Surgery versus external beam radiation therapy for AJCC stage I hepatocellular carcinoma

To compare the survival of American Joint Committee on Cancer (AJCC) stage I hepatocellular carcinoma (HCC) treated with surgery versus external beam radiation therapy (EBRT).Surveillance, Epidemiology, and End Results (SEER) database was used to identify the patients diagnosed with HCC between 2004 and 2013. Overall survival (OS) and liver-specific survival (LSS) were compared between patients treated with surgery and EBRT. A 1:1 propensity score matching (PSM) analysis was employed by matching age, sex, and race.Among the 1553 patients with HCC ≤2cm, there was no significant difference in OS (p=0.605, before PSM; p=0.891, after PSM) and LSS (p=0.281, before PSM; p=0.346, after PSM) between patients treated with surgery and EBRT. Among the 1752 patients with HCC2cm and ≤3cm, patients treated with surgery had significantly better OS (p=0.001) than those treated with EBRT, but statistically similar LSS (p=0.072) before PSM; however, there was no significant difference in OS (p=0.139) and LSS (p=0.722) between patients treated with surgery and EBRT after PSM. Additionally, 1157, 723, and 1331 patients had HCC3cm and ≤4cm, HCC4cm and ≤5cm, and HCC5cm, respectively; among them, patients treated with surgery had significantly better OS and LSS than those treated with EBRT regardless of PSM.At the AJCC stage I, the survival after EBRT might be comparable to that after surgery for HCC ≤3cm, but the survival after EBRT was inferior to that after surgery for HCC3cm.