Stereotactic body radiotherapy versus hepatic resection for hepatocellular carcinoma (≤ 5 cm): a propensity score analysis

• Published in: Hepatology international Vol. 14; no. 5; pp. 788 - 797
• Main Authors: Sun, Jing, Wang, Quan, Hong, Zhi-Xian, Li, Wen-Gang, He, Wei-Ping, Zhang, Tao, Zhang, Ai-Min, Fan, Yu-Ze, Sun, Ying-Zhe, Zheng, Li, Duan, Xue-Zhang
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.09.2020; Springer Nature B.V
• Subjects: Cirrhosis; Colorectal Surgery; Complications; Hepatitis; Hepatitis B; Hepatocellular carcinoma; Hepatology; Liver cancer; Liver cirrhosis; Medical prognosis; Medicine; Medicine & Public Health; Original Article; Radiation; Radiation therapy; Surgery; Survival; Toxicity; Viruses; Hepatitis-related cirrhosis; Prognosis; Overall survival rates; HCC; HR; CK-SBRT; Hepatitis B virus; Hepatitis C virus; Platelet count; Progression-free survival rates
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-020-10088-0

Background CyberKnife stereotactic body radiation therapy (CK-SBRT) has been applied to hepatocellular carcinoma (HCC) patients for several years. The study aim was to compare the efficacy of hepatic resection (HR) and CK-SBRT in naive small hepatocellular carcinoma (sHCC) patients with hepatitis virus-related cirrhosis using a 5-year follow-up study. Materials and methods This retrospective cohort study included 317 naive sHCC patients (246 men and 71 women) with hepatitis B or C virus cirrhosis who were treated with HR ( n  = 195) or CK-SBRT ( n  = 122) from November 2011 to December 2015. Cumulative overall survival (OS) rates and progression-free survival (PFS) rates were calculated using Kaplan–Meier method. Results After the propensity score-matched analysis, 104 patients were selected from each group for further analysis. The 1-, 2-, 3-, and 5-year OS rates were 96.2%, 89.4%, 85.5% and 70.7% in the HR group and 93.3%, 89.4%, 83.7% and 71.0% in the CK-SBRT group, respectively. The 1-, 2-, 3-, and 5-year PFS rates were 78.8%, 64.3%, 56.4% and 47.3% in the HR group and 84.5%, 67.8%, 58.9% and 49.0% in the CK-SBRT group, respectively. No significant difference was found between the two groups in the OS and PFS rates (OS, p  = 0.673; PFS, p  = 0.350). No death occurred due to the toxicity or complications of HR or CK-SBRT. Conclusion CK-SBRT could be an effective alternative to HR for sHCC naive patients with hepatitis-related cirrhosis, especially if patients have higher CP scores and lower PLT counts. PLT counts should be factored into survival evaluation of HCC treatment.