Comparison of repeat hepatectomy with radiofrequency ablation for the survival of hepatocellular carcinoma with solitary intrahepatic recurrence after hepatectomy.

[PURPOSE] To compare survival outcomes between repeat hepatectomy (RHT) and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) patients with solitary intrahepatic recurrence after initial hepatic resection, and to identify associated prognostic factors.

[PATIENTS AND METHODS] This study included 377 HCC patients with solitary intrahepatic recurrence after initial hepatectomy (RHT=280, RFA=97). Propensity score matching (PSM) was used to balance intergroup characteristics. Survival outcomes (OS and rRFS) were analyzed using Kaplan-Meier method and compared by log-rank test. Variables that were significant in univariate analysis were further included in multivariate analysis.

[RESULTS] No significant differences were observed in either OS or rRFS between RFA and RHT groups before (P = 0.37 for OS; P = 0.30 for rRFS) or after PSM (P = 0.58 for OS; P = 0.76 for rRFS). Era-stratified analysis (earlier cohort [1996-2005]: P = 0.40 for OS, P = 0.62 for rRFS; later cohort [2006-2010]: P = 0.18 for OS, P = 0.08 for rRFS) confirmed this finding. Subgroup analyses confirmed the equivalent survival outcomes between RFA and RHT in patients with tumors ≤ 3 cm or > 3 cm but ≤ 5 cm. Multivariate analysis identified HBsAg positivity and tumor diameter > 2 cm as independent risk factors for OS, while recurrence time ≤ 24 months was an independent risk factor for both OS and rRFS.

[CONCLUSION] RFA provides comparable OS and rRFS to RHT for HCC patients with solitary intrahepatic recurrence ≤ 5 cm after hepatic resection.