Radiofrequency ablation versus surgical resection of hepatocellular carcinoma: contemporary treatment trends and outcomes from the United States National Cancer Database

  • Johannes Uhlig
  • Cortlandt M. Sellers
  • Stacey M. Stein
  • Hyun S. KimEmail author



To compare utilization and effectiveness of radiofrequency ablation (RFA) and surgical resection for hepatocellular carcinoma (HCC).


The 2004–2015 United States National Cancer Database was queried for HCC patients treated by RFA and surgical resection. Patients were 1:1 propensity score matched. Duration of hospital stay, unplanned readmission rates, and overall survival (OS) were compared in the matched cohort via multivariable regression models.


Eighteen thousand two hundred ninety-six patients were included (RFA, n = 8211; surgical resection, n = 10,085). RFA was more likely in young male whites with high degree of hepatic fibrosis, high bilirubin levels, high INR, and multifocal HCC; resection was more likely in those with private insurance, high income, high cancer grade and stage, and larger HCC. RFA rates varied between 32.3% (East South Central) and 58.5% (New England). Post-treatment outcomes were superior for RFA versus resection regarding duration of hospital stay (median 1 vs. 5d, p < 0.001), 30-day unplanned hospital readmission rates (3.1% vs. 4.5%, p < 0.001), and 30-/90-day mortality (0% vs. 4.6%/8%, p < 0.001). Overall survival was comparable for RFA and resection for severe hepatic fibrosis/cirrhosis (5-year OS 37.3% vs. 39.4%, p = 0.07), for patients > 65 years old (5-year OS 21.9% vs. 26.5%, p = 0.47), and for HCC < 15 mm (5-year OS 49.7% vs. 52.3%, p = 0.78). OS in the full cohort was superior for surgical resection (5-year OS 29.9% vs. 45.7%, p < 0.01).


RFA for HCC shows substantial variation by geography, socioeconomic factors, liver function, and tumor extent. RFA offers superior post-treatment outcomes versus surgical resection and may be an alternative for older patients with cirrhosis and/or small HCC.

Key Points

• Duration of hospital stay, unplanned readmissions, and 30-/90-day mortality are lower for RFA versus surgical resection.

• RFA and surgical resection show similar survival in severe hepatic fibrosis.

• In HCC < 15 mm, RFA and surgical resection yield similar survival.


Hepatocellular carcinoma Ablation technique; operative surgical procedures Demographic factors Survival 



Charlson comorbidity index


Hepatocellular carcinoma


International normalized ratio


Interquartile range


National Cancer Database


Overall survival


Radiofrequency ablation



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Hyun S. Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Yale University internal review board due to analyses of anonymized NCDB data.

Ethical approval

The study was received prior approval by the Yale University internal review board.


• observational

Supplementary material

330_2018_5902_MOESM1_ESM.docx (409 kb)
ESM 1 (DOCX 409 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Johannes Uhlig
    • 1
    • 2
  • Cortlandt M. Sellers
    • 1
  • Stacey M. Stein
    • 3
    • 4
  • Hyun S. Kim
    • 1
    • 3
    • 4
    Email author
  1. 1.Division of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGöttingenGermany
  3. 3.Division of Medical Oncology, Department of MedicineYale School of MedicineNew HavenUSA
  4. 4.Yale Cancer CenterYale School of MedicineNew HavenUSA

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