Prognostic impact of surgery and radiofrequency ablation on single nodular HCC ≤5 cm: Cohort study based on serum HCC markers

Background & Aims: Serological markers of hepatocellular carcinoma (HCC) indicate its invasiveness. We aimed to investigate whether the prognostic impact of surgical resection (SR) and radiofrequency thermal ablation (RFA) on patients with single nodular HCC <= 5 cm were different regarding positive conditions of the following three HCC markers: alpha-fetoprotein (AFP); lens culinaris agglutinin-reactive fraction of AFP; and des-gamma-carboxy prothrombin. Methods: This study reviewed 296 patients with single nodular HCC <= 5 cm with Child-Pugh grade A between 2001 and 2011 (SR, n = 136; RFA, n = 160). Based on positive conditions of previous HCC markers (defined as non-positive, single-positive, double-positive, and triple-positive), overall survival (OS) and prognostic factors were analyzed. Results: Five-year OS rates of SR and RFA among all patients were 70.1% and 69.8%, respectively (p = 0.14). However, when stratified by the positive conditions of three HCC markers, their rates of non-, single-, double-, and triple-positive patients were 60.6%, 78.2%, 54.2%, and 75.9% in the SR group, whereas rates were 83.3%, 75.7%, 62.2%, and 47.6% in the RFA group (p values between SR and RFA of each tumor marker condition were 0.45, 0.10, 0.77, and <0.01, respectively). Multivariate analyses showed that RFA itself became an independent prognostic factor in the triple-positive group, with an odds ratio of 1.78 (95% confidence interval, 1.16-2.72). Conclusions: Positive conditions of three HCC markers differently influenced survival rates of those who underwent SR and RFA when treating single nodular HCC <= 5 cm. RFA itself became an independent prognostic risk when all three HCC markers were positive. Preoperative evaluation of multiple HCC markers might become an index for selecting treatment modalities. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.