Hepatectomy versus stereotactic body radiotherapy for primary early hepatocellular carcinoma: A propensity-matched analysis in a single institution


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Abstract

Objective:To evaluate the efficacy of both surgical resection and stereotactic body radiotherapy for small hepatocellular carcinoma.Background:Although the number of stereotactic body radiotherapies being performed for hepatocellular carcinoma has gradually increased, data comparing surgical resection and stereotactic body radiotherapy are limited.Methods:Between 2008 and 2015, a total of 281 patients with 1 to 3 small hepatocellular carcinoma tumors (≤3 cm in diameter), treated initially with curative intent (surgical resection, 254; stereotactic body radiotherapy, 27), were retrospectively analyzed. Overall survival and disease-free survival were compared in a propensity score matching analysis.Results:Patients in the surgical resection group tended to be younger, had more tumors, and had better hepatic function than those in the stereotactic body radiotherapy group (P < .05). The percent recurrence of the same sub-segment in the stereotactic body radiotherapy group was significantly higher than that in the surgical resection group (P=.0034). Propensity score analysis revealed that 54 patients with surgical resection and 27 with stereotactic body radiotherapy had the same baseline characteristics. The 5-year overall survival and disease-free survival rates for the surgical resection and stereotactic body radiotherapy groups were 75.2% vs 47.8% (P=.0149) and 33.8% vs 16.4% (P=.0512), respectively. Multivariate analysis showed that surgical resection was a significant favorable factor for overall survival and disease-free survival of patients with one to three small hepatocellular carcinomas.Conclusion:Surgical resection provided better long-term overall survival and disease-free survival in patients with small hepatocellular carcinoma tumors. However, stereotactic body radiotherapy may be an effective alternative treatment for inoperable patients with early hepatocellular carcinoma.

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