Surgical resection versus radiofrequency ablation very early‐stage HCC (≤2 cm Single HCC): A propensity score analysis

Abstract Background & aim Hepatocellular carcinoma (HCC) is increasingly being detected at a very early‐stage due to the wide implementation of the surveillance of at‐risk patient populations combined with improved imaging technologies. Whether patients with HCC at a very early stage can be offered local ablation as a first‐line treatment option still remains controversial. We retrospectively compared the effectiveness of surgical resection (SR) and radiofrequency ablation (RFA) for Barcelona Clinic Liver Cancer (BCLC) very early‐stage HCC in patients with long‐term follow‐up. Methods Propensity score analysis using inverse probability weighting (IPW) from a large‐volume liver centre. We included adult patients who between 2000 and 2013 received a diagnosis of very early‐stage HCC (BCLC stage 0; a single tumour ≤2 cm, Child‐Pugh A class, eastern cooperative oncology group [ECOG] 0) and who were treated with SR or RFA as the first‐line treatment. Results We identified 1208 patients, 631 in the SR group and 577 in the RFA group. The median follow‐up time was 86.2 months. After propensity score analysis using IPW, the 15‐year overall survival rates were 60.4% and 51.6% in the SR and RFA group respectively. RFA group showed poorer overall survival than SR group (adjusted hazard ratio, 1.29; P = .0378). The 15‐year recurrence‐free survival rates were 37% and 23.6% in the SR and RFA group respectively ( P < .001). Conclusion For patients with very early‐stage HCC, the SR group was associated with better overall and recurrence‐free patient survival compared to the RFA group. Therefore, SR should be considered as the first‐line treatment for these patients.