Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or =4 cm

Abstract

Aim: To determine which treatment modality--hepatectomy or percutaneous ablation--is more beneficial for patients with small hepatocellular carcinoma (HCC) (< or =4 cm) in terms of long-term outcomes.

Methods: A retrospective analysis of 149 patients with HCC < or =4 cm was conducted. Eighty-five patients underwent partial hepatectomy (anatomic in 47 and non-anatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6). The median follow-up period was 69 mo.

Results: Hepatectomy was associated with larger tumor size (P<0.001), whereas percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent following hepatectomy (P<0.0001). Survival was better following hepatectomy (median survival time: 122 mo) than following percutaneous ablation (median survival time: 66 mo; P=0.0123). When tumor size was divided into < or =2 cm vs >2 cm, the favorable effects of hepatectomy on long-term survival was seen only in patients with tumors>2 cm (P=0.0001). The Cox proportional hazards regression model revealed that hepatectomy (P=0.006) and tumors < or =2 cm (P=0.017) were independently associated with better survival.

Conclusion: Hepatectomy provides both better local control and better long-term survival for patients with HCC < or =4 cm compared with percutaneous ablation. Of the patients with HCC < or =4 cm, those with tumors >2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits resection.

Figure 1

Kaplan-Meier estimates of local recurrence. The incidence of local recurrence reached a plateau of 28% at 20 mo after percutaneous ablation, and a plateau of 3% at 22 mo after hepatectomy.

Figure 2

Kaplan-Meier estimates of local recurrence by tumor size. A: Among tumors ≤ 2 cm, the incidence of local recurrence reached a plateau of 12% at 15 mo after percutaneous ablation, whereas no recurrences had occurred after hepatectomy; B: among tumors > 2 cm, the incidence of local recurrence reached a plateau of 61% at 21 mo after percutaneous ablation, whereas it reached a plateau of 4% at 22 mo after hepatectomy.

Figure 3

Kaplan-Meier estimates of survival. The median survival time was 122 mo with a 10-year survival rate of 53% in patients who had undergone hepatectomy. The median survival time was 66 mo with a 10-year survival rate of 31% in patients who had undergone percutaneous ablation.

Figure 4

Kaplan-Meier estimates of survival by tumor size. A: Among patients with tumors ≤ 2 cm, survival was better following hepatectomy (median survival time of 122 mo; 10-year survival rate of 58%) than following percutaneous ablation (median survival time of 76 mo; 10-year survival rate of 45%); B: among patients with tumors >2 cm, survival was better following hepatectomy (median survival time of 126 mo; 10-year survival rate of 51%) than following percutaneous ablation (median survival time of 26 mo; 10-year survival rate of 0%).