Overall survival is comparable between percutaneous radiofrequency ablation and liver resection as first-line therapies for solitary 3-5 cm hepatocellular carcinoma.
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PURPOSE: Few studies have compared survival outcomes between liver resection (LR) and percutaneous radiofrequency ablation (RFA) for treating solitary 3-5 cm hepatocellular carcinoma (HCC). We aimed to clarify this issue. METHODS: Patients with Child-Pugh class A liver disease and a solitary HCC of 3-5 cm without macrovascular invasion or extrahepatic metastasis who underwent LR or percutaneous RFA between 2011 and 2021 were enrolled in this retrospective study; 310 patients underwent LR and 114 patients underwent percutaneous RFA. Propensity score matching (PSM) was used to balance baseline variables, including age, sex, alpha-fetoprotein level, and Model for End-Stage Liver Disease score, between the two groups. RESULTS: Before PSM, 5-year overall survival (OS) and recurrence-free survival (RFS) were significantly lower in the percutaneous RFA group than in the LR group (both p < 0.001). After PSM, 5-year OS was comparable between the two modalities (p = 0.367); however, 5-year RFS was significantly lower in the RFA group than in the LR group (p = 0.001). The two modalities did not differ in severe post-treatment complications (p = 1.000). CONCLUSIONS: Five-year OS did not differ between treatment modalities for patients with a solitary HCC of 3-5 cm; however, the LR group's 5-year RFS was superior. LR should be recommended as the first-line treatment for these patients.