Safety and Efficacy of Radiofrequency Ablation for Solitary Hepatocellular Carcinoma (3–5 cm): a Propensity Score Matching Cohort Study

  • Qing-wang Ye
  • Shu-jie Pang
  • Ning Yang
  • Hai-bin Zhang
  • Yong Fu
  • Bin LinEmail author
  • Guang-shun YangEmail author



We aim to investigate the safety and efficacy of radiofrequency ablation in the treatment of solitary hepatocellular carcinoma (3–5 cm) in comparison with surgical resection.


Included in this study were 388 patients with primary and solitary hepatocellular carcinoma, of whom 196 patients underwent surgical resection and the other 192 patients received radiofrequency ablation. Clinicopathological characteristics, prognosis, post-treatment complications, hospital stay, and financial expenditures between the two groups were compared retrospectively.


The result of propensity score matching and subgroup analysis showed that the 1-, 3-, and 5-year overall survival and disease-free survival were comparable in patients with tumors of 3–4 cm in diameter between surgical resection and radiofrequency ablation groups. However, when the tumor size exceeded 4 cm in diameter, surgical resection exhibited a superior long-term prognosis compared with radiofrequency ablation. Nevertheless, hepatectomy was associated with high occurrences of postoperative complications, long hospital stay, and high hospitalization cost as compared with radiofrequency ablation. Further analysis of the relationship between tumor size and pathological features of hepatocellular carcinoma showed that tumors larger than 4 cm were positively correlated with a high rate of microvascular invasion and satellite nodule formation.


For solitary hepatocellular carcinoma of 3–4 cm in diameter, radiofrequency ablation could achieve a comparable prognosis with a low incidence of post-treatment complications and low hospitalization costs, while surgical resection is recommended for solitary hepatocellular carcinoma tumors of 4–5 cm in diameter when long-term prognosis is considered.


Hepatocellular carcinoma Radiofrequency ablation Prognosis Hepatectomy 



Thanks for Dr. Xu Lin’s help (an intervention radiologist) in the description of RFA.


Guang-shun Yang, Qing-wang Ye, and Shu-jie Pang designed the project. Qing-wang Ye and Shu-jie Pang wrote the manuscript with Guang-shun Yang. Guang-shun Yang and Lin Bin provided revisions of the manuscript; Yang Ning, Hai-bin Zhang, Fu Yong, and Guang-shunYang collected and assembled the data; Qing-wang Ye, Shu-jie Pang, Lin Bin, and Guang-shun Yang analyzed the data and interpreted results; and all authors have given their final approval for the manuscript.

Financial Support

This study was supported by the General Program of Shanghai Municipal Commission of Health and Family Planning (No. 201440445) and the National Nature Science Foundation of China (No. 81372355).

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

This study complied with the ethical guidelines of the Declaration of Helsinki and was approved by our Ethics Committee of the hospital. Informed consent was obtained from all patients before treatment for their data to be used in this study.

Conflict of Interest

The authors declare that there are no competing interests.

Supplementary material

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Flow-diagram for screening of patients enrolled in this study (PNG 255 kb)

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High resolution image (TIF 2625 kb)
11605_2019_4229_MOESM2_ESM.docx (22 kb)
ESM 2 (DOCX 22 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Hepatic SurgerySuqian People’s Hospital of Nanjing Drum-Tower Hospital GroupSuqianChina

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