Faculty Collaboration Database

Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis. HPB (Oxford) 2015 Oct;17(10):896-901

Date

08/01/2015

Pubmed ID

26228076

Pubmed Central ID

PMC4571757

DOI

10.1111/hpb.12446

Scopus ID

2-s2.0-84941879772 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

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 TC

Authors

Anjishnu Banerjee PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Kathleen 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

Aged
Carcinoma, 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