Survival outcome with liver resection versus percutaneous radiofrequency ablation in patients with 2–3 cm single hepatocellular carcinoma

Previous studies have yielded inconclusive results regarding the efficacy of percutaneous radiofrequency ablation (RFA) versus liver resection (LR) in patients with early-stage hepatocellular carcinoma (HCC), specifically those classified as Barcelona Clinic Liver Cancer (BCLC) stage A with a single 2.0–3.0 cm tumor. To date, only one study has applied propensity score matching (PSM) to investigate this comparison; however, its findings are limited by the lack of data on liver function reserve and BCLC staging, which incorporates performance status (PS) as a key component. Between 2011 and 2021, we enrolled 378 patients who underwent LR and 238 patients who underwent RFA for BCLC stage A HCC with a single 2.0–3.0 cm tumor and Child–Pugh class A liver function. PSM was performed based on age, sex, alpha-fetoprotein level, Charlson Comorbidity Index, hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV) status, receipt of antiviral therapy, and clinically significant portal hypertension. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using the Kaplan–Meier method. Before PSM, LR was associated with significantly better survival outcomes compared to RFA (five-year OS: 83 % vs. 61 %, p < 0.001; five-year RFS: 62 % vs. 30 %, p < 0.001). After PSM, LR continued to demonstrate a significant survival advantage (five-year OS: 80 % vs. 60 %, p = 0.001; five-year RFS: 58 % vs. 32 %, p < 0.001). LR provides a superior survival benefit compared to RFA in patients with early-stage HCC presenting with a single 2.0–3.0 cm tumor. • After PSM, resection demonstrate a significant survival advantage compared with ablation for those classified as BCLC stage A with a single 2.0–3.0 cm tumor.