Irreversible electroporation versus radiofrequency ablation for hepatocellular carcinoma: a single centre propensity-matched comparison

Abstract

Background and aims

Irreversible electroporation (IRE) is a relatively new non-thermal ablative method for unresectable hepatocellular carcinoma (HCC). We aimed to compare the longer-term efficacy of IRE to the standard thermal technique of radiofrequency ablation (RFA) in HCC.

Methods

All patients who underwent IRE or RFA for HCC in our centre were identified and demographic and clinical data were analysed up until 1st March, 2020. Local recurrence-free survival (LRFS) was compared between groups after propensity score matching for age, gender, Child–Pugh grade, BCLC stage, lesion size and alpha-fetoprotein (AFP) level.

Results

A total of 190 HCC ablations (31 IRE and 159 RFA) were identified. After propensity score matching, we compared 25 IRE procedures (76% males, median age 62.4 years, median tumour size 20 mm) to 96 RFA procedures (84.4% males, median age 64.3 years, median tumour size 18.5 mm). LRFS did not differ between groups, with a 1-, 2- and 5-year LRFS of 80.4% (95% CI 55.8–92.2), 69.1% (95% CI 43.3–84.9) and 44.9% (95% CI 18.9–68.1%), respectively for IRE and 84.8% (95% CI 75.2–90.9), 71.3% (95% CI 58.3–81.0) and 52.1% (95% CI 35.4–66.4%), respectively for RFA (p = .63). There were no major procedure-related complications or deaths in either group.

Conclusions

Whilst IRE remains a relatively novel therapy for HCC cases where standard thermal ablation is contraindicated, the LRFS in our centre is comparable to that of RFA. IRE should therefore be considered as a treatment option in such cases when available before stage-migration to non-curative therapies such as transarterial chemoembolization (TACE).

Keywords:

• Irreversible electroporation
• hepatocellular carcinoma
• liver neoplasms
• radiofrequency ablation
• microwave ablation

Authors’ contributions

All authors contributed to the study conception and design. EF and AM analyzed data. EF developed the primary manuscript draft. All authors read and approved the final manuscript.

Ethical approval

The study protocol was approved by the Alfred Hospital Ethics Committee (Project No: 163/20).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated during the current study are available from the corresponding author on reasonable request.