Propensity score-matched comparison of non-anatomical resection and radiofrequency ablation for hepatocellular carcinoma in patients with up to three tumours, each measuring up to 3 cm in diameter. Issue 4 (28th May 2018)

• Record Type: Journal Article
• Authors: Kato, Y; Okamura, Y; Omae, K; Sugiura, T; Ito, T; Yamamoto, Y; Ashida, R; Sato, R; Aramaki, T; Uesaka, K
• Is Part Of: BJS open. Volume 2:Issue 4(2018)
• Page Start: 213
• Page End: 219
• Publication Date: 2018-05-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.60
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Non-anatomical liver resection (NAR) and radiofrequency ablation (RFA) are treatment options for early-stage hepatocellular carcinoma (HCC). The aim was to compare the outcomes of NAR and RFA for HCC in patients with three or fewer tumour nodules, each measuring not more than 3 cm in maximum diameter. Methods: Eligible patients undergoing NAR or RFA with curative intent between September 2002 and December 2014 were identified. A propensity score-matching analysis was performed to reduce bias, and outcomes in these patients were analysed. Results: From a total of 199 patients, 1:1 propensity score matching identified 70 matched pairs. Patients having NAR had a longer hospital stay (median 10 days versus 4 days for those who had RFA; P < 0·001) and a higher morbidity rate (24 versus 10 per cent respectively; P = 0·042). Patients who had NAR had slightly better recurrence-free survival but this failed to reach statistical significance in univariable analysis ( P = 0·064). There was no significant difference in overall survival between the two groups ( P = 0·475). RFA was identified as an independent risk factor for recurrence-free survival (hazard ratio (HR) 1·57; P = 0·041) in multivariable analysis. Local recurrence was significantly more common in patients receiving RFA (23 versus 1 per cent; P < 0·001). Conclusion: RFA was an independent risk factor for shorter recurrence-free survival, with a significantly higher local recurrence rate than NAR. Despite these differences, overall survival was not affected. Graphical Abstract: The aim was to compare the outcomes of non-anatomical liver resection (NAR) and radiofrequency ablation (RFA) for early-stage hepatocellular carcinoma (HCC). A propensity score matching analysis was performed to reduce the influence of potential bias by indication. RFA resulted in an independent risk factor for recurrence-free survival, with significantly higher local recurrence rate than NAR. However, NAR did not improve overall survival in comparison to RFA. Each treatment has its merits