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. 2025 Jul 23:12:1587-1598.
doi: 10.2147/JHC.S496470. eCollection 2025.

Comparison of Long-Term Outcomes Between Repeated Hepatic Resection and Radiofrequency Ablation in Patients with Small Recurrent Hepatocellular Carcinoma After Initial Curative Resection: A Propensity Score Matched Study

Chih-Yang Hsiao  1   2 , Rey-Heng Hu  1 , Po-Chin Liang  3 , Chih-Horng Wu  4   5   6
Affiliations

Comparison of Long-Term Outcomes Between Repeated Hepatic Resection and Radiofrequency Ablation in Patients with Small Recurrent Hepatocellular Carcinoma After Initial Curative Resection: A Propensity Score Matched Study

Chih-Yang Hsiao et al. J Hepatocell Carcinoma. .

Abstract

Background: Repeat hepatic resection (re-resection) and radiofrequency ablation (RFA) are both standard treatments for small recurrent hepatocellular carcinoma (HCC) after curative resection. This study compares long-term outcomes of these treatments.

Methods: This retrospective study included patients with recurrent HCC smaller than 3 cm treated with re-resection or RFA from 2001 to 2019 in a tertiary center. Propensity score matching (PSM) minimized baseline differences. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Subgroup analyses explored outcomes based on recurrence interval, hepatitis infection status, and RFA guidance method (ultrasound [US] versus computed tomography [CT]). Multivariate Cox regression identified predictors of survival and secondary recurrence.

Results: After PSM, 106 patients in the re-resection group and 106 in the RFA group were compared. OS rates at 3, 5, and 8 years for re-resection were 97.9%, 85.4%, and 75.8%, compared to 87.8%, 77.9%, and 62.8% for RFA (p = 0.15). DFS rates were 53.3%, 41.8%, and 26.7% for re-resection versus 43.9%, 28.1%, and 24.0% for RFA (p = 0.15). Subgroup analysis indicated re-resection was superior in early recurrence (<24 months) and HBV-related HCC. US-guided and CT-guided RFA showed no significant differences in OS or DFS. HCV infection and multiple tumors were independent predictors of secondary recurrence.

Conclusion: Repeat hepatic resection and RFA offer comparable survival for small recurrent HCC. Re-resection is preferred for early recurrence and HBV-related HCC. US- and CT-guided RFA are equally effective alternatives.

Keywords: hepatocellular carcinoma; outcome; radiofrequency ablation; recurrence; repeat resection.

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Conflict of interest statement

All author declared no conflict of interest.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study flowchart. HCC: hepatocellular carcinoma; RFA: radiofrequency ablation.
Figure 2
Figure 2
Comparison of long-term overall survival rates between repeat liver resection and radiofrequency ablation (RFA) in patients with recurrent HCC. (A) Unmatched cohort. (B) Propensity score matched cohort. There were no significant differences in survival outcomes before or after propensity score matching. There are also no significant differences in survival outcomes whether ultrasound (US) or computed tomography (CT) was used as guiding instruments for RFA (C and D).
Figure 3
Figure 3
Comparison of long-term disease-free survival rates between repeat liver resection and radiofrequency ablation (RFA) in patients with recurrent HCC. (A) Unmatched cohort. (B) Propensity score matched cohort. There are also no significant differences in survival outcomes whether ultrasound (US) or computed tomography (CT) was used as guiding instruments for RFA (C and D).
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