A propensity score matching analysis of hepatectomy and radiofrequency ablation for patients with solitary hepatocellular carcinoma less than or equal to 5 cm and portal hypertension

Abstract

Objective To compare the clinical efficacy of hepatectomy and radiofrequency ablation (RFA) for patients with solitary hepatocellular carcinoma (HCC) less than or equal to 5 cm (≤5 cm) and portal hypertension (PHT). Methods The propensity score matching and retrospective case-control study was conducted. The clinicopathological data of 154 patients with solitary HCC ≤ 5 cm and PHT who were admitted to the Qingdao University between January 2011 and July 2016 were collected. Of 154 patients, 61 and 93 underwent R0 hepatectomy and RFA, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between groups after the propensity score matching: patients′ data were matched by the propensity score matching, patients undergoing hepatectomy and RFA were respectively allocated into the hepatectomy group and RFA group; (2) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor-free and overall survival up to July 31, 2018. Patients received enhanced scans of computed tomography (CT) or magnetic resonance imaging (MRI) in 1 month postoperatively, and then reexaminations of liver function, level of alpha-fetoprotein (AFP), B ultrasound and pulmonary CT within 3 months postoperatively, once every 3 months from 3 months postoperatively to 2 years and once every 6 months after 2 years postoperatively. Measurement data with skewed distribution were described as M (range). Comparisons of count data were analyzed using chi-square test. The Logistic regression model was used for the propensity score matching. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between groups after the propensity score matching: 118 of 154 patients had successful matching, including 59 in each group. There were statistically significant differences in the tumor diameter and level of preoperative albumin (Alb) before the propensity score matching between groups (χ2=11.050, 6.687, P 0.05). (2) Follow-up and survival: all the 154 patients were followed up for 4.5-91.4 months before the propensity score matching, with a median time of 44.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 88.1%, 79.5%, 64.1%, 40.3% in patients of hepatectomy group and 84.9%, 68.6%, 52.8%, 43.4% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=0.997, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 95.1%, 88.5%, 85.0%, 70.1% in patients of hepatectomy group and 100.0%, 95.7%, 85.6%, 73.7% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.053, P>0.05). One hundred and eighteen patients were followed up for 4.5-91.4 months after the propensity score matching, with a median time of 49.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 89.4%, 82.3%, 66.4%, 41.7% in patients of hepatectomy group and 83.1%, 64.2%, 47.4%, 38.5% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=2.612, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 94.9%, 89.8%, 86.1%, 70.8% in patients of hepatectomy group and 100.0%, 91.5%, 79.4%, 67.6% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.383, P>0.05). Conclusion The both hepatectomy and RFA are reliable radical treatments for solitary HCC ≤ 5 cm and PHT. Key words: Hepatocellular carcinoma; Portal hypertension; Hepatectomy; Radiofrequency ablation; Prognosis; Propensity score matching