Jungnam Lee, Young-Joo Jin, Seung Kak Shin, Jung Hyun Kwon, Sang Gyune Kim, Young Ju Suh, Yujin Jeong, Jung Hwan Yu, Jin-Woo Lee, Oh Sang Kwon, Soon Woo Nahm, Young Seok Kim
Clin Mol Hepatol 2022;28(2):207-218. Published online November 24, 2021
Background/Aims We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA).
Methods We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment.
Results The median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (P=0.215) and 1.698 (1.777–2.448) (P=0.005), respectively.
Conclusions SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.
Citations
Citations to this article as recorded by
Comparison of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (≤ 3 cm): an updated meta-analysis Long-Ao Dai, Min Sun, Tian Li, Dong Wei, Ren-Chao Zou Systematic Reviews.2026;[Epub] CrossRef
Radiofrequency ablation versus surgical resection as first-line treatment for very early stage hepatocellular carcinoma: a systematic review with meta-analysis Eduardo Freitas Viana, Diego Falcão Araújo, Thiago Francischetto Ribeiro, Vaner Paulo da Silva Fonseca Pinheiro, Rodrigo Leal Alves, André Luiz Aleluia da Silva, Helma Pinchemel Cotrim, André Castro Lyra Surgical Oncology.2026; 65: 102359. CrossRef
Recurrence-free survival as a predictor of overall survival among patients with early-stage hepatocellular carcinoma treated with surgical resection or local ablation Neil Mehta, Kaushal Desai, Shital Kamble, Yan Song, Emily Gao, Usha Malhotra, Angie Lax, Sanjana Sundaresan, Nathaniel Downes, Adina Zhang, Abby Siegel Surgical Oncology Insight.2026; : 100251. CrossRef
Imaging Classification of Exophytic HCC and Our Experience with Microwave Ablation of Type 2 Lesions Soumil Singhal, Pallav Bhatter, Girendra Shankar, Anubhav Khandelwal, Sanjay Saran Baijal Indian Journal of Radiology and Imaging.2025; 35(01): 017. CrossRef
Insights on risk score development: Considerations for early-stage hepatocellular carcinoma models Zhanna Zhang, Gongqiang Wu Clinical and Molecular Hepatology.2025; 31(1): e8. CrossRef
Liver resection versus radiofrequency ablation for solitary small hepatocellular carcinoma measuring ≤3 cm: a systematic review and meta-analysis Ming Yang, Guangjun Li, Kunlin Chen, Youwei Wu, Ting Sun, Wentao Wang International Journal of Surgery.2025; 111(5): 3456. CrossRef
Recurrence rate, features, and outcome after hepatocellular carcinoma curative resection or ablation according to the IMbrave050 criteria: a real-world study Edoardo G. Giannini, Andrea Pasta, Laura Bucci, Maria Corina Plaz Torres, Giulia Pieri, Ciro Celsa, Angelo Sangiovanni, Fabio Piscaglia, Claudia Campani, Gabriele Missale, Gianpaolo Vidili, Giorgia Ghittoni, Filippo Pelizzaro, Francesco Giuseppe Foschi, F Digestive and Liver Disease.2025; 57(8): 1673. CrossRef
Microwave ablation versus radiofrequency ablation for hepatocellular carcinoma: a propensity score matching and inverse probability weighting analysis Wenlong Yang, Xiaoyan Li, Xufang Tan International Journal of Hyperthermia.2025;[Epub] CrossRef
Liver resection versus radiofrequency ablation for hepatocellular carcinoma: A systemic review and meta-analysis Zheng He, Guolang Song, Guangchao Yang, Xuan Fu, Meng Tian, Yanhui Zhu Frontiers in Oncology.2025;[Epub] CrossRef
Engineered macrophage membrane-mimicking nanodrugs activate cGAS/STING pathway to reverse tumor immune suppression after incomplete radiofrequency ablation Wei-Hua Zhang, Lei Chen, Lin Gao, Ye-Ming Wu, Zhi-Cheng Jin, Jian-Jian Chen, Yan-Li An, Gao-Jun Teng Journal of Nanobiotechnology.2025;[Epub] CrossRef
Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis Jeong-Ju Yoo, Sujin Koo, Gi Hong Choi, Min Woo Lee, Seungeun Ryoo, Jungeun Park, Dong Ah Park Current Oncology.2024; 31(1): 324. CrossRef
Thermal ablation versus liver resection for hepatocellular carcinoma in patients with cirrhosis: a systematic review and meta-analysis of propensity-score matched studies Qiuxia Wei, Shiyu Xiong, Wanrong Luo, Ming Liang, Baoming Luo Clinical and Experimental Medicine.2024;[Epub] CrossRef
Comparison of Surgical Resection and Radiofrequency Ablation in Elderly Patients with Hepatocellular Carcinoma Jun Il Kim, Jayoun Lee, Gi Hong Choi, Min Woo Lee, Dong Ah Park, Jeong-Ju Yoo Digestive Diseases and Sciences.2024; 69(3): 1055. CrossRef
The Role of Laparoscopic Surgery in the Management of Hepatocellular Carcinoma Justin A. Steggerda, Steven A. Wisel, Nicholas N. Nissen, Georgios Voidonikolas, Kambiz Kosari Current Hepatology Reports.2024; 23(3): 378. CrossRef
Clinical outcomes of transarterial chemoembolization in Child–Turcotte Pugh class A patients with a single small (≤3 cm) hepatocellular carcinoma Jungnam Lee, Young‐Joo Jin, Seung Kak Shin, Jung Hyun Kwon, Sang Gyune Kim, Jung Hwan Yu, Jin‐Woo Lee, Oh Sang Kwon, Soon Woo Nahm, Young Seok Kim Journal of Gastroenterology and Hepatology.2024; 39(9): 1924. CrossRef
Nomogram for predicting post-therapy recurrence in BCLC A/B hepatocellular carcinoma with Child-Pugh B cirrhosis Wenying Qiao, Shugui Sheng, Yiqi Xiong, Ming Han, Ronghua Jin, Caixia Hu Frontiers in Immunology.2024;[Epub] CrossRef
Meta analysis of radiofrequency ablation versus surgical resection in small and large nodule of hepatocellular carcinoma Rino A. Gani, Maria Teressa, Refael A. Budiman, Kemal F. Kalista, Cosmas Rinaldi A. Lesmana HPB.2024; 26(10): 1216. CrossRef
Primary treatments for solitary hepatocellular carcinoma ≤ 3 cm: A systematic review and network meta-analysis Sang-Hoon Kim, Ki-Hun Kim, Byeong-Gon Na, Sung Min Kim, Rak-Kyun Oh Annals of Hepato-Biliary-Pancreatic Surgery.2024; 28(4): 397. CrossRef
Microwave Ablation of Recurrent Hepatocellular Carcinoma after Curative Surgical Resection Hamzah Adwan, Lars Hammann, Thomas J. Vogl Journal of Clinical Medicine.2023; 12(7): 2560. CrossRef
Understanding the causes of recurrent HCC after liver resection and radiofrequency ablation Carlo Bosi, Margherita Rimini, andrea Casadei-Gardini, Giorgio Ercolani Expert Review of Anticancer Therapy.2023; 23(5): 503. CrossRef
Persistently Elevated HBV Viral-Host Junction DNA in Urine as a Biomarker for Hepatocellular Carcinoma Minimum Residual Disease and Recurrence: A Pilot Study Selena Y. Lin, Dina Halegoua-DeMarzio, Peter Block, Yu-Lan Kao, Jesse Civan, Fwu-Shan Shieh, Wei Song, Hie-Won Hann, Ying-Hsiu Su Diagnostics.2023; 13(9): 1537. CrossRef
Development and validation of prognostic nomograms for large hepatocellular carcinoma after HAIC Wang Yao, Ran Wei, Jia Jia, Wang Li, Mengxuan Zuo, Shuqing Zhuo, Ge Shi, Peihong Wu, Chao An Therapeutic Advances in Medical Oncology.2023;[Epub] CrossRef
Construction and validation of a nomogram for HBV-related hepatocellular carcinoma: A large, multicenter study Ke Su, Qiuni Shen, Jian Tong, Tao Gu, Ke Xu, Han Li, Hao Chi, Yanlin Liu, Xueting Li, Lianbin Wen, Yanqiong Song, Qulian Guo, Jiali Chen, Zhenying Wu, Yi Jiang, Kun He, Lu Guo, Yunwei Han Annals of Hepatology.2023; 28(4): 101109. CrossRef
Tenofovir versus entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma: a systematic review and meta-analysis Hui Liu, Cheng-Long Han, Bao-Wen Tian, Zi-Niu Ding, Ya-Fei Yang, Yun-Long Ma, Chun-Cheng Yang, Guang-Xiao Meng, Jun-Shuai Xue, Dong-Xu Wang, Zhao-Ru Dong, Zhi-Qiang Chen, Jian-Guo Hong, Tao Li Expert Review of Gastroenterology & Hepatology.2023; 17(6): 623. CrossRef
Establishment and application of a survival rate graph model based on biomarkers and imaging indexes after primary hepatocellular carcinoma resection Yue Xu, Xiaoqin Yao, Jinmei Li, Guoyuan Zhang, Guangcheng Luo, Qiang Wang Cancer Medicine.2023; 12(12): 13329. CrossRef
Comparative Study of Long-Term Outcomes of Laparoscopic Liver Resection versus Radiofrequency Ablation for Single Small Hepatocellular Carcinoma Located in Left Lateral Segments of the Liver MeeYoung Kang, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, Hae Won Lee, Boram Lee, Yeshong Park, Jinju Kim, Chang Jin Yoon Medicina.2023; 59(6): 1063. CrossRef
Prediction model of hepatitis B virus-related hepatocellular carcinoma in patients receiving antiviral therapy Beom Kyung Kim, Sang Hoon Ahn Journal of the Formosan Medical Association.2023; 122(12): 1238. CrossRef
Primary non-response to antiviral therapy affects the prognosis of hepatitis B virus-related hepatocellular carcinoma Peng Wang, Xinhui Wang, Xiaoli Liu, Fengna Yan, Huiwen Yan, Dongdong Zhou, Lihua Yu, Xianbo Wang, Zhiyun Yang BMC Cancer.2023;[Epub] CrossRef
Comparison of Open versus Laparoscopic Approaches in Salvage Hepatectomy for Recurrent Hepatocellular Carcinoma after Radiofrequency Ablation Yeshong Park, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, Hae Won Lee, Boram Lee, MeeYoung Kang, Jinju Kim Medicina.2023; 59(7): 1243. CrossRef
Tumor size and survival in intrahepatic cholangiocarcinoma treated with surgical resection or ablation Elishama N. Kanu, Kristen E. Rhodin, Sabran J. Masoud, Austin M. Eckhoff, Alex J. Bartholomew, Thomas C. Howell, Jiayin Bao, Nicholas T. Befera, Charles Y. Kim, Dan G. Blazer, Sabino Zani, Daniel P. Nussbaum, Peter J. Allen, Michael E. Lidsky Journal of Surgical Oncology.2023; 128(8): 1329. CrossRef
Salvage Hepatectomy for Recurrent Hepatocellular Carcinoma after Radiofrequency Ablation: A Retrospective Cohort Study with Propensity Score-Matched Analysis Yeshong Park, Ho-Seong Han, Yoo-Seok Yoon, Chang Jin Yoon, Hae Won Lee, Boram Lee, MeeYoung Kang, Jinju Kim, Jai Young Cho Cancers.2023; 15(19): 4745. CrossRef
Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-Analysis Elizabeth M. Garcia, Sanjna N. Nerurkar, Eunice X. Tan, Shaun Y.S. Tan, Ern-Wei Peck, Sabrina X.Z. Quek, Readon Teh, Margaret Teng, Andrew Tran, Ee Jin Yeo, Michael Le, Connie Wong, Ramsey Cheung, Daniel Q. Huang Digestive Diseases.2023; 43(2): 206. CrossRef
Surgical resection versus ablation for early hepatocellular carcinoma: The debate is still open Bo Hyun Kim Clinical and Molecular Hepatology.2022; 28(2): 174. CrossRef
Liver resection, radiofrequency ablation, and radiofrequency ablation combined with transcatheter arterial chemoembolization for very-early- and early-stage hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis for comparison of Yunlong Zhang, Yunlong Qin, Peng Dong, Houfa Ning, Guangzhi Wang Frontiers in Oncology.2022;[Epub] CrossRef
Predictors of Hepatocellular Carcinoma Early Recurrence in Patients Treated with Surgical Resection or Ablation Treatment: A Single-Center Experience Mauro Giuffrè, Enrico Zuliani, Alessia Visintin, Paola Tarchi, Paola Martingano, Riccardo Pizzolato, Deborah Bonazza, Flora Masutti, Rita Moretti, Lory Saveria Crocè Diagnostics.2022; 12(10): 2517. CrossRef
Suboptimal Performance of Hepatocellular Carcinoma Prediction Models in Patients with Hepatitis B Virus-Related Cirrhosis Jae Lee, Tae Lim, Hye Lee, Seung Kim, Jun Park, Do Kim, Sang Ahn, Hyun Lee, Jung Lee, Ja Kim, In Min, Beom Kim Diagnostics.2022; 13(1): 3. CrossRef
First
Prev
