What question did this study set out to answer?

The study aims to compare survival outcomes of patients with large hepatocellular carcinoma treated with ablation versus chemotherapy.

April 10, 2026Open Access

Comparative Effectiveness of Radiofrequency or Microwave Ablation and Chemotherapy for the Treatment of Large (>5 cm) Hepatocellular Carcinoma Tumors

Key Points

The study aims to compare survival outcomes of patients with large hepatocellular carcinoma treated with ablation versus chemotherapy.
Retrospective cohort study using the National Cancer Database from 2004 to 2017.
Compared patients with HCC tumors greater than 5 cm treated with ablation or chemotherapy.
Utilized inverse probability-weighted propensity scores and Cox proportional hazards model for analysis.
Total of 14,783 patients analyzed, with 14,127 receiving chemotherapy and 656 receiving ablation.
Ablation led to a significant survival improvement, estimated at 19 months longer than chemotherapy (p<0.001; 95% CI: 10.1-28.2).
The analysis suggests that, despite hesitance, ablation may be a superior option for large tumors.

Abstract

Background and objectives Treatment of hepatocellular carcinoma (HCC) >5 cm is problematic, as patients are often outside transplantation criteria, and cirrhosis compromises curative resection. The purpose of this study was to evaluate survival following treatment with ablation compared to chemotherapy in large HCC. Methods This was a retrospective cohort study of the National Cancer Database (NCDB) Participant User File from 2004 to 2017. Patients with HCC >5 cm in diameter treated with ablation versus chemotherapy alone were compared. Inverse probability-weighted propensity scores were used to model treatment assignments in the Cox proportional hazards model. Results A total of 14,783 HCC patients with tumors >5 cm and 5 cm, our analysis suggests a survival advantage when compared to chemotherapy. These results are promising, and future trials should evaluate ablation in combination with other local and systemic therapies.

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