Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis. HPB (Oxford) 2015 Oct;17(10):896-901
Date
08/01/2015Pubmed ID
26228076Pubmed Central ID
PMC4571757DOI
10.1111/hpb.12446Scopus ID
2-s2.0-84941879772 (requires institutional sign-in at Scopus site) 34 CitationsAbstract
BACKGROUND: Ablation for ≤ 3-cm hepatocellular carcinoma (HCC) has been demonstrated to be an effective treatment strategy. The present study sought to examine the outcomes of patients with ≤3 cm HCC after ablation versus resection.
METHODS: Patients treated by ablation or surgical resection for ≤ 3 cm T1 HCC were identified from the National Cancer Database (2002-2011). Survival outcomes were analysed according to propensity score modelling.
RESULTS: A total of 2804 patients underwent ablation (n = 1984) or a resection (n = 820) for solitary HCC ≤ 3 cm. Patients treated with ablation as compared with a resection had a higher frequency in alpha-fetoprotein level (AFP) elevation (46.5% versus 39.1%, P < 0.01) and the presence of cirrhosis (22.2% versus 14.5%, P < 0.01). Unadjusted overall survival (OS) at 3 and 5 years was greater after a resection (67%, 55%) versus ablation (52%, 36%, P < 0.01). After propensity score matching, the improved overall survival (OS) was sustained among the resection cohort (5 year OS: 54% versus 37%, P < 0.001). In multivariable models, a resection was independently associated with an improved OS [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.48-0.81; P < 0.01].
CONCLUSION: Resection of HCC ≤ 3 cm results in better long-term survival as compared with ablation. Treatment strategies for small solitary HCC should emphasize a resection first approach, with ablation being reserved for patients precluded from surgery.
Author List
Miura JT, Johnston FM, Tsai S, Eastwood D, Banerjee A, Christians KK, Turaga KK, Gamblin TCAuthors
Anjishnu Banerjee PhD Associate Professor in the Data Science Institute department at Medical College of WisconsinKathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedCarcinoma, Hepatocellular
Catheter Ablation
Female
Follow-Up Studies
Hepatectomy
Humans
Kaplan-Meier Estimate
Liver Neoplasms
Male
Middle Aged
Neoplasm Staging
Population Surveillance
Prognosis
Propensity Score
Retrospective Studies
Survival Rate
Time Factors
Wisconsin