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Saudi J Gastroenterol. 2018 Nov-Dec;24(6):317-325. doi: 10.4103/sjg.SJG_261_18.

Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage.

Author information

1
Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
2
Department of General Surgery, Xiangyang Central Hospital, Xiangyang, China.
3
Department of Pathology and Pathophysiology, Wuhan University School of Basic Medical Sciences, Wuhan, China.

Abstract

Background/Aims:

To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm.

Patients and Methods:

Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM).

Results:

Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65-75, >75 years) and tumor size (≤3.0, 3.1-5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM.

Conclusion:

Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those> 75 years with single HCC ≤3 cm.

KEYWORDS:

Elderly patients; hepatocellular carcinoma; prognosis; radiofrequency ablation; surgical resection

PMID:
30117492
DOI:
10.4103/sjg.SJG_261_18

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