A nationwide propensity score analysis comparing ablation and resection for hepatocellular carcinoma

Abstract

AbstractBackground and ObjectivesStudies have reported ambiguous results regarding the efficacy of ablation for early‐stage hepatocellular carcinoma (HCC). Our study compared outcomes of ablation versus resection for HCC ≤50 mm to identify tumor sizes that would most benefit from ablation in terms of long‐term survival.MethodsThe National Cancer Database was queried for patients with stage I and II HCC ≤50 mm who underwent ablation or resection (2004−2018). Three cohorts were created based on tumor size: ≤20, 21−30, and 31−50 mm. A propensity score‐matched survival analysis was performed using the Kaplan−Meier method.ResultsIn total, 36.47% (n = 4263) and 63.53% (n = 7425) of patients underwent resection and ablation, respectively. After matching, resection was associated with a significant survival benefit compared to ablation (3‐year survival: 78.13% vs. 67.64%; p < 0.0001) in patients with HCC of ≤20 mm. The impact of resection was even more striking among patients with HCC of 21−30 mm (3‐year survival: 77.88% vs. 60.53%; p < 0.0001) and 31−50 mm (3‐year survival: 67.21% vs. 48.55%; p < 0.0001).ConclusionsWhile resection offers a survival benefit over ablation in the treatment of early‐stage HCC ≤50 mm, ablation may provide a feasible bridging strategy in patients awaiting transplantation.