Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3cm) hepatocellular carcinoma.

Background and Aims We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and a single small (≤3cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). Methods We retrospectively analyzed 391 patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for a single small (≤3cm) HCC. Survival was compared according to tumor size (≤2cm/2-3cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. Results The median follow-up period was 64.8 months (range 0.1-162.6 months). After IPW, the estimated OS was similar in the SR and RFA groups (p=0.215), and even in patients with HCC of ≤2cm (p=0.816) and without cirrhosis (p=0.195). The estimated RFS was better in the SR group than the RFA groups (p=0.005), also in patients without cirrhosis (p<0.001), but not in those with HCC of ≤2cm (p=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS and RFS after RFA versus SR were 0.698 (0.396-1.232) (p=0.215) and 1.698 (1.777-2.448) (p=0.005), respectively. Conclusions SR was similar for OS compared to RFA, but a better for RFS in patients with CTP class-A and a single small (≤3cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong RFS although there is no OS difference.