Long-term outcomes of thermal ablation vs surgical resection for single small hepatocellular carcinoma.
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BACKGROUND: Thermal ablation (TA), including radiofrequency ablation and microwave ablation, is a commonly used curative treatment for single small hepatocellular carcinoma (sHCC). The relative advantages of TA and surgical resection (SR) in terms of long-term survival remain controversial. AIM: To compare their long-term efficacy in this patient population. METHODS: This population-based retrospective cohort study included 257 patients who received a first diagnosis of single sHCC and underwent SR or TA from January 2012 to September 2017. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). RESULTS: The average follow-up duration was 11.4 years. The 1-, 3-, 5-, and 10-year OS rates were 95.8%, 86.0%, 82.5%, and 74.2% in the SR group vs 97.4%, 85.8%, 78.6%, and 65.6% in the TA group, with the median OS not yet reached. The 1-, 3-, 5-, and 10-year RFS rates were 79.8%, 59.6%, 46.2%, and 24.7% in the SR group vs 83.9%, 61.5%, 47.9%, and 41.2% in the TA group, with median RFS values of 3.95 and 4.63 years, respectively. No significant differences in OS or RFS were observed overall (OS: P = 0.244; RFS: P = 0.180), but in patients ≤ 60 years, TA led to a higher RFS than SR (P = 0.021). Multivariate analysis identified age, tumor differentiation grade, and Child-Pugh classification as independent risk factors for OS, whereas age and differentiation grade were significant risk factors for RFS. CONCLUSION: In patients with single sHCC, SR, and TA offered comparable long-term efficacy. However, TA showed superior RFS in patients ≤ 60 years, suggesting that TA may be a reasonable option for younger patients, pending confirmation by prospective studies.