BACKGROUND effective ratios 2.18:1 and 2.43:1). RESULTS: 1040 patients were included (median age: 64 years; male 82.9%), with 606, 266 and 168 treated by mbpRFA, LLR and OLR. Most HCCs were solitary (84.8%) and on cirrhosis (89.2%). In months, the follow-up was 50.2 (95% CI: 45.3, 54.3), 43.3 (95% CI: 40.0, 48.6) and 47.4 (95% CI: 40.8, 58.7) for mbpRFA, LLR and OLR patients. After matching, OLR patients had similar overall survival (OS) (HR = 1.05 CI 95% = 0.65, 1.69, p = 0.853), transplant-free survival (TFS) (HR = 0.91 CI 95% = 0.56, 1.47; p = 0.690) or recurrence-free survival (RFS) (HR = 0.99 CI 95% = 0.69, 1.43; p = 0.968) compared to mbpRFA patients but with more severe adverse events (RR = 2.58 CI 95% = 1.16, 5.71; p = 0.02) and mortality (RR = 4.51 CI 95% = 1.16, 17.59; p = 0.03). After matching, LLR patients had better OS (HR = 0.57 CI 95% = 0.38, 0.88, p = 0.01) but similar TFS (HR = 0.77 CI 95% = 0.55, 1.1; p = 0.152) and more severe adverse events (RR = 2.61 CI 95% = 1.15, 5.96; p = 0.022) compared to mbpRFA patients. LLR patients had a better RFS (HR = 0.7 CI 95% = 0.53, 0.91; p = 0.009) than mbpRFA patients. When distant-only recurrences were considered in the mbpRFA patients, there was no significant difference in RFS (p = 0.087). The LLR survival benefit was consistent across pre-specified subgroups, with no interaction surviving correction for multiple testing. CONCLUSIONS: Minimally invasive modalities (LLR or mbpRFA) should be prioritized when treating early HCC. LLR maximizes oncological outcomes, but mbpRFA maintains optimal TFS with less morbidity.
Hobeika et al. (Mon,) studied this question.