• Sunyoung Lee, Tae Wook Kang, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Hyo Keun Lim, So Yeon Kim, Dong Hyun Sinn, KimJong ManJMDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Kyunga Kim, and Sang Yun Ha.
• Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
• Ann. Surg. 2021 Mar 1; 273 (3): 564-571.

ObjectiveWe compared surgical resection (SR) and radiofrequency ablation (RFA) as first-line treatment in patients with hepatocellular carcinoma (HCC) based on the risk of microvascular invasion (MVI).BackgroundThe best curative treatment modality between SR and RFA in patients with HCC with MVI remains unclear.MethodsData from 2 academic cancer center-based cohorts of patients with a single, small (≤3 cm) HCC who underwent SR were used to derive (n = 276) and validate (n = 101) prediction models for MVI using clinical and imaging variables. The MVI prediction model was developed using multivariable logistic regression analysis and externally validated. Early recurrence (<2 years) based on risk stratification between SR (n = 276) and RFA (n = 240) was evaluated via propensity score matching.ResultsIn the multivariable analysis, alpha-fetoprotein (≥15 ng/mL), protein induced by vitamin K absence-II (≥48 mAU/mL), arterial peritumoral enhancement, and hepatobiliary peritumoral hypointensity on magnetic resonance imaging were associated with MVI. Incorporating these factors, the area under the receiver operating characteristic curve of the predictive model was 0.87 (95% confidence interval: 0.82-0.92) and 0.82 (95% confidence interval: 0.74-0.90) in the derivation and validation cohorts, respectively. SR was associated with a lower rate of early recurrence than RFA based on the risk of MVI after propensity score matching (P < 0.05).ConclusionsOur model predicted the risk of MVI in patients with a small (≤ 3 cm) HCC with high accuracy. Patients with MVI who had undergone RFA were more vulnerable to recurrence than those who had undergone SR.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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