• Li Jiang, Lunan Yan, Tianfu Wen, Bo Li, Yong Zeng, Jiayin Yang, Wentao Wang, Mingqing Xu, and Hong Wu.
• Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
• J. Am. Coll. Surg. 2015 Nov 1;221(5):951-61.

BackgroundAlthough hepatic resection (HR) has been recommended as the first-line treatment option for patients with a solitary tumor, the first-line treatment for patients with multifocal tumors meeting the Barcelona-Clinic Liver Cancer (BCLC) stage A still remains unclear. This study compared outcomes for patients with multifocal tumors meeting the BCLC stage A treated by HR and radiofrequency ablation (RFA).Study DesignA total of 384 consecutive patients with multifocal tumors meeting the BCLC stage A, who underwent HR (n = 224) or RFA (n = 160), were included. Moreover, propensity score-matched patients were analyzed to adjust for baseline differences.ResultsThe 1-, 3-, and 5-year overall survival (OS) rates after HR and RFA were 96%, 71.7%, and 36.3%, and 90.0%, 72.7%, and 37.8%, respectively (p = 0.609); HR provided significantly better recurrence-free survival (RFS) rates than RFA at 1, 3, and 5 years (87.5%, 53.1%, and 20.1% vs 83.1%, 34.0%, and 9.7%, respectively, p = 0.001). Patients selected in the propensity-matching model showed similar results. Subgroup analysis also showed that HR was associated with better RFS than RFA for patients with 2 tumors, multifocal tumors located in the same lobe (Couinaud's segmentation) and segment (Takasaki's segmentation). Multivariate analysis revealed that 3 tumors, portal hypertension, and tumors located in different segments (Takasaki's segmentation) are independent predictors of poor prognosis in patients with multifocal tumors meeting the BCLC stage A.ConclusionsFor patients with multifocal tumors meeting the BCLC stage A, HR may offer significantly better RFS than RFA, and HR may be considered as the first-line treatment option for those patients.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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