Clinical Usefulness of Surgical Resection Including the Complementary Use of Radiofrequency Ablation for Intermediate-Stage Hepatocellular Carcinoma

SIMPLE SUMMARY: Transarterial chemoembolizaion or systemic therapy are recommended for intermediate-stage hepatocellular carcinoma (HCC), but the curative potentials are not high. This study aimed to elucidate the clinical usefulness of surgical resection (SR) including the complementary use of radio frequency ablation (RFA) for intermediate-HCC. Forty-five were treated with SR only and 25 were treated with SR and RFA (Comb). There were no significant differences between them in regard to RFS (median 17.7 months vs. 13.1 months, p = 0.36), OS (66.5 months vs. 72.0 months, p = 0.57). An acceptable five-year cumulative survival rate was obtained in both groups (54% vs. 64%). This retrospective study found no significant differences for RFS or OS between the present SR and Comb groups with intermediate-HCC. ABSTRACT: Background/Aim: For intermediate-stage hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC]-B) cases, transarterial chemoembolization (TACE) is recognized as the standard treatment, while systemic therapy is recommended for TACE-unsuitable HCC. However, because the curative potential is not high, this study was conducted to elucidate the potential outcomes of surgical resection (SR) for BCLC-B HCC cases. Materials/Methods: From January 2000 to July 2022, 70 patients with BCLC-B HCC treated with surgery as the initial treatment were enrolled (median age 67.5 years, beyond up-to-7 criteria 44). Forty-five were treated with SR only (SR group), while twenty-five underwent that with complemental radiofrequency ablation (RFA) (Comb group). Recurrence-free survival (RFS) and overall survival (OS) were retrospectively evaluated in both groups. Results: The median albumin–bilirubin (ALBI) score was better in the SR as compared with the Comb group (−2.74 vs. −2.52, p = 0.02), while there were no significant differences between them for median RFS (17.7 vs. 13.1 months; p = 0.70) or median OS (66.6 vs. 72.0 months p = 0.54). As for those beyond up-to-7 criteria, there were no significant differences for median RFS (18.2 vs. 13.0 months; p = 0.36) or median OS (66.5 vs. 72.0 months; p = 0.57). An acceptable five-year cumulative survival rate (>50%) was obtained in both groups (54% vs. 64%). Conclusion: This retrospective study found no significant differences for RFS or OS between the present SR and Comb groups with BCLC-B HCC. When possible to perform, the outcome of SR for BCLC-B is favorable, with a five-year survival rate greater than 50%.