Comparison of Surgical Resection and Radiofrequency Ablation for Early-Stage HCC Patients With Child-Pugh Class B.

[AIM] The aim of this study is to compare the clinical outcomes of surgical resection (SR) and radiofrequency ablation (RFA) in patients with early-stage hepatocellular carcinoma (HCC) and Child-Pugh Class B liver function.

[METHODS] Among 7210 treatment-naïve HCC patients in our group between 2000 and 2021, this retrospective study included 41 and 456 patients who underwent SR and RFA, respectively. All included patients had Child-Pugh Class B liver function, an Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2, and early-stage HCC (≤ 3 nodules, ≤ 3 cm in diameter). To adjust for baseline imbalances between the two groups, we applied inverse probability of treatment weighting (IPTW) analysis. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier survival analysis and Cox regression models.

[RESULTS] Before IPTW analysis, significant differences were observed between the SR and RFA groups in Child-Pugh scores (p = 0.003), total bilirubin levels (p = 0.04), prothrombin time (p = 0.003), and the presence of ascites (p = 0.01), all of which were more favorable in the SR group. The SR group also had fewer tumors (p = 0.03) and larger tumor diameters (p = 0.002) compared to the RFA group. In the entire cohort, there were no significant differences in RFS between the two groups (p = 0.6). After IPTW analysis, the differences remained statistically nonsignificant (p = 0.4). Regarding OS, the difference was not observed between the two groups in the entire cohort (p = 0.5) and in the IPTW cohort (p = 0.9).

[CONCLUSION] RFA appears to be as effective as SR in patients with early-stage HCC with the liver function of Child-Pugh Class B.