[Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial]

Abstract

Objective: To compare the clinical results of surgical resection (SR) and percutaneous thermal ablation (PTA) for early-stage hepatocellular carcinoma (HCC) (single tumor nodule <or= 5 cm in diameter, or <or= 3 nodules with <or= 3 cm in diameter).

Methods: One hundred and five patients with 114 HCC nodules were randomly allocated to SR (n = 54) and ultrasound-guided PTA with microwave or radiofrequency energy (n = 51).

Results: The complete tumor elimination rates in SR and PTA groups were similar (100% vs 94.7%) and the local recurrence rates were both 0. There were no significant differences in distance recurrence rate (16.7% vs 27.5%, P = 0.182) and time to the first recurrence (4.9 month vs 9.6 month, P = 0.130) between the SR and PTA groups. One, 2-, and 3-year disease-free survival rates were 82.4%, 82.4% and 82.4%, respectively, in SR group, whereas they were 78.5%, 61.5% and 51.3% in PTA group, respectively. The difference between these two groups was statistically not significant (P = 0.128). The overall survival rates in SR group were 91.3%, 86.4% and 86.4% at 1, 2, and 3 years, respectively, and those in PTA group were 93.5%, 87.1% and 87.1%, respectively. There was no significant difference between these two groups (P = 0.808). Compared with SR, PTA required less treatment time (27 min vs 145 min, P < 0.005), less necessity for blood transfusion (0 patient vs 7 patients, P = 0.013) and less hospital-stay (5.2 d vs 19.1, P < 0.005). There was no significant difference in the rate of treatment-related complication between the two groups (11.1% for SR vs 7.8% for PTA, P = 0.742). At day 7 and day 30 after treatment, the numbers of patient with physical status (WHO Performance Status grades) of grade 0 - 1 were 32 and 44 in PTA group, respectively, significantly more than 16 and 33 in SR group (P = 0.001 and P = 0.004, respectively).

Conclusion: Besides minimal invasiveness, easy to access and cost saving, PTA achieved equivalent local therapeutical effectiveness and 3-year survival outcomes as SR did, and may be considered as a one of the first-choice treatment modality for treatment of early-stage HCC.