Superior long-term outcomes after surgery in child-pugh class a patients with single small hepatocellular carcinoma compared to radiofrequency ablation

Abstract

There are insufficient data comparing long-term prognoses after radiofrequency ablation (RFA) and surgery. We compared the baseline characteristics and survival rates of patients (single, ≤3cm, and Child-Pugh class A) treated surgically (n=215) and with RFA (n=255) from January 2000 to December 2007 at our institution. The surgery group was characterized by younger age, higher prevalence of HBsAg, less cirrhosis, and an increased chance of Child-Pugh score of 5 and CLIP score of 1, compared to the RFA group. During the median follow-up period of 42months (range 1-109), the 3-, 5- and 7-year overall survival rates in the surgery group were 98, 94, and 94%, respectively, which were significantly higher than those in the RFA group (92, 87, and 76%, respectively, P=0.002). The 3- and 5-year recurrence-free survival rates were 72 and 66%, respectively, in the surgery group, which were significantly higher than those in the RFA group (34 and 24%, respectively, P<0.001). The superiority of the survival rates in the surgery group persisted in most patients throughout the subgroup analysis, based on the Child-Pugh score and CLIP score. Multivariate analysis showed that age and surgery as a procedure type were the significant predictive factors for both overall survival [HR=1.04 (CI 1.001-1.08), P=0.047 for age; HR=2.97 (CI 1.19-7.45), P=0.02 for surgery] and recurrence-free survival [HR=1.02 (CI 1.01-1.04), P=0.01 for age; HR=2.44 (CI 1.76-3.37), P<0.001 for surgery]. The long-term outcome after surgery for Child-Pugh class A and single small HCC is superior to that after RFA.