Prognostic Impact of Hepatectomy Versus Radiofrequency Ablation for Non-Small Hepatocellular Carcinoma (2-3 cm): A...

While the surgery versus radiofrequency ablation (RFA) (SURF) trial demonstrated no significant difference in long-term outcomes between hepatectomy and RFA for patients with small hepatocellular carcinomas (HCCs) (≤ 3 cm and less than three nodules), uncertainty persists regarding the potential risk of local recurrence and inferior overall survival (OS) associated with RFA for HCCs with a diameter ≥ 2 cm when compared to hepatectomy. This study aimed to elucidate the prognostic outcomes of hepatectomy versus RFA for treating primary HCC of 2-3 cm and less than three nodules.

This retrospective study included 398 patients with primary HCC measuring 2-3 cm and having less than three nodules. Propensity score matching (PSM) was employed to balance the hepatectomy (n = 281) and RFA (n = 117) cohorts, resulting in 101 matched pairs. OS and recurrence-free survival (RFS) were assessed.

Before PSM, hepatectomy showed better RFS (hazard ratio [HR] = 0.57, p < 0.001) and OS (HR = 0.74, p = 0.005) than RFA. After PSM, hepatectomy retained a trend of improved outcomes (RFS: HR = 0.72, p = 0.051, OS: HR = 0.63, p = 0.08), and the local recurrence rate (3.0 vs. 22.8%, p < 0.001) in hepatectomy were significantly lower than RFA. In the subgroup analysis, hepatectomy showed significantly better OS than RFA in the cohort with alpha-fetoprotein (AFP) ≥ 20 ng/mL (HR = 0.40, p = 0.03).

For patients with primary HCC measuring 2-3 cm and having less than three nodules, hepatectomy may offer superior prognostic benefits, particularly in those with elevated AFP levels. These findings emphasize the importance of individualized treatment decisions based on tumor size and AFP levels.