Comparison of Radiofrequency Ablation and Hepatic Resection for the Treatment of Hepatocellular Carcinoma 2 cm or Less

Abstract Purpose To compare survival outcome of radiofrequency (RF) ablation and surgical resection (SR) for treatment of hepatocellular carcinoma (HCC) ≤ 2 cm. Materials and Methods In this retrospective study, patients from the US National Cancer Database with HCC ≤ 2 cm received RF ablation or SR as sole treatment. Overall survival (OS) was compared using log-rank test, multivariable Cox proportional hazard regression, and propensity score matched analysis. Results Of 833 patients included, 620 received RF ablation and 213 received SR. The 1-, 3-, and 5-year OS rates were 90%, 64%, and 47% for RF ablation and 89%, 75%, and 62% for SR. On univariate analyses, patients who received SR had longer OS than patients who received RF ablation, but this did not achieve statistical significance ( P  = .113). On multivariate analyses, female sex (HR = 0.700; 95% CI, 0.501–0.979; P  = .037), African American (HR = 0.611; 95% CI, 0.398–0.938; P  = .024) and Asian ethnicity (HR = 0.427; 95% CI, 0.230–0.790; P  = .007), and median income ≥ $48,000 (HR = 0.695; 95% CI, 0.518–0.932; P  = .015) were associated with longer OS, whereas higher Model for End-stage Liver Disease (MELD) scores (HR = 1.023; 95% CI, 1.009–1.037; P = .001) were associated with shorter OS. After matching on age, sex, ethnicity, MELD score, and income, there was no significant difference in OS between the 2 treatment groups (log-rank P  = .646). Conclusions There was no significant difference in OS between RF ablation and SR in treatment of HCC measuring ≤ 2 cm.