Thermal ablation versus wedge or segmental resection in patients with early stage hepatocellular carcinoma: a population survival analysis

Abstract Background The aim of this retrospective review was to evaluate the long-term survival benefits of thermal ablation versus wedge or segmental resection in solitary HCC lesions using tumor size and clinical factors. Methods Survival analysis was performed on 43,601 patients from 2004 to 2015 in the National Cancer Database with solitary HCC lesions ≤5 cm with further stratification by tumor size, fibrosis score, and type of resection. Results In patients with moderate fibrosis or less, survival benefit was seen with one-segment resection over ablation in tumors 1.1–3 cm (HR 0.54, p = 0.03) while tumors of 3.1–5 cm received survival benefit from wedge (HR 0.44, p = 0.04), one (HR 0.28, p = 0.001) and two-segment (HR 0.20, p = 0.001) resections over ablation. In patients with severe fibrosis to cirrhosis, wedge resection demonstrated survival benefit over ablation in patients with tumors 1.1–3 cm (HR 0.48, p = 0.01) with no survival benefit of any resection type in patients with tumors of 3.1–5 cm. Conclusion These findings suggest that the decision to utilize thermal ablation versus resection to extend survival in solitary HCC lesions should include tumor size, fibrosis score, and type of resection.