Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas

Background: This study aimed to investigate whether radiofrequency ablation (RFA) is an alternative to surgical resection for hepatocellular carcinoma (HCC) within the context of current guidelines. Methods: This retrospective study included patients with normal portal pressure and serum bilirubin level who initially underwent liver resection or RFA for a single HCC of maximum size 3 cm. Between-group differences in cumulative rates of survival and recurrence specific for HCC were analysed in the entire cohort and in a propensity score-matched cohort. Results: A total of 604 patients were enrolled, 273 in the liver resection group and 331 in the RFA group. The 5- and 10-year HCC-specific survival rates for the resection and RFA groups were 87.6 versus 82.1 per cent and 59.0 versus 61.2 per cent respectively (P = 0.214), whereas overall 5- and 10-year recurrence-free survival rates for the corresponding groups were 60.6 versus 39.4 per cent and 37.5 versus 25.1 per cent respectively (P < 0.001). In the propensity score- matched cohort (152 pairs), there were no differences in HCC-specific survival (hazard ratio (HR) 1.03 for RFA versus resection; P = 0.899), whereas recurrence- free survival again differed between the treatment groups (HR 1.75; P < 0.001). RFA was independently associated with poorer outcomes in terms of treatment-site recurrence- free survival (adjusted HR 1.66; P = 0.026), but not non-treatment- site recurrence- free survival (adjusted HR 1.15; P = 0.354). Conclusion: Although RFA carries a higher risk of treatment-site recurrence than hepatic resection, it provides comparable overall survival in patients with a single small HCC without portal hypertension or a raised bilirubin level.