Radiofrequency Ablation Versus Hepatic Resection As An Initial Treatment For Solitary Small-Sized Hepatocellular Carcinoma

290 Background: Nowadays Radiofrequency ablation (RFA) is a popular method and demonstrates favorable results for the treatment of small-sized hepatocellular carcinoma (HCC). However, whether RFA is as effective as hepatic resection (HR) for long-term outcomes remains controversial. The aim of this study is to compare HR and RFA with regard to survival and recurrence for the establishment of treatment strategy of small-sized HCC. Methods: A total of 183 patients with solitary small-sized (≤3cm) HCC were enrolled in this study: 101 patients underwent HR and 82 underwent RFA as an initial treatment. Overall survival (OS) and disease-free survival (DFS) were compared between the two groups and in subgroup analyses. Results: Patients who underwent RFA had less platelet count (HR: 15.3±7.0, RFA: 9.8±3.6, P<0.01), and more advancer Child-Pugh class (A/B = HR: 97/4, RFA: 61/22, P<0.01). The 5-year OS and DFS were significantly higher in the HR group compared with the RFA group (OS: 90% vs 59%, P<0.01, DFS: 45% vs 27%, P<0.01, respectively). In multivariate analyses, treatment modality (HR or RFA) and gender were indipendent predicting factors for DFS (RR: 1.85, P=0.05, and RR: 2.15, P=0.01, respectively). In subgroup analyses of HCC <2cm, there was no significant difference in OS and DFS between the two group (5-year OS: 90% vs 74%, P=0.40, 5-year DFS: 43% vs 28%, P=0.24, respectively), despite the differences in liver functional reserve. However, HR was superior to RFA for OS and DFS in subgroup ≥2cm (5-year OS: 85% vs 32%, P<0.01, 5-year DFS: 40% vs 23%, P<0.01). In the subgroup analyses treated by RFA, GPT >35mIU/ml and tumor ≥2cm were significant predicting factors for DFS (RR: 2.34, P=0.01, and RR: 2.09, P=0.02, respectively). For OS, tumor ≥2cm was the only prognostic factor (RR: 2.9, P=0.04). Conclusions: RFA might be as effective as HR for the treatment of solitary HCC <2cm. However, in the patients with HCC ≥2cm, HR provides a better OS and DFS than RFA.