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Comparison of percutaneous ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma

Objectives: The objectives of the study were to compare overall survival (OS) and disease-free survival (DFS) following percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). Material and Methods: This is a single-institution retrospective cohort study. Patients who underwent PEI or RFA between January 1, 2008, and December 31, 2009, for HCC were included in this study. Patient data were collected from the time of their procedure to October 31, 2017. One hundred and twenty-five patients received RFA or PEI during the study period. Twenty-one patients were excluded from the study because they received RFA or PEI for non-HCC cancers, leaving 47 patients in the PEI group and 57 patients in the RFA group. Primary endpoints were OS and DFS following PEI or RFA. Secondary endpoints included rates of secondary intervention and liver transplant. Statistical analysis was performed using SAS Enterprise Guide 7.13 (Cary, NC). Results: One-hundred and four patients are included in this study: 47 in the PEI group and 57 in the RFA group. At 9-year follow-up, the OS rates were not statistically significant between the RFA and PEI groups, 23.9% and 22.8%, respectively (P = 0.25). However, at earlier time points, there was a statistically significant difference between the two groups with higher rates of OS in the RFA group (Wilcoxon, P = 0.04). Patients in the RFA group had OS rates of 56.1%, 43.9%, and 35.1% at 3, 5, and 7 years, respectively, compared to the PEI rates of 36.4%, 27.3%, and 25.1% at those same time points (P = 0.0035). The RFA group had 29% decreased risk of death at 5 years compared to PEI based on the Cox proportional hazards model. The DFS was not significantly different between the two groups at all-time points (P = 0.96). The PEI group showed DFS rates of 32.4% at 3 years and 29.5% at 5, 7, and 9 years. The RFA group demonstrated DFS rates of 32.2% at 3 years, 26.3% at 5 years, 23.4% at 7 years, and 19.5% at 9 years. Conclusion: RFA and PEI have comparable 9-year OS and DFS in patients with HCC. However, at earlier time points, RFA has superior OS.