Microwave Ablation Versus Surgical Resection for Small (≤3 cm) Hepatocellular Carcinoma in Older Patients: A Propensity Score Matching Analysis.

Abstract

Objective: To compare the efficacy of microwave ablation (MWA) and surgical resection (SR) for small (≤3 cm) hepatocellular carcinoma (HCC) in older patients.

Materials and methods: This retrospective study initially enrolled 319 patients who were aged ≥65 years, had a single HCC ≤3 cm, and had Child-Pugh class A or B. Of these, 108 received MWA and 211 received SR. Overall survival (OS), disease-free survival (DFS), local tumor progression (LTP), complications, and postoperative hospital stay were compared between the groups. Hazard ratios (HRs) were estimated using the SR group as reference. Propensity score matching (PSM) was used to minimize confounding biases.

Results: After PSM, 80 patients each were included in the MWA and SR groups. There were no statistically significant differences in the 1-, 3-, and 5-year OS rates (MWA: 96.2%, 80.3%, and 55.4%, respectively; SR: 91.3%, 81.4%, and 64.8%, respectively; HR = 1.06; 95% confidence interval [CI], 0.61-1.85; P = 0.839) and DFS rates (MWA: 72.4%, 43.2%, and 26.4%, respectively; SR: 78.8%, 51.2%, and 38.0%, respectively; HR = 1.27; 95% CI, 0.84-1.90; P = 0.247) between the MWA and SR groups. MWA was associated with a higher LTP rate (HR = 2.96; 95% CI, 1.21-7.28; P = 0.028). Additionally, older patients in the MWA group had fewer complications (52.5% vs. 97.5%, P < 0.001) and shorter postoperative hospital stay (3 days vs. 6 days, P < 0.001) than those in the SR group.

Conclusion: In older patients with a single HCC ≤3 cm, MWA was superior to SR in terms of complications and postoperative hospital stay, and there was no significant difference in the 5-year OS and DFS outcomes. Therefore, MWA may be an alternative curative treatment for such patients.