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A Randomized Trial Comparing Radiofrequency Ablation and Surgical Resection for HCC Conforming to the Milan Criteria

Huang, Jiwei MD; Yan, Lvnan MD; Cheng, Zheyu MD; Wu, Hong MD; Du, Liang PhD; Wang, Jinzhou; Xu, Yinglong; Zeng, Yong MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181efc656
Feature: ORIGINAL STUDY
Abstract

Objective: To compare the long-term outcomes of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (HCC).

Summary Background Data: Radiofrequency ablation (RFA) is a promising, emerging therapy for small HCC. Whether it is as effective as surgical resection (RES) for long-term outcomes is still indefinite.

Methods: Two hundred thirty HCC patients who met the Milan criteria and were suitable to be treated by either RES or RFA entered into a randomized controlled trial. The patients were regularly followed up after treatment for 5years (except for those who died). The primary end point was overall survival; the secondary end points were recurrence-free survival, overall recurrence, and early-stage recurrence.

Results: The 1-, 2-, 3-, 4- and 5-year overall survival rates for the RFA group and the RES group were 86.96%, 76.52%, 69.57%, 66.09%, 54.78% and 98.26%, 96.52%, 92.17%, 82.60%, 75.65%, respectively. The corresponding recurrence-free survival rates for the 2 groups were 81.74%, 59.13%, 46.08%, 33.91%, 28.69% and 85.22%, 73.92%, 60.87%, 54.78%, 51.30%, respectively. Overall survival and recurrence-free survival were significantly lower in the RFA group than in the RES group (P = 0.001 and P = 0.017). The 1-, 2-, 3-, 4-, and 5-year overall recurrence rates were 16.52%, 38.26%, 49.57%, 59.13%, and 63.48% for the RFA group and 12.17%, 22.60%, 33.91%, 39.13%, and 41.74% for the RES group. The overall recurrence was higher in the RFA group than in the RES group (P = 0.024).

Conclusions: Surgical resection may provide better survival and lower recurrence rates than RFA for patients with HCC to the Milan criteria.

In Brief

230 HCC patients who met the Milan criteria were randomly treated by surgical resection and radiofrequency ablation. The patients were regularly followed up after treatment for 5 years except in the case of death. Results showed better survival and lower recurrence rates were achieved in the operation group.

Author Information

From the Department of Hepato-Biliary-Pancreatic Surgery, Treatment Centre of Liver Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Corresponding Author: Yong Zeng, MD, Department of Hepato-Bilio-Pancreatic Surgery, Treatment Centre of Liver Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China. E-mail: zengyongmd@gmail.com.

Financial Support: This study has not received any support from industry or private corporations.

This trial was registered at the Chinese Clinical Trial Register (ChiCTR-TRC-00000372).

Lvnan Yan and Yong Zeng contribute equally to this work.

© 2010 Lippincott Williams & Wilkins, Inc.