Surgical resection vs. Percutaneous ablation for single hepatocellular carcinoma: Exploring the impact of li‐rads classification on oncological outcomes

Background: Single hepatocellular carcinoma (HCC) benefits from surgical resection (SR) or US‐guided percutaneous ablation (PA), although the best approach is still debated. We evaluated the impact of Li‐RADS classification on the oncological outcomes of SR vs. PA as single HCC first-line treatment. Methods: We retrospectively and blindly classified treatment‐naïve single HCC that underwent SR or PA between 2010 and 2016 according to Li‐RADS protocol. Overall survival (OS), recurrence free survival (RFS) and local recurrence after SR and PA were compared for each Li‐ RADS subclass before and after propensity‐score matching (PS‐M). Results: Considering the general population, SR showed better 5‐year OS (68.3% vs. 52.2%; p = 0.049) and RFS (42.5% vs. 29.8%; p = 0.002), with lower incidence of local recurrence (8.2% vs. 44.4%; p < 0.001), despite a significantly higher frequency of clinically‐relevant complications (12.8% vs. 1.9%; p = 0.002) and a higher Comprehensive Complication Index (12.1 vs. 2.2; p < 0.001). Focusing on different Li‐RADS subclasses, we highlighted better 5‐year OS (67.1% vs. 46.2%; p = 0.035), RFS (45.0% vs. 27.0% RFS; p < 0.001) and lower incidence of local recurrence (9.7% vs. 48.6%; p < 0.001) after SR for Li‐RADS‐5 HCCs, while these outcomes did not differ for Li‐RADS‐3/4 subclasses; such results were confirmed after PS‐M. Conclusions: Our analysis suggests a potential prognostic role of Li‐RADS classification, sup-porting SR over PA especially for Li‐RADS‐5 single HCC.