Elsevier

Journal of Hepatology

Volume 56, Issue 2, February 2012, Pages 412-418
Journal of Hepatology

Research Article
Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma

https://doi.org/10.1016/j.jhep.2011.05.020Get rights and content

Background & Aims

To compare the survival between surgical resection (SR) and radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) very early/early stage.

Methods

Between 2002 and 2009, patients with newly diagnosed BCLC very early/early stage HCC who received SR or RFA were enrolled. Medical records were reviewed. The cumulative overall survival (OS) and disease-free survival (DFS) were compared.

Results

A total of 605 patients, including 143 very early (SR: 52; RFA: 91) and 462 early stages (SR: 208; RFA: 254) were enrolled. For very early stage, the 3- and 5-year OS rates were 98% and 91.5% for SR, and 80.3% and 72% for RFA, respectively (p = 0.073). The 3- and 5-year DFS rates were 62.1% and 40.7% for SR, and 39.8% and 29.3% for RFA, respectively (p = 0.006). Either multiple adjustment by Cox model or match analysis based on propensity score showed no significant difference in OS between the two groups. For early stage, the 3- and 5-year OS rates were 87.8% and 77.2% for SR, and 73.5% and 57.4% for RFA, respectively (p = 0.001). The 3- and 5-year DFS rates were 59.9% and 50.8% for SR, and 28.3% and 14.1% for RFA, respectively (p <0.001). After adjusting covariates, there was no significant difference in OS between the two groups. However, SR was superior to RFA in DFS.

Conclusions

For HCC patients in BCLC very early/early stage, there was no significant difference in OS between SR and RFA. However, SR yielded better DFS than RFA.

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, with increasing incidence in several developed countries [1]. In chronic liver disease, the implementation with ultrasound of screen and surveillance programs for HCC, led to an increase in the number of patients with HCC diagnosed at early stage [2]. Because of the limited availability of livers for transplantation, surgical resection (SR) of HCC is traditionally considered as the treatment of choice and yields a 5-year survival of 41–72% [3]. Local ablation therapy, including ethanol injection and radiofrequency ablation (RFA), is safe and effective in the treatment of HCC smaller than 5 cm, not fit for surgical profile [4]. Recent meta-analysis has suggested that RFA achieved better survival than ethanol injection [5]. Therefore, RFA is recommended as a curative treatment option for patients in early stage HCC in the practice guidelines of Western and Eastern countries [6], [7], [8].

Although RFA was the treatment of choice for patients with early stage HCC and limited liver function reserve, whether RFA is equal to SR in terms of long-term overall and recurrence-free survivals for patients with well-preserved liver function is controversial in cohort studies [9], [10], [11]. Two randomized control trials have been performed and showed contradictory conclusions [12], [13]. Recent meta-analysis showed that surgical resection was superior to RFA only for HCC larger than 3 cm [14]. However, low level of evidence of enrolled studies hindered conclusions about the first-line treatment for patients with early stage HCC [14]. Therefore, the first-line treatment for early stage HCC, SR or RFA, in patients with a well-preserved liver function, still remains unclear. To elucidate the survival benefits of SR and RFA as first-line treatment for patients with Barcelona Clinic Liver Cancer (BCLC) very early/early stage HCC, we analyzed the long-term survival of these patients in one medical center, retrospectively.

Section snippets

Patients and methods

From January 2002 to June 2009, patients with newly diagnosed HCC in BCLC very early/early stage and receiving SR or RFA were enrolled. Patients who received liver transplantation during the study period were excluded. The diagnosis of HCC was based on the criteria of practice guidelines of the European Association for the Study of the Liver (EASL) or the American Association for the Study of Liver Disease (AASLD) [6], [7]. The demographics, clinical characteristics, initial HCC treatments,

Patients

Six hundred and five HCC patients, 143 in BCLC very early stage and 462 in BCLC early stage, were enrolled. Among patients in very early stage, 52 underwent SR and 91 underwent RFA. The median follow-up period was 2.3 and 2.5 years in SR and RFA groups, respectively. Table 1 shows the demographics and clinical characteristics of patients in both groups. In the SR group, patients were predominantly younger and with normal platelet counts. In the RFA group, a larger proportion of patients had

Discussion

Liver transplantation is known to be the best treatment for patient with HCC who met Milan criteria. However, organ shortage and long waiting time had prohibited it as initial treatment for HCC in some areas [16]. Thus, SR and RFA were the main treatment options for very early/early stage HCC patients in this study. Whether SR or RFA should be the first-line treatment for these patients is a matter of debate due to the lack of well-designed randomized trials. Performing prospective randomized

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Acknowledgements

This study was supported by a grant (CMRPG 870583) from Chang Gung Memorial Hospital to Sheng-Nan Lu.

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    These authors contributed equally to this work.

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