AUTHOR=Yue Yang-yang , Zhou Wei-li 

TITLE=Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00110

DOI=10.3389/fonc.2020.00110

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold> The prognosis of patients with hepatocellular carcinoma (HCC) is of major public health interest. However, studies comparing hepatic resection (HR) and radio-frequency ablation (RFA) applied to multifocal HCC are limited. This study aimed to compare the efficacies of HR and RFA in patients with multifocal HCC.</p><p><bold>Methods:</bold> We retrospectively analyzed a cohort from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Disease-specific survival and overall survival rates were assessed before and after propensity score matching (PSM).</p><p><bold>Results:</bold> In total, 2,201 patients with multifocal HCC treated with HR (<italic>n</italic> = 1,095) or RFA (<italic>n</italic> = 1,106) were included; 1,096 patients were identified after nearest-neighbor PSM at a ratio of 1:1 (HR: <italic>n</italic> = 548; RFA: <italic>n</italic> = 548). In the multivariate Cox regression model, HR was associated with significantly improved disease-specific survival [before PSM: hazard ratio 0.67, 95% confidence interval (CI) 0.57–0.79, <italic>p</italic> &lt; 0.001; after PSM: hazard ratio 0.69, 95% CI 0.58–0.82, <italic>p</italic> &lt; 0.001] and overall survival (before PSM: hazard ratio 0.67, 95% CI 0.58–0.78, <italic>p</italic> &lt; 0.001; after PSM: hazard ratio 0.69, 95% CI 0.59–0.80, <italic>p</italic> &lt; 0.001) compared to RFA in patients with multifocal HCC. In the survival curve analysis, the disease-specific survival of the HR group was similar to that of the RFA group before PSM (<italic>p</italic> = 0.936, log-rank test) but was significantly longer after PSM (<italic>p</italic> &lt; 0.001) in all patients. Multivariate analyses revealed that differentiation grade, alpha-fetoprotein, tumor size, and tumor extension were independent predictors of poor prognosis in patients with multifocal HCC.</p><p><bold>Conclusions:</bold> The long-term survival rate of HR is better than that of RFA in patients with multifocal HCC. HR may serve as a first-line treatment for patients with multifocal HCC. The presence of large tumors and vascular invasion are not contraindications for HR.</p>