Efficacy of Hepatic Resection vs. Radiofrequency Ablation for Patients With Very-Early-Stage or Early-Stage Hepatocellular Carcinoma: A Population-Based Study With Stratification by Age and Tumor Size

Background: Because of the poor health conditions of elderly patients (age >65) with very-early-stage and early-stage hepatocellular carcinoma (HCC), primary treatment via hepatic resection (HR) or radiofrequency ablation (RFA) must be considered. However, few studies have examined this issue. Methods: A retrospective cohort was obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2004-2015. Patients were grouped by tumour size (0-20, 21-30, 31-35 and 31-50 mm) and age (>65 and ≤65). Overall survival (OS) and disease-specific survival (DSS) were assessed. Results: In total, 1912 patients aged >65 and 2784 patients aged ≤65 were analysed after propensity score matching (PSM). For patients >65 with tumours ≤20 mm, OS and DSS did not differ significantly between the RFA and HR groups (p=0.47 and p=0.76, respectively). For patients with tumours measuring 21-30 mm, the HR group had better OS and a trend towards better DSS compared with the RFA group (p=0.03 and p=0.09, respectively). For patients with tumours measuring 31-50 mm, the HR group had better OS and DSS compared with the RFA group (p65), RFA is recommended for tumours ≤20 mm. For patients older than 65 with tumours measuring 21-50 mm and for those younger than 65 with tumours of any size, HR is the better choice.