Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma

Abstract

Background: The prognosis of patients with hepatocellular carcinoma (HCC) is of major public health interest. However, studies comparing hepatic resection (HR) and radio-frequency ablation (RFA) applied to multifocal HCC are limited. This study aimed to compare the efficacies of HR and RFA in patients with multifocal HCC. Methods: We retrospectively analyzed a cohort from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Disease-specific survival and overall survival rates were assessed before and after propensity score matching (PSM). Results: In total, 2,201 patients with multifocal HCC treated with HR (n = 1,095) or RFA (n = 1,106) were included; 1,096 patients were identified after nearest-neighbor PSM at a ratio of 1:1 (HR: n = 548; RFA: n = 548). In the multivariate Cox regression model, HR was associated with significantly improved disease-specific survival [before PSM: hazard ratio 0.67, 95% confidence interval (CI) 0.57-0.79, p < 0.001; after PSM: hazard ratio 0.69, 95% CI 0.58-0.82, p < 0.001] and overall survival (before PSM: hazard ratio 0.67, 95% CI 0.58-0.78, p < 0.001; after PSM: hazard ratio 0.69, 95% CI 0.59-0.80, p < 0.001) compared to RFA in patients with multifocal HCC. In the survival curve analysis, the disease-specific survival of the HR group was similar to that of the RFA group before PSM (p = 0.936, log-rank test) but was significantly longer after PSM (p < 0.001) in all patients. Multivariate analyses revealed that differentiation grade, alpha-fetoprotein, tumor size, and tumor extension were independent predictors of poor prognosis in patients with multifocal HCC. Conclusions: The long-term survival rate of HR is better than that of RFA in patients with multifocal HCC. HR may serve as a first-line treatment for patients with multifocal HCC. The presence of large tumors and vascular invasion are not contraindications for HR.

Keywords: hepatic resection; hepatocellular carcinoma; liver cancer; multifocal tumor; radio-frequency ablation.

Figure 1

Flow chart of the sample selection procedure.

Figure 2

Comparison of Kaplan-Meier survival curves of DSS between the HR and RFA groups before and after PSM in all patients. DSS was similar between the HR and RFA groups before PSM (A) but significantly different after PSM (B). DSS, disease-specific survival; HR, hepatic resection; RFA, radio-frequency ablation; PSM, propensity score matching.

Figure 3

Comparison of Kaplan-Meier survival curves of DSS between the HR and RFA groups stratified by differentiation grade after PSM. Patients treated with HR and RFA had similar survival rates in well (A), poor (C), undifferentiated/anaplastic (D), and unknown (E) differentiation subgroups. However, patients treated with HR had a significantly improved survival in moderate differentiation subgroup (B). DSS, disease-specific survival; HR, hepatic resection; RFA, radio-frequency ablation; PSM, propensity score matching.

Figure 4

Comparison of Kaplan-Meier survival curves of DSS between the HR and RFA groups stratified by tumor size after PSM. Patients treated with HR had comparable prognoses with those treated with RFA in tumor size 0–2 cm (A) and 2–3 cm (B) subgroups. However, patients treated with HR had a significantly prolonged survival in tumor size 3–5 cm (C) and >5 cm (D) subgroups. DSS, disease-specific survival; HR, hepatic resection; RFA, radio-frequency ablation; PSM, propensity score matching.

Figure 5

Comparison of Kaplan-Meier survival curves of DSS between the HR and RFA groups stratified by tumor extension after PSM. Patients treated with HR had a significantly better prognosis than those treated with RFA in subgroups of tumor extension 390 (A), 630 (E), and 635 (F). However, patients treated with HR had a comparable survival with those treated with RFA in tumor extension 400 (B), 420 (C), and 440 (D) subgroups. DSS, disease-specific survival; HR, hepatic resection; RFA, radio-frequency ablation; PSM, propensity score matching.