Propensity Score Matching Between Radiofrequency Ablation And Laparoscopic Hepatectomy In The Treatment Of Single Hepatocellular Carcinoma Less Than 5 Cm In Diameter

Objective: To compare the efficacy of radiofrequency ablation and laparoscopic hepatectomy in the treatment of single liver cancer with a diameter of less than 5 cm,and to explore the clinical value of the two.Methods: Data of 1180 patients with primary hepatocellular carcinoma admitted to the Department of Hepatobiliary Surgery of Jiangxi Provincial People’s Hospital from June 2014 to June 2017 were included,and a total of 210 patients met the research criteria.Propensity score matching(PSM)was used to eliminate differences in baseline data.After 1:1 matching,106 patients were enrolled in the study,including 53 patients in the radiofrequency ablation group and 53 patients in the laparoscopic hepatectomy group.The operative time,intraoperative blood loss,intraoperative blood transfusion rate,postoperative complications,length of hospital stay,total cost of hospital stay and long-term survival benefit were compared between the two groups.Results: Before PSM matching,9 items of baseline data were unevenly distributed in the two groups,including age,platelet,alanine transaminase,aspartate transaminase,albumin,tumor size,location,liver function grade,and cirrhosis(P < 0.05).After PSM matching,106 patients were reenrolled in the study(53 matched pairs)and the general data of the two groups were comparable without showing statistical differences.(P > 0.05).In the radiofrequency ablation group,the operative time was shorter,the intraoperative blood loss was less,the postoperative hospital stay was shorter,and the total hospital cost was less,with statistical differences(P < 0.05).There was no intraoperative blood transfusion in the radiofrequency ablation group and intraoperative blood transfusion in 3 patients in the laparoscopic hepatectomy group,and there was no statistical difference(P = 0.241).Postoperative complications in the radiofrequency ablation group(13 cases)and laparoscopic hepatectomy group(23 cases)were statistically significant(P = 0.04).There was no postoperative death in the two groups.34 patients(64.2%)in the radiofrequency ablation group and 24 patients(45.3%)in the laparoscopic hepatectomy group relapsed.Twelve patients(22.6%)in the radiofrequency ablation group and four(7.5%)in the laparoscopic hepatectomy group died.The RFS of 1,2 and 3 years after radiofrequency ablation were 56.6%,47.2% and 35.8%.In the laparoscopic hepatectomy group,the RFS at 1,2 and 3 years were 86.0%,69.8% and 54.7%(P = 0.024).The OS of 1,2 and 3 years after radiofrequency ablation was 98.1%,86.8% and 77.4%.In the laparoscopic hepatectomy group,the postoperative OS at 1,2 and 3 years were 98.1%,96.2% and 92.5%(P = 0.031).In the subgroup with tumor diameter less than 3 cm,the RFS of the radiofrequency ablation group(N=34)was 61.8%,52.9% and 44.1% at 1,2 and 3 years after surgery.In the laparoscopic hepatectomy group(N=29),the RFS at 1,2 and 3 years after operation were 79.3%,69.0% and 62.1%(P = 0.144).In the radiofrequency ablation group(N=34),the postoperative OS at 1,2 and 3 years were 100%,91.2% and 85.3%.In the laparoscopic hepatectomy group(N=29),the postoperative OS at 1,2 and 3 years were 100%,100% and 96.6%(P = 0.132).In the subgroup with tumor diameter of 3-5 cm,the RFS of the radiofrequency ablation group(N=19)was 47.4%,36.8% and 21.1% at 1,2 and 3 years after surgery.In the laparoscopic hepatectomy group(N=24),the RFS at 1,2 and 3 years after surgery were 83.3%,70.8% and 45.8%(P = 0.024).In the frequent ablation group(N=19),the OS of 1,2 and 3 years after ablation were 94.7%,78.9% and 63.2%.In the laparoscopic hepatectomy group(N=24),the postoperative OS at 1,2 and 3 years were 95.8%,91.7% and 87.5%(P = 0.070).The tumor was located in the central hepatic subgroup.In the radiofrequency ablation group(N=38),the RFS at 1,2 and 3 years after surgery were 63.2%,52.6% and 42.1%.In the laparoscopic hepatectomy group(N=31),the RFS at 1,2 and 3 years after surgery were 87.1%,74.2% and 58.1%(P = 0.117).In the radiofrequency ablation group(N=38),the OS at 1,2 and 3 years after surgery were 100%,94.7% and 89.5%.In the laparoscopic hepatectomy group(N=31),the postoperative OS at 1,2 and 3 years were 96.8%,93.5% and 90.3%(P = 0.936).The tumor was located in the non-central hepatic subgroup.The RFS of the radiofrequency ablation group(N=15)was 40.0%,33.3%,20.0% at 1,2,and 3 years after surgery.In the laparoscopic hepatectomy group(N=22),the RFS at 1,2 and 3 years after operation were 72.7%,63.6% and 50.0%(P = 0.041).In the radiofrequency ablation group(N=15),the postoperative OS at 1,2 and 3 years were 93.3%,66.7% and 46.7%.In the laparoscopic hepatectomy group(N=22),the postoperative OS at 1,2 and 3 years were 100%,100% and 95.5%(P < 0.001).Conclusion: Radiofrequency ablation can effectively shorten the operative time,control intraoperative blood loss,reduce postoperative adverse events and reduce hospitalization costs.In the treatment of liver tumors less than 3 cm,it can achieve the same survival benefits as laparoscopic hepatectomy,and can be used as a treatment option superior to surgical resection.When the tumor diameter was 3-5 cm,the relapse-free survival rate was significantly reduced with radiofrequency ablation,and laparoscopic hepatectomy was preferred for overall survival benefit.At the same time,the location of the tumor is also one of the important factors affecting the treatment.Radiofrequency ablation is preferred when the tumor is located in liver segments IV,V,and VIII,and laparoscopic hepatectomy is more suitable when the tumor is located in liver segments II,III,VI,and VII.