Resection versus microwave ablation following conversion therapy for unresectable hepatocellular carcinoma.

Résumé

BACKGROUND AIMS: Conversion therapy may transform some unresectable hepatocellular carcinomas (uHCCs) into curable ones, but data remained limited comparing subsequent curative-intent treatment options. Therefore, we aimed to compare the efficacy and safety of surgical resection (SR) and microwave ablation (MWA) following conversion for initially uHCC.METHODS: From June 2008 to October 2022, this multi-center retrospective study included 1035 consecutive patients with treatment-naive BCLC A/B beyond-Milan uHCC receiving curative-intent SR or MWA after successful conversion from 15 tertiary-care hospitals. For the propensity score-matched cohort, overall survival (OS), recurrence-free survival (RFS), and treatment-related complications were compared; a risk-stratification Conversion-Ablation or REsection (CARE) score was developed for OS and externally compared against major prognostic models.RESULTS: After matching (421 patients in each treatment group), SR was associated with similar RFS (p = 0.167), less beyond-Milan recurrence (p = 0.003), and longer OS (p