• Po-Hong Liu, Chia-Yang Hsu, Cheng-Yuan Hsia, Yun-Hsuan Lee, Yi-Hsiang Huang, Yi-You Chiou, Han-Chieh Lin, and Teh-Ia Huo.
• *Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan †Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ‡Department of Biostatistics, UCLA, Los Angeles, CA §Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan ¶Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan ||Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan **Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
• Ann. Surg. 2016 Mar 1; 263 (3): 538-45.

ObjectivesTo evaluate the efficacy of surgical resection (SR) and radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) 2  cm or less.BackgroundThe optimal management for Barcelona Clínic Liver Cancer (BCLC) very early-stage HCC is undetermined.MethodsBetween 2002 and 2013, a total of 237 (SR, 109; RFA, 128) patients with BCLC very early-stage HCC were enrolled. Their overall survival (OS) and recurrence-free survival (RFS) were compared. Propensity score matching analysis identified 79 matched pairs of patients to compare outcomes.ResultsAt baseline, patients with SR were younger and had larger tumors (both P < 0.05). The 5-year OS rates were 81% versus 76% (P = 0.136), whereas 5-year RFS rates were 49% versus 24% (P < 0.001) for SR and RFA groups, respectively. In the propensity model, the baseline variables were well balanced between 2 groups. Surgical resection was significantly associated with better OS and RFS compared with RFA; the 5-year OS rates were 80% versus 66% (P = 0.034), and 5-year RFS rates were 48% versus 18% (P < 0.001) for SR and RFA groups, respectively. The Cox proportional hazards model identified RFA as an independent predictor for mortality and tumor recurrence in the propensity model (hazard ratio, 2.120 and 2.421, respectively; both P < 0.05). Patients with recurrent HCC had inferior prognosis compared with patients without recurrence (P = 0.001). However, the survival after recurrence was similar between patients initially treated with SR or RFA (P = 0.415).ConclusionsSurgical resection provides better long-term OS and RFS compared with RFA in patients with BCLC very early-stage HCC. Surgical resection should be considered as the first-line treatment for these patients.

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