Comparison Of Surgical Resection With Percutaneous Radiofrequency Ablation For Medium-sized Hepatocellular Carcinoma:Long-term Results And Prognostic Factors

Background and Purpose: Liver transplantation 、 surgical resection(SR) and percutaneous radiofrequency ablation(PRFA) are curative therapy for early stage hepatocellular carcinoma(HCC), but the treatments of choice used more frequently in clinic are resection and percutaneous radiofrequency ablation.However,the effect between SR and PRFA in patients with medium sized(ranging from 3 to 5 cm in size) HCC is still a matter of debate.The aim of this study was to compare the effect of RES with PRFA in a retrospective cohort of patients with primary single medium-sized HCC.patients and Methods: Retrospectively collected clinical datas of patients,treated in Shanghai Eastern Hepatobiliary Surgery Hospital from January 2007 to December 2011,with a single medium sized HCC not been treated before(comforming to inclusion criteria).Total of 388 patients were enrolled,among them,196 patients were treated RES and 192 were underwent PRFA.The tow groups were similar for HCC size and liver disease status. The outcome was considered in terms of overall survival(OS) and disease free survival(DFS) calculated by the Kaplan-Meier method.Defferences among groups were validated by Log-rank test.Univariate and multivariate analysis were performed by Cox proportional hazard modle. long-term outcome and prognostic factors were evaluated comprehensively.Results: A total of 388 patients were included in the study.196 cases in SR(172 males and 24 females, Mean age was 52.9±10.5(22.0-80.0)years),the others in PRFA(167males and 25 females, Mean age was 57.9±10.9(34.0-79.0)years).One patient died due to Posthepatectomy liver faliure(PHLF) during perioperative period in SR group.In SRgroup,43(21.9%)(P=0.048)cases occured complications,there ware 9 cases in third class of Clavein classification and 1 case in fifth class of Clavein classification.On the other hand,27(14.1%)cases experienced complications in PRFA group,none of them was in third class or fifth class of Clavin classification.The mean posthepatectmy hospital stay were 8.8±3.2(4-21)days in SR and 2.4±0.9(1-8)(P<0.001)days.The SR group seemed to present a better long-term OS(93.8%、61.9% and 41.0% VS 92.2%、55.1% and 30.8% at 1、3、and 5 years,respectively)(P=0.01)and DFS(73.2%、30.4% and 16.9% VS 65.6%、26.0%and 8.7% at 1、3、and 5 years,respectively)(P=0.005) than PRFA group. Cox proportional hazards analysis showed that satellite nodules、Microvascular invasion(MVI)、Local tumor progression(LTP)、 Child-pugh class B and γ-GT were the risk factors for long-term survival.PRFA itsefe and tumor size more than 4cm were independent risk factors for LTP.tumor size over 4cm and serum albumin(ALB)<35g/L were independent risk factors for LTP in PRFA group.But,in SR group,tumor nearclose great vessels or cholecyst was independent risk factors for LTP.Conclusions: SR may promise better long-term OS and DFS for patients with primary single medium-sized HCC than PRFA.PRFA may provided less posthepatectomy hospital stay and lower complication incidence rate. satellite nodules、MVI、LTP、Child-pugh class B and γ-GT were the risk factors for long-term survival. PRFA itsefe and tumor size more than 4cm were independent risk factors for LTP.