LAUSR

BACKGROUND Curative treatment for hepatocellular carcinoma (HCC) is limited to hepatic resection (HR), radiofrequency ablation, and liver transplantation, while the value of particle therapy (PT) as an initial treatment remains unclear. This study aimed to compare the outcomes of HR and PT for single HCC. STUDY DESIGN A total of 554 patients with single HCC without vascular invasion were enrolled from January 2000 to December 2015. Patients underwent either HR (n = 279) or PT (n = 275) as initial treatments. A one-to-one propensity score matching (PSM) analysis was performed to evaluate the overall survival (OS) and progression-free survival (PFS) after dividing patients according to liver function as assessed by the modified albumin-bilirubin (mALBI) grade. RESULTS The median OS (130 vs. 85 month, p = 0.001) and PFS (47 vs. 30 month, p = 0.004) of HR were also significantly better than that of PT in the PSM cohort with mALBI grade 1/2a (n = 145 per group). Meanwhile, in a PSM cohort with mALBI grade 2b/3 (n = 53 per group), there were no significant differences in median OS and PFS between HR and PT. CONCLUSION HR may be preferable as an initial treatment for patients with single HCC without vascular invasion, especially those with preserved liver function. PT can be an acceptable alternative to HR for patients without surgical indication and/or impaired liver function.