Comparison of Outcomes of Hepatic Resection and Radiofrequency Ablation for Hepatocellular Carcinoma Patients with Multifocal Tumors Meeting the Barcelona-Clinic Liver Cancer Stage A Classification

BACKGROUND: Although hepatic resection (HR) has been recommended as the first-line treatment option for patients with a solitary tumor, the first-line treatment for patients with multifocal tumors meeting the Barcelona-Clinic Liver Cancer (BCLC) stage A still remains unclear. This study compared outcomes for patients with multifocal tumors meeting the BCLC stage A treated by HR and radiofrequency ablation (RFA). STUDY DESIGN: A total of 384 consecutive patients with multifocal tumors meeting the BCLC stage A, who underwent HR (n = 224) or RFA (n = 160), were included. Moreover, propensity score-matched patients were analyzed to adjust for baseline differences. RESULTS: The 1-, 3-, and 5-year overall survival (OS) rates after HR and RFA were 96%, 71.7%, and 36.3%, and 90.0%, 72.7%, and 37.8%, respectively (p = 0.609); HR provided significantly better recurrence-free survival (RFS) rates than RFA at 1, 3, and 5 years (87.5%, 53.1%, and 20.1% vs 83.1%, 34.0%, and 9.7%, respectively, p = 0.001). Patients selected in the propensity-matching model showed similar results. Subgroup analysis also showed that HR was associated with better RFS than RFA for patients with 2 tumors, multifocal tumors located in the same lobe (Couinaud's segmentation) and segment (Takasaki's segmentation). Multivariate analysis revealed that 3 tumors, portal hypertension, and tumors located in different segments (Takasaki's segmentation) are independent predictors of poor prognosis in patients with multifocal tumors meeting the BCLC stage A. CONCLUSIONS: For patients with multifocal tumors meeting the BCLC stage A, HR may offer significantly better RFS than RFA, and HR may be considered as the first-line treatment option for those patients. (C) 2015 by the American College of Surgeons)