Survival outcome was superior with liver resection versus percutaneous radiofrequency ablation in patients with single hepatocellular carcinoma 2-3 cm

Abstract Purpose Previous reports are ambiguous about the efficacy of percutaneous radiofrequency ablation (pRFA) in treating patients with early-stage hepatocellular carcinoma (HCC) with a single 2.0–3.0 cm tumor. Our study compared outcomes of pRFA and liver resection (LR) in these patients. Methods From 2011 to 2021, 378 patients undergoing LR and 238 patients undergoing pRFA for early-stage HCC with a single 2.0–3.0 cm tumor and Child–Pugh class A liver disease were enrolled. Survival analysis was performed using the Kaplan − Meier method after propensity score matching (PSM) by age, sex, serum alpha-fetoprotein level, and the Model for End-Stage Liver Disease score. Results In multivariate analysis, pRFA vs. LR was the only comparison associated with five-year OS (HR: 2.278; 95% CI: 1.515–3.427; p < 0.001) and five-year RFS (HR: 1.995; 95% CI: 1.505–2.643; p < 0.001). After PSM, LR was associated with a significantly higher survival benefit than pRFA (five-year OS: 82% vs. 61%; p = 0.001; five-year RFS: 60% vs. 35%; p = 0.001). Conclusion LR offers a higher survival benefit than pRFA for patients with early-stage HCC with a single 2.0–3.0 cm tumor.