Radiofrequency ablation versus open hepatic resection for elderly patients (> 65 years) with very early or early hepatocellular carcinoma

BACKGROUND This study retrospectively compared the safety and efficacy of percutaneous radiofrequency ablation (RFA) with open hepatic resection (HR) in elderly patients (age > 65 years) with very early or early hepatocellular carcinoma (HCC). METHODS Elderly patients (n = 180) with very early or early HCC were studied. This study was approved by the Ethics Committee of the Cancer Center of Sun Yat‐Sen University, Guangzhou, China. Written informed consent was obtained from each patient before treatment. As an initial treatment, 89 patients were treated by RFA and 91 patients by HR. The survival curves were constructed by the Kaplan‐Meier method and compared by log‐rank test. RESULTS The 1‐, 3‐, and 5‐year overall survivals were 93.2%, 71.1%, and 55.2% for the RFA group and 88.8%, 62.8%, and 51.9% for the HR group, respectively (P = .305). The corresponding recurrence‐free survivals for these 2 groups were 84.1%, 62.7%, and 35.5% and 76.7%, 39.3%, and 33.1%, respectively (P = .035). On subgroup analysis for tumor ≤ 3 cm, the 1‐, 3‐, and 5‐year overall survivals were 94.2%, 82.6%, and 67.5% for the RFA group and 90.1%, 65.0%, and 55.1% for the HR group, respectively (P = .038). The corresponding recurrence‐free survivals for the 2 groups were 85.5%, 69.1%, and 40.7%, and 82.2%, 40.1%, and 31.8%, respectively (P = .049). For tumor > 3 cm, there was no significant difference between these 2 groups for overall survivals and recurrence‐free survivals (P = .543, P = .356, respectively). A multivariate regression analysis showed that treatment type was the only significant prognostic factor for recurrence‐free survival (P = .039). CONCLUSIONS There was no difference between the HR and RFA groups for overall survival, but RFA had better efficacy than HR for elderly patients with HCC ≤ 3 cm. Cancer 2013;119:3812–3820. © 2013 American Cancer Society. For elderly patients with hepatocellular carcinoma, radiofrequency ablation might be a better treatment than hepatic resection because of its safety, efficacy, and short hospital stay. Elderly patients with hepatocellular carcinoma ≤ 3 cm in size may be the best candidates to receive radiofrequency ablation.