Stereotactic body radiotherapy versus laparoscopic liver resection for single hepatocellular carcinoma ≤ 5 cm: a retrospective, multicenter, cohort study

Abstract Objectives To compare the efficacy of stereotactic body radiotherapy (SBRT) and laparoscopic liver resection (LLR) for patients with single hepatocellular carcinoma (HCC) ≤ 5 cm. Materials and methods This retrospective cohort study included 383 patients from four hospitals between January 2017 and December 2019, with 268 patients in the LLR group and 115 in the SBRT group. Propensity score matching (PSM) and subgroup analyses were performed. Results After PSM adjustment, 98 patients were selected from each group for further analysis. The 1-, 3- and 5-year OS rates were 94.9%, 88.8%, and 85.7% in the LLR group and 94.9%, 74.5% and 67.3% in the SBRT group, respectively (p = 0.005). The 1-, 3- and 5-year RFS rates were 86.7%, 71.4%, and 70.4% in the LLR group and 83.7%, 61.2% and 53.1% in the SBRT group, respectively (p = 0.011). LLR provided better OS and RFS than SBRT. However, SBRT resulted in comparable OS and RFS times to LLR for tumors ≤ 3 cm ((p = 0.158; p = 0.418)), and perivascular tumors (p = 0.082; p = 0.166). Conclusion LLR is the first choice for treating single HCC ≤ 5 cm, while SBRT offers advantages in treating small and perivascular lesions.