Zheng W, Lv P, Zhu Q, Zhang QL, Yin GG, Chen WG. Comparative analysis of curative efficacy and prognostic factors across treatment modalities for early-stage hepatocellular carcinoma (BCLC 0/A). World J Gastrointest Oncol 2026; 18(7): 119136 [DOI: 10.4251/wjgo.v18.i7.119136]
Corresponding Author of This Article
Wei-Gang Chen, MD, Department of Gastroenterology, The First Affiliated Hospital of Shihezi University, No. 107 North 2nd Road, Hongshan Sub-district, Shihezi 832000, Xinjiang Uygur Autonomous Region, China. 13579456959@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen Zheng, Qing-Lin Zhang, Gang-Gang Yin, Wei-Gang Chen, Department of Gastroenterology, The First Affiliated Hospital of Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China
Ping Lv, Qiang Zhu, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Co-first authors: Wen Zheng and Ping Lv.
Author contributions: Zheng W and Lv P contribute equally to this study as co-first authors; conception and design were performed by Zheng W, Lv P, Zhu Q and Chen WG; administrative support was performed by Zheng W, Lv P, Zhu Q, Zhang QLZ and Yin GG; provision of study materials or patients was performed by Zheng W, Lv P, Zhu Q, Zhang QL, Yin GG and Chen WG; collection and assembly of data were performed by Zheng W, Lv P, Zhu Q, Zhang QL and Yin GG; data analysis and interpretation were performed by Zheng W, Lv P, Zhu Q, Zhang QL and Yin GG; manuscript writing and final approval of manuscript were performed by all authors.
Institutional review board statement: The study was reviewed and approved by the Science and Technology Ethical Committee of the First Affiliated Hospital of Shihezi University (Approval No. KJX2022-073-01).
Informed consent statement: Informed consent was waived by given the retrospective study design.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Wei-Gang Chen, MD, Department of Gastroenterology, The First Affiliated Hospital of Shihezi University, No. 107 North 2nd Road, Hongshan Sub-district, Shihezi 832000, Xinjiang Uygur Autonomous Region, China. 13579456959@126.com
Received: January 23, 2026 Revised: February 12, 2026 Accepted: March 3, 2026 Published online: July 15, 2026 Processing time: 163 Days and 16.8 Hours
Abstract
BACKGROUND
While the prognostic impact of radiofrequency ablation (RFA) vs liver resection (LR) remains controversial for Barcelona Clinic Liver Cancer (BCLC) stage 0/A hepatocellular carcinoma (HCC).
AIM
To comparatively analyze prognostic outcomes across therapeutic approaches.
METHODS
We conducted a multicenter retrospective analysis of treatment-naïve HCC patients meeting BCLC stage 0/A criteria at the First Affiliated Hospital of Shihezi University and Shandong Provincial Hospital between January 2012 and December 2022, stratifying patients into three therapeutic cohorts: LR monotherapy (LR; n = 30), RFA alone (RFA; n = 40), and combined therapy (LR plus adjuvant treatment; n = 32), with primary endpoints of five-year overall survival (OS), progression-free survival (PFS), and median survival time analyzed using Kaplan-Meier (K-M) methodology.
RESULTS
A total of 102 patients with HCC were included, and they were followed up until December 31, 2023. The follow-up rate was 100%. Treatment modalities significantly impacted five-year OS (P = 0.03). Cox regression confirmed both LR [hazard ratio (HR) = 0.297; 95% confidence interval (CI): 0.104-0.848; P = 0.02] and combination therapy (HR = 0.331; 95%CI: 0.118-0.931; P = 0.04) significantly reduced mortality risk versus RFA. Furthermore, K-M analysis demonstrated significant differences in OS among the three treatment modalities (RFA, LR, and combined treatment; log-rank test, P = 0.02), and the LR group exhibited significantly improved 5-year OS compared to the RFA group (P = 0.047). Similarly, significant differences in PFS were observed among the three treatment modalities (log-rank test, P = 0.009), and both the LR group (P = 0.049) and combined therapy group (P = 0.033) exhibited significantly longer PFS compared to the RFA group.
CONCLUSION
We recommend LR as the first-line therapeutic option for early-stage HCC, while advocating active pursuit of combination therapy regimens for high-risk early-stage HCC patients to obtain comparable survival outcomes with LR alone.
Core Tip: Our findings support liver resection (LR) as the first-line preferred treatment modality for hepatocellular carcinoma (HCC) patients with Barcelona Clinic Liver Cancer 0/A stages. Simultaneously, we observed that combination therapy regimens achieve non-inferior overall survival and progression-free survival benefits compared to LR alone. Therefore, treatment-eligible early-stage HCC patients clinically indicated for combination therapy should actively pursue such regimens to attain similarly favorable prognostic outcomes.
