European Radiology

, Volume 28, Issue 9, pp 3651–3660 | Cite as

Combined percutaneous radiofrequency ablation and ethanol injection versus hepatic resection for 2.1–5.0 cm solitary hepatocellular carcinoma: a retrospective comparative multicentre study

  • Shuling Chen
  • Zhenwei Peng
  • Manxia Lin
  • Zebin Chen
  • Wenjie Hu
  • Xiaoyan Xie
  • LongZhong Liu
  • Guojun Qian
  • Baogang Peng
  • Bin Li
  • Ming Kuang



To compare combined percutaneous radiofrequency ablation and ethanol injection (RFA-PEI) with hepatic resection (HR) in the treatment of resectable solitary hepatocellular carcinoma (HCC) with 2.1–5.0 cm diameter.


From June 2009 to December 2015, 271 patients whom underwent RFA-PEI (n = 141) or HR (n = 130) in three centres were enrolled. The overall survival (OS) and recurrence-free survival (RFS) between groups were compared with Kaplan–Meier method and log-rank tests. Complications, hospital stay and cost were assessed.


The OS rates at 1, 3 and 5 years were 93.5%, 72.7%, 58.6% in RFA-PEI group and 82.3%, 57.5%, 51.8% in HR group (p = 0.021). The corresponding 1-, 3- and 5-year RFS rates were 65.8%, 41.3%, 34.3% in RFA-PEI group and 50.5%, 33.8%, 28.4% in HR group (p = 0.038). For patients with 2.1–3.0 cm tumours, the 1-, 3- and 5-year OS after RFA-PEI and HR were 98.0%, 82.3%, 74.2% and 89.4%, 65.1%, 61.9%, respectively (p = 0.024). The corresponding RFS were 79.6%, 54.7%, 45.1% in RFA-PEI group, and 57.6%, 43.9%, 31.7% in HR group, respectively (p = 0.020). RFA-PEI was superior to HR in major complication rates, length of hospital stay and cost (all p < 0.001).


RFA-PEI had a survival benefit over HR in the treatment of solitary HCCs, especially for those with 2.1–3.0 cm in diameter.

Key Points

• RFA-PEI provided superior survival to HR in solitary HCC with 2.1–5.0 cm in diameter.

• RFA-PEI is superior to HR in complications, length of hospital stay and cost.

• RFA-PEI might be an alternative treatment for solitary HCC within 5.0 cm in diameter.


Ablation techniques Ethanol Hepatectomy Carcinoma, hepatocellular Comparative study 



Barcelona clinic liver cancer


Contrast-enhanced computed tomography


Contrast-enhanced ultrasound


Eastern cooperative oncology group


Hepatocellular carcinoma


Hepatic resection


Local tumour progression


Microwave ablation


Overall survival


Percutaneous ethanol injection


Randomized controlled trial


Radiofrequency ablation


Recurrence-free survival


Transarterial chemoembolization



This study has received funding by the National Natural Science Foundation of China (No. 81272312; No. 81301842), Pearl River S&T Nova Program of Guangzhou, China (No. 2014J2200087) and Guangdong Medical Science and Technology Foundation (No. 20161192364982).

Compliance with ethical standards


The scientific guarantor of this publication is Ming Kuang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Bin Li) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• multicentre study

Supplementary material

330_2018_5371_MOESM1_ESM.docx (92 kb)
ESM 1 (DOCX 92 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Shuling Chen
    • 1
  • Zhenwei Peng
    • 2
    • 3
  • Manxia Lin
    • 1
  • Zebin Chen
    • 4
  • Wenjie Hu
    • 4
  • Xiaoyan Xie
    • 1
  • LongZhong Liu
    • 5
  • Guojun Qian
    • 6
  • Baogang Peng
    • 4
  • Bin Li
    • 3
  • Ming Kuang
    • 1
    • 4
  1. 1.Division of Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  2. 2.Department of OncologyThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  3. 3.Clinical Trial UnitThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  4. 4.Department of Liver SurgeryThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  5. 5.Department of UltrasoundSun Yat-sen University Cancer CenterGuangzhouChina
  6. 6.Department of Minimal Invasion TherapyThe Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical UniversityShanghaiChina

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