Surgery or external beam radiation for solitary small hepatocellular carcinoma

Background:There is little evidence on the efficacy of external beam radiation (EBR) compared to liver resection (LR) for patients with solitary small (<= 5 cm) hepatocellular carcinoma (HCC). Objective:We aimed to investigate this clinical question based on the Surveillance, Epidemiology, and End Results (SEER) database. Method:SEER database was used to identify 416 patients with solitary small HCC who underwent LR or EBR. Survival analysis and Cox proportional hazards model were performed to evaluate overall survival (OS) and identify prognostic factors for OS. Propensity score matching (PSM) method was used to adjust the baseline characteristics of the two groups. Result:Before PSM, the 1- and 2-year OS rates were 92.0% and 85.2% in the LR cohort and 76.0% and 60.3% in the EBR cohort, respectively (P < 0.001). After PSM, LR (n = 62) demonstrated improved OS compared to EBR (n = 62) (1-year OS rate: 96.5% vs. 76.0%; 2-year OS rate: 89.3% vs. 60.3%, P < 0.001), despite stratification on tumor size. Multivariate Cox regression analysis indicated that treatment type was the only factor associated with OS (hazard ratio: 5.297; 95% confidence interval: 1.952-14.371, P = 0.001). Conclusion:For patients with solitary small HCC, LR may offer better survival outcomes than EBR.