Surgery Versus Ablation for Hepatocellular Carcinoma: A Randomized Controlled Trial (SURF‑RCT Trial) and a Nonrandomized Prospective Observational Trial (SURF‑Cohort Trial)

Rákkutatás · Hepatocellular carcinoma

Surgery is not superior to radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC).

PURPOSE: We conducted a randomized controlled trial (SURF‑RCT) to evaluate the efficacy of surgery versus radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Simultaneously, eligible patients who declined random assignment were enrolled in a nonrandomized prospective observational trial (SURF‑Cohort). We aimed to report the final analyses of overall survival (OS) and updated recurrence‑free survival (RFS) in the SURF‑RCT and SURF‑Cohort trials. METHODS: The trials were conducted at 49 institutions in Japan. Patients with a largest HCC diameter of ≥3 cm and ≥3 HCC nodules were eligible. The co‑primary endpoints were RFS and OS. RESULTS: During 2009‑2015, 1,094 patients were registered. After excluding ineligible patients, 302 and 753 patients were included in the SURF‑RCT (surgery, n = 150; RFA, n = 152) and SURF‑Cohort trial (surgery, n = 382; RFA, n = 371), respectively. In the SURF‑RCT, 90% of patients had solitary HCC, and approximately 65% had an HCC diameter of ≥2.0 cm. Serious adverse effects occurred in 3.3% of the surgery group and none in the RFA group. The 5‑year OS was 74.6% in the surgery group and 70.4% in the RFA group (hazard ratio = 0.96; adjusted P = 0.84). The 5‑year RFS was 42.9% in the surgery group and 42.7% in the RFA group (HR = 0.90; adjusted P = 0.84). In the surgery group, 86 patients had recurrences; 14 (16.3%) underwent surgery, and 50 (58.1%) underwent RFA. In the RFA group, 95 patients had recurrences; 8 (8.4%) underwent surgery, and 55 (57.9%) underwent RFA. In the SURF‑Cohort trial, baseline factors were imbalanced between groups. After adjusting with the inverse probability of treatment weighting analysis, OS and RFS showed no significant difference (P = 0.77 and P = 0.08). CONCLUSION: The SURF trial did not demonstrate that surgery was superior to RFA for small HCC.

The findings suggest that for small hepatocellular carcinoma, radiofrequency ablation provides overall survival and recurrence‑free survival comparable to surgery, potentially influencing treatment choice towards a less invasive approach.

Bizonyítékszint: Számítógépes vagy elméleti. Modellből vagy adatbányászatból származó jel.

Eredeti forrás

Kapcsolódó jelek