long-term effectiveness for patients with single HCC(≤3cm)treated by LR and RFA within the context of current guidelines.Methods:Between January 2014 and December 2017,a total of 393 consecutive patients with solitary HCC(≤3cm,Barcelona Clinic Liver Cancer stage 0-A)underwent LR(n=176)or RFA(n=217)as a first-line treatment in the Department of Hepatobiliary Cancer,Tianjin Medical University Cancer Hospital.The patient and tumors characteristics,operative results,and survival outcomes were investigated.The data collected was analyzed by SPSS 26.0 statistical software to explore factors influencing the long-term survival of solitary HCC(≤3cm)within BCLC stage 0-A after curative treatment.Subgroup analysis was conducted according to the diameter of the tumor,between-group differences in DFS and OS for HCC were analysed in the entire cohort and in a propensity score-matched cohort.Results:A total of 393 patients were enrolled,176 in the LR group and 217 in the RFA group.The median follow-up was 45 months.Multivariable Cox analysis showed that treatment regimen was predictive factors for recurrence survival(RFS)(HR 0.617;p<0.001)and overall survival(OS)(HR 1.577;p=0.006).Tumor size(HR 1.485;p=0.015)and serum alanine aminotransferase(ALT)level(HR 3.330;p=0.016)before medical therapy were closely associated with RFS.Liver cirrhosis(HR 1.270;p=0.047)was identified as independent predictors of OS.The propensity score matching(PSM)model analysis showed that there were 60 pairs matched patients with solitary HCC(>2cm,≤3cm)of BCLC stage A for the LR and RFA groups,the4-year RFS rates were 45.1 versus 24.1 percent respectively(p=0.016),whereas 4-OS rates for the corresponding groups were 62.2 versus 46.2 percent respectively(p=0.169).Matching yielded 56 patients with solitary HCC(≤2cm)in each group,subgroup analysis showed no difference in term of 4-RFS(p=0.405)and 4-OS rates(p=0.615).Conclusions:The present study suggests that,in spite of a higher rate of local tumor progression,RFA can provide overall survival results comparable to LR in patients with a single HCC of 3cm or less and BCLC stage A,whereas for the BCLC stage 0 patients,if is not feasible LR,RFA may be considered as an alternative in the treatment option.