Comparative Outcomes of Surgery and Contemporary Interventional Radiology Therapies for Early-Stage Hepatocellular Carcinoma: A National Cancer Database Propensity-Weighted Analysis

Monday, April 13, 2026

3:00 PM - 3:09 PM ET

Location: 701B

Presenting Author(s)

Talha Khan

Medical Student
UNC School of Medicine, United States

Author/Co-author(s)

MX

Minzhi Xing, MD, MPH

Clinical Associate Professor
University of North Carolina - Chapel Hill, United States
AT

Alexander K. Tanas (he/him/his)

Medical Student
UNC School of Medicine, United States
TB

Thad Benefield, MS

Statistician
UNC Chapel Hill, United States
Alex Villalobos, MD

Assistant Professor
University of North Carolina - Chapel Hill, United States
DM

David Mauro, MD

Associate Professor
University of North Carolina, United States
Hyeon Yu, MD, FSIR (he/him/his)

Professor
UNC School of Medicine, United States
BH

Bryan Harris, MD

Resident
UNC Chapel Hill, United States
Nima Kokabi, MD

Associate Professor of Radiology
University of North Carolina - Chapel Hill, United States

Purpose: Although surgical resection is considered a curative option for small hepatocellular carcinoma (HCC), only about 20–30% of patients are eligible, with most ineligible due to comorbidities or inadequate liver reserve. This study evaluated outcomes of minimally invasive locoregional therapies (LRT’s) compared with surgery in early-stage HCC using a national cancer registry.

Materials and Methods: The 2022 NCDB Participant User File was queried for adult patients with AJCC stage I HCC, tumor size ≤40 mm, and no metastases. Eligible patients (n=9,084) were stratified by initial treatment: surgical resection (transplants excluded), thermal ablation, Stereotactic Body Radiation Therapy (SBRT), Trans-arterial radioembolization (TARE), or Trans-arterial chemoembolization (TACE). Inverse probability of treatment weighting (IPTW) was applied using demographic, clinical, and tumor covariates to match cohorts. Standardized mean differences confirmed covariate balance. Kaplan–Meier analysis estimated overall survival (OS), and Cox proportional hazards models evaluated relative risk of death.

Results: After IPTW adjustment, surgery demonstrated the most favorable outcomes (1-, 3-, and 5-year OS: 95.3%, 88.7%, 79.4%). Among LRT’s, ablation and TARE yielded superior survival compared with SBRT and TACE. Median OS was 62.6 months for ablation, 59.3 months for TARE, 45.3 months for SBRT, and 40.3 months for TACE, not reached for surgery. On Cox regression, ablation (HR 2.91, 95% CI 1.89–4.50), TARE (HR 3.32, 95% CI 2.13–5.18), SBRT (HR 3.840, 95% CI 2.39–6.19), and TACE (HR 4.45, 95% CI 2.87–6.90) were all associated with significantly lower survival than surgery (p< 0.0001). Among LRT’s, TACE (HR 1.53, 95% CI 1.36–1.72) and SBRT (HR 1.32, 95% CI 1.06–1.65) had increased mortality relative to ablation, while survival was not different between ablation and TARE (HR 0.88, 95% CI 0.77–1.00).

Conclusion: While surgery remains the benchmark for small HCC, most patients are not surgical candidates. Among minimally invasive LRT’s, ablation and TARE provided the most favorable long-term survival and represent effective alternatives when surgery is not feasible.