In two Japanese studies (SURF-RCT and SURF-Cohort) reported in the Journal of Clinical Oncology, Kawaguchi et al compared the outcomes of surgery vs radiofrequency ablation (RFA) in patients with small hepatocellular carcinoma (HCC).
Study Details
Two multicenter studies were performed, with enrollment between 2009 and 2015. In SURF-RCT, patients were randomly assigned to surgery (n = 150) or RFA (n = 152). In the prospective observational SURF-Cohort trial, eligible patients who declined randomization received surgery (n = 382) or RFA (n = 371). All patients had a largest HCC diameter of ≤ 3 cm and ≤ 3 HCC nodules. The primary endpoints were overall survival and recurrence-free survival.
Key Findings
In the SURF-RCT trial, 90% of patients had solitary HCC and approximately 65% had HCC diameter of ≤ 2.0 cm. Serious adverse effects occurred in 3.3% of the surgery group vs 0% of the RFA group. Overall survival at 5 years was 74.6% in the surgery group vs 70.4% in the RFA group (hazard ratio [HR] = 0.96, P = .84). Recurrence-free survival at 5 years was 42.9% in the surgery group vs 42.7% in the RFA group (HR = 0.90, P = .84). Among the 86 patients in the surgery group vs 95 in the RFA group with recurrence, 16.3% vs 8.4% underwent surgery and 58.1% vs 57.9% underwent RFA.
In the SURF-Cohort trial, an inverse probability of treatment weighting (IPTW) analysis was performed to address the significant imbalance in baseline factors between groups. On the IPTW analysis, no differences between the surgery group and the RFA group were observed in overall survival (5-year overall survival = 80.0% vs 79.0%; HR = 0.96, P =.77) or recurrence-free survival (5-year recurrence-free survival = 45.1% vs 38.7%; HR = 0.84, P = .08).
The investigators concluded: “The SURF trial did not demonstrate that surgery was superior to RFA for small HCC.”
Kiyoshi Hasegawa, MD, PhD, of the Graduate School of Medicine, The University of Tokyo, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Japanese Foundation for Multidisciplinary Treatment of Cancer and the Health and Labor Sciences Research Grant for Clinical Cancer Research. For full disclosures of all study authors, visit ascopubs.org.
