Quality of life after surgical resection compared with radiofrequency ablation for small hepatocellular carcinomas

Background: Health-related quality of life (HRQL) is an important outcome measure in studies of cancer therapy. This study aimed to investigate HRQL and survival in patients with small hepatocellular carcinoma (HCC) treated with either surgical resection or percutaneous radiofrequency ablation (RFA). Methods: Between January 2006 and June 2009, patients with newly diagnosed solitary, small (3 cm or less) HCC were invited to participate in this non-randomized prospective parallel cohort study. The Functional Assessment of Cancer Therapy - Hepatobiliary (FACT-Hep) instrument was used for assessing HRQL. HRQL and survival were compared between the two treatment groups. Results: A total of 389 patients were enrolled. Questionnaires were completed fully by 99.7 per cent of invited participants (388 of 389) at baseline, 98.7 per cent (383 of 388) at 3 months, 99.0 per cent (379 of 383) at 6 months, 98 4 per cent (365 of 371) at 1 year, 96 6 per cent (336 of 348) at 2 years and 95.1 per cent (289 of 304) at 3 years. There were no significant differences in disease-free and overall survival between the two groups. Patients treated with percutaneous RFA had significantly better HRQL total scores after 3, 6, 12, 24 and 36 months than those who had surgical resection (P < 0.001, P < 0.001, P = 0.001, P = 0.003 and P = 0.025 respectively). On multivariable analysis, the presence of concomitant disease, cirrhosis and surgical resection were significant risk factors associated with a worse HRQL score after treatment. Conclusion: Percutaneous RFA produced better post-treatment HRQL than surgical resection for patients with solitary small (no more than 3 cm) HCC.