Ablation for hepatocellular carcinoma in hepatitis B-related recompensated vs. compensated cirrhosis.

[OBJECTIVES] To compare the efficacy and safety of ablation therapy in hepatocellular carcinoma (HCC) patients with hepatitis B-related compensated cirrhosis versus those with recompensated cirrhosis.

[MATERIALS AND METHODS] In this multicenter, retrospective cohort study, we enrolled hepatitis B-related HCC patients (73 with recompensated cirrhosis and 666 with compensated cirrhosis) who underwent ablation between January 2009 and February 2024. Propensity score matching was performed to balance baseline characteristics, resulting in 73 matched pairs. Recurrence-free survival (RFS), overall survival (OS), and complications were compared.

[RESULTS] A total of 739 patients (median age, 59 years [interquartile range, 53-66 years]; 579 men [78.2%]) were enrolled. Following propensity score matching procedures, no significant difference in major complications was observed between patients with recompensated cirrhosis and those with compensated cirrhosis (6.8% vs. 2.7%, p = 0.438). Critically, no postoperative liver failure or decompensation events occurred after ablation therapy in patients with either recompensated cirrhosis or compensated cirrhosis. Moreover, RFS was comparable between patients with recompensated cirrhosis and those with compensated cirrhosis (73.7% vs. 74.0% at 1 year; 43.3% vs. 43.2% at 3 years; 24.8% vs. 36.9% at 5 years; p = 0.699). The overall survival rates at 1, 3, and 5 years were 97.3%, 84.5%, and 73.4% in patients with recompensated cirrhosis, and 98.6%, 92.7%, and 83.7% in patients with compensated cirrhosis, respectively (p = 0.363).

[CONCLUSIONS] Ablation therapy is effective and safe in HCC patients with hepatitis B-related recompensated cirrhosis, representing a viable curative option for these patients.

[KEY POINTS] Question Is ablation as safe and effective for patients with hepatitis B-related recompensated cirrhosis as it is for those with compensated cirrhosis? Findings The incidence of major complications and long-term survival did not differ statistical significantly between patients with hepatitis B-related recompensated cirrhosis and those with compensated cirrhosis. Clinical relevance Ablation therapy is effective and safe in hepatocellular carcinoma patients with hepatitis B-related recompensated cirrhosis, representing a viable curative option for these patients.