Differences in Survival Between First-Line Radiofrequency Ablation versus Surgery for Early-Stage Hepatocellular Carcinoma: A Population Study Using the Surveillance, Epidemiology, and End Results Database

BACKGROUND The first-line therapy for early-stage hepatocellular carcinoma (HCC) is unclear. This study was conducted to assess and compare survival after surgery vs. after radiofrequency ablation (RFA) for early-stage HCC. MATERIAL AND METHODS Data from HCC patients with a single tumor measuring 31-50 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Overall survival (OS) and cancer-specific survival (CSS) were assessed and compared between surgery and RFA treatment. Propensity score matching was performed. Multiple imputations were used to create 5 sets of complete data. Fine and Gray competing risk multivariate regression models were used to control biases. RESULTS This study included 839 patients: 339 (40.41%) received RFA and 500 (59.59%) underwent surgery. Surgery improved the 5-year OS (63.95% vs. 37.13%, p<0.01) and CSS (64.01% vs. 38.29%, p<0.01) compared with RFA after propensity score matching. The competing risk regression models revealed that, compared with RFA, surgery resulted in better survival in the unmatched cohort with an adjusted sub-distribution hazard ratio of 0.689 (95% confident interval [CI], 0.562-0.868; p=0.001) and in the propensity-matched cohort with an adjusted sub-distribution hazard ratio of 0.642 (95% CI, 0.514-0.801; p<0.001). CONCLUSIONS Surgery appears to be a better therapy choice than RFA for patients with early-stage HCC with a single tumor measuring 31-50 mm.