Comparison of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma patients: a SEER population-based propensity score matching study

Abstract

This study was designed to compare the efficacy of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in terms of their therapeutic effect on small hepatocellular carcinoma (SHCC). The SEER database was employed to integrate SHCC patients who had received treatment with either LH (n = 1132) or RFA (n = 797). The LH group (n = 623) and the RFA group (n = 623) were matched with 1:1 propensity score matching (PSM) in order to reduce the possibility of selection bias. The Kaplan-Meier method and Cox proportional hazards regression method were employed to ascertain the prognostic factors associated with overall survival (OS) and disease-specific survival (DSS). Both before and after PSM, the 1, 3 and 5-years OS and DSS were significantly higher in the LH groups compared to the RFA group. Besides, for SHCC with tumor size ≤ 2cm (n = 418), even P values not reaching statistical significance, the survival curves were compatible with a superiority of LH over RFA for OS and DSS in overall (P = 0.054 and P = 0.077), primary SHCC (P = 0.110 and P = 0.058) and recurrent SHCC (P = 0.068 and P = 1.000) cohorts. In contrast, for SHCC with tumor size between 2 and 3 cm (n = 828), LH group always had a better OS and DSS in the all cohorts (all P < 0.05). In addition, higher AFP level, poor differentiation grade, recurrent tumor and treatment type were independent prognostic factors for OS, while poor differentiation grade, larger tumor size and treatment type were the independent prognostic factors for DSS (all P < 0.05). LH was associated with better OS and DSS than RFA in SHCC patients. Even in tumor size ≤ 2 cm, LH still should be the first choice as its long-term survival benefits.

Keywords: Laparoscopic hepatectomy; Prognosis; Propensity score matching; Radiofrequency ablation; Small hepatocellular carcinoma.

Fig. 1

The flowchart of SHCC patients enrolled in this study

Fig. 2

OS and DSS of LH group and RFA group in overall cohort. (A OS in overall cohort before PSM; B DSS in overall cohort before PSM; C OS in overall cohort after PSM; D DSS in overall cohort after PSM)

Fig. 3

OS and DSS of LH group and RFA group in primary and recurrent SHCC cohort. (A, OS in primary SHCC cohort before PSM; B, DSS in primary SHCC cohort before PSM; C, OS in recurrent SHCC cohort before PSM; D, DSS in recurrent SHCC cohort before PSM; E, OS in primary SHCC cohort after PSM; F, DSS in primary SHCC cohort after PSM; G, OS in recurrent SHCC cohort after PSM; H, DSS in recurrent SHCC cohort after PSM)

Fig. 4

OS and DSS of LH group and RFA group for patients with tumor size ≤ 2 cm in overall cohort, primary SHCC cohort, and recurrent SHCC cohort after PSM. (A, OS in overall cohort; B, OS in primary SHCC cohort; C, OS in recurrent SHCC cohort; D, DSS in overall cohort; E, DSS in primary SHCC cohort; F, DSS in recurrent SHCC cohort)

Fig. 5

OS and DSS of LH group and RFA group for patients with tumor size between 2 and 3 cm in overall cohort, primary SHCC cohort, and recurrent SHCC cohort after PSM. (A OS in overall cohort; B OS in primary SHCC cohort; C OS in recurrent SHCC cohort; D DSS in overall cohort; E DSS in primary SHCC cohort; F DSS in recurrent SHCC cohort)