Surgery benefits transplant-ineligible HCC patients more than less invasive options

Editor's Note

Liver resection provides a significant survival benefit over percutaneous radiofrequency ablation (PRFA) or transarterial chemoembolization (TACE) in patients with early multinodular hepatocellular carcinoma (HCC), according to findings published May 15 in JAMA Surgery. Thus, liver resection should be considered the first therapeutic option in patients with early multinodular HCC who are not eligible for transplant, researchers write, contradicting the 2022 Barcelona Clinic Liver Cancer algorithm that discourages liver resection (LR) for patients presenting with 2 or 3 nodules that are each 3 cm or smaller.

The retrospective analysis uses data from the HE.RC.O.LE.S register (n = 5331)  for LR patients and the the ITA.LI.CA database (n = 7056) for PRFA and TACE patients, with a total of 720 patients participating. Among the 296 in the LR group, 240 underwent PRF, and 184 underwent TACE. After matching-adjusted indirect comparison (MAIC), the group exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Additionally, competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE.