Purpose Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group ( P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.

中文翻译：

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非手术治疗患者局部肝细胞癌的射频消融与立体定向放射治疗：美国国家癌症数据库分析

目的 缺乏指导选择最佳局部消融疗法治疗局部肝细胞癌 (HCC) 的数据。由于这些治疗方式的前瞻性比较数据有限，我们旨在通过使用国家癌症数据库来比较射频消融 (RFA) 与立体定向放疗 (SBRT) 的有效性。方法 我们进行了一项观察性研究，以比较 RFA 与 SBRT 在非手术治疗的 I 或 II 期 HCC 患者中的有效性。通过使用基于患者、设施和肿瘤水平特征的倾向评分加权和倾向评分匹配分析来比较总生存期。进行敏感性分析以评估严重纤维化/肝硬化的影响。此外，我们进行了探索性分析，以确定 RFA 和 SBRT 在临床相关患者亚群中的有效性。结果 总体而言，分别有 3,684 (92.6%) 和 296 (7.4%) 名非手术治疗的 I 期或 II 期 HCC 患者接受了 RFA 或 SBRT。倾向匹配后，RFA 组的 5 年总生存率为 29.8%（95% CI，24.5% 至 35.3%），而 SBRT 组为 19.3%（95% CI，13.5% 至 25.9%）（ P < .001 ）。逆概率加权分析产生了类似的结果。RFA 的益处在所有检查的亚组中是一致的，并且对严重纤维化/肝硬化的影响是稳健的。结论 我们的研究表明，对于非手术治疗的 I 期或 II 期 HCC 患者，RFA 治疗与 SBRT 相比具有更高的生存率。