Long-term Outcomes of Ablation, Liver Resection, and Liver Transplant as First-line Treatment for Solitary HCC of 3 cm or Less

Long-term Outcomes of Ablation, Liver Resection, and Liver Transplant as First-line Treatment for Solitary HCC of 3 cm or Less Using an Intention-to-treat Analysis: a Retrospective Cohort Study

Curative-intent therapies for hepatocellular carcinoma (HCC) include radiofrequency ablation (RFA), liver resection (LR), and liver transplantation (LT). Controversy exists in treatment selection for early-stage tumors. We sought to evaluate the oncologic outcomes of patients who received either RFA, LR, or LT as first-line treatment for solitary HCC ≤ 3cm in an intention-to-treat analysis.

Inclusion Criteria:

• Adult (≥18 years) patients
• Solitary HCC ≤ 3cm
• Receipt of either radiofrequency ablation, liver resection, or listing for a liver transplant
• Treatment received between Feb-2000 and Nov-2018

Exclusion Criteria:

• Pathology other than hepatocellular carcinoma (HCC)
• Receipt of prior treatment (i.e., not treatment naive)
• Not eligible for all of the three treatments (ablation, liver resection, or liver transplant listing)
• Platelet count <100,000 before treatment
• Alpha-1 fetoprotein (AFP) level > 1000 before treatment
• Age > 70 years
• Child-Pugh score C
• Esophageal varices grade greater than 2
• Model for End-stage Liver Disease (MELD) score before treatment exceeding 15
• Presence of ascites pretreatment
• Presence of encephalopathy pretreatment
• Spleen size greater than 12 cm