Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide, but only a small percentage of patients are eligible for curative surgical intervention. Over the past decade, radiofrequency ablation (RFA) has been increasingly shown to offer long-term survival benefits. Our study objective was to compare outcomes of patients with HCC who underwent surgical resection with those who received RFA. Using the Surveillance, Epidemiology, and End Results registry, we identified 1209 (21%) and 4595 (79%) patients with HCC who received RFA and surgical resection, respectively, between the years 1988 and 2008. When comparing the groups, patients undergoing RFA were older (years, 62.6 vs 58.7; P < 0.001) and had smaller tumors (less than 5 cm; 84.4 vs 61.2%; P < 0.001), yet patients who underwent surgical resection had improved survival over patients undergoing RFA (median survival, 5 vs 3 years, respectively; P < 0.001). Univariate and multivariate analysis verified the superiority of surgical resection over ablation (hazard ratio [HR], 0.6; 95% confidence interval [CI], 0.60 to 0.80; P < 0.001 and HR, 0.57; 95% CI, 0.52 to 0.63; P < 0.001, respectively). In summary, our investigation demonstrates that surgical resection provides durable long-term survival for surgical candidates with HCC; however, RFA remains an appropriate alternative therapy that also provides long-term survival in select patients.