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Comparison of Surgical Resection and Radiofrequency Ablation in Elderly Patients with Hepatocellular Carcinoma

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An Invited Commentary to this article was published on 01 February 2024

Abstract

Background/Aims

The aim of this study was to examine whether the efficacy of radiofrequency ablation (RFA) and surgical resection (SR) are comparable for hepatocellular carcinoma (HCC) less than 3 cm in elderly individuals aged 65 years or older.

Methods

We used the National Health Insurance Service claims data in Korea, which was linked with liver cancer stage data from the Central Cancer Registry of the National Cancer Center, as well as death data from the National Statistical Office. Out of the 9213 registrants, we focused on 141 patients who underwent SR and 225 patients who underwent RFA when they were 65 years or older. To ensure comparability, a 1:1 propensity score (PS) matching was conducted.

Results

The SR group had lower performance status and better liver function compared to the RFA group. Tumor diameter was larger in the SR group than in the RFA group (2.1 cm vs. 1.7 cm), and the proportion of stage II cases was higher (62.4% vs. 33.8%). After PS matching, the mortality rate in the RFA group did not significantly differ from the SR group (HR 1.33, 95% CI 0.86–2.06, P = 0.19). Also, liver related mortality was similar between the SR and RFA group after matching (log rank P = 0.13). However, recurrence free survival was significantly longer in the SR group than RFA group before and after matching (log rank P = 0.03).

Conclusion

In patients aged 65 years or older with resectable HCC, RFA demonstrates a therapeutic effect comparable to SR.

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Data availability

Data can be provided upon reasonable request.

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Acknowledgments

None.

Funding

This study was funded by the National Evidence-based Healthcare Collaborating Agency (NECA; project number NA22-006). This research was also supported by the Soonchunhyang University Research Fund. This funding source had no role in the study design, collection, analysis, or interpretation of data.

Author information

Author notes

  1. Jun Il Kim, Jayoun Lee, Dong Ah Park, and Jeong-Ju Yoo have contributed equally.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea

    Jun Il Kim & Jeong-Ju Yoo

  2. Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), 173 Toegye-ro, Jung-gu, Seoul, 04554, Republic of Korea

    Jayoun Lee & Dong Ah Park

  3. Department of General Surgery, Yonsei University School of Medicine, Cheonan, Republic of Korea

    Gi Hong Choi

  4. Department of Radiology, Samgsung Medical Cente, Sungkyunkwan University, Seoul, Republic of Korea

    Min Woo Lee

  5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang Bucheon Hospital, 170 Jomaruro Wonmigu, Bucheonsi, Gyeonggido, 14584, Republic of Korea

    Jeong-Ju Yoo

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  1. Jun Il Kim
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Contributions

DAP: Study concept and design. JL, DAP: Provision of study materials or patients. JL, DAP: Collection and assembly of data. All authors: Data analysis and interpretation. JIK, J-JY: Manuscript writing. All authors: Final approval of the manuscript.

Corresponding author

Correspondence to Jeong-Ju Yoo.

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Conflict of interest

All authors have no conflict of interest relevant to this study.

Ethical approval

The study protocol received approval from the Institutional Review Boards of the National Evidence-based Healthcare Collaborating Agency (IRB number: NECA-IRB21-016, Date of registration: 17-June-2021) and adhered to the ethical guidelines outlined in the World Medical Association Declaration of Helsinki.

Consent to participate

Informed consent was waived form the IRB due to the retrospective design.

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N/A.

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An invited commentary on this article is available at https://doi.org/10.1007/s10620-023-08247-y.

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Kim, J.I., Lee, J., Choi, G.H. et al. Comparison of Surgical Resection and Radiofrequency Ablation in Elderly Patients with Hepatocellular Carcinoma. Dig Dis Sci 69, 1055–1067 (2024). https://doi.org/10.1007/s10620-023-08245-0

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