Irreversible Electroporation vs. Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma: A Propensity Score Analysis.

RATIONALE AND OBJECTIVES

The therapeutic efficacy of irreversible electroporation (IRE) for treating subcapsular hepatocellular carcinoma (HCC) remains under-explored. The current study aimed to compare IRE and radiofrequency ablation (RFA) outcomes in an HCC patient group.

MATERIALS AND METHODS

In this retrospective cohort study, we analyzed 213 patients with subcapsular HCC who met the Milan criteria and underwent either IRE (n = 80) or RFA (n = 133). We assessed local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications rates, using inverse probability of treatment weighting (IPTW).

RESULTS

After a median follow-up of 22 months, patients in the IRE group showed significantly lower LTP rates (1-year: 6.2% [95% CI: 2.1-14.0%], 2-year: 8.8% [95% CI: 3.6-17.2%] vs. RFA 18.0% [95% CI: 11.9-25.6%], 21.1% [95% CI: 14.5-29.0%]; P = 0.008) and higher RFS rates (1-year: 75.0% [95% CI: 64.1-84.0%], 2-year: 67.5% [95% CI: 56.1-77.6%] vs. RFA 60.9% [95% CI: 52.1-69.2%], 51.9% [95% CI: 43.1-60.6%]; P = 0.003). However, 2-year OS remained comparable across groups (IRE 100% [95.5-100%] vs. RFA 99.1% [95.9-100%]; P = 0.990). IPTW-adjusted analyses confirmed these findings. We determined that treatment modality was an independent influencing factor for LTP (RFA vs. IRE HR [95% CI]: 2.46 [1.05, 5.74], P = 0.037) and RFS (RFA vs. IRE HR [95% CI]: 1.62 [1.01, 2.61], P = 0.046). However, the complication rate (6.3% vs. 9.8%) and median hospital stay (3 vs. 3 days) were similar across groups (both P > 0.05).

CONCLUSION

For patients with subcapsular HCC meeting the Milan criteria, IRE demonstrated significantly improved LTP and RFS compared to RFA. These results may suggest that IRE is a viable therapeutic alternative for this tumor subtype.