Editorial: is microwave ablation an alternative to liver resection for hepatocellular carcinoma?

Tong et al demonstrated that liver resection had a better recurrence-free survival (RFS) and similar overall survival (OS) compared to per-cutaneous microwave ablation (MWA) in the “ideal candidate for ablation” population according to the Barcelona clinic liver cancer (BCLC) staging system and in the BCLC- A subgroup, whereas the OS and RFS were similar in patients with BCLC- 0 disease. 1 Our previous study 2 enrolled patients with a similar tumour burden (hepatocellular carcinoma [HCC] meeting the Milan criteria) and compared the efficacy of MWA and resection in the overall and in a matched population. Again, although MWA offered a lower 5- year RFS (30.6% vs. 57.5%) than resection, both treatments yielded similar 5- year OS (82.2% vs. 80.5%). These two studies from different centres further confirm that MWA provides an OS benefit similar to that of resection for patients in China. However, it should be noted that the main drawback of MWA is the high rate of local recurrence. In our study, the recurrence rate was higher in the MWA group in the overall population and the subgroup with tumours smaller than 3 cm. Tong et al further explored the subgroup of patients with solitary HCC smaller than 2 cm and found a similar RFS between groups. This suggests that we need to further restrict the target population for MWA to reduce the risk of recurrence. Many studies comparing the efficacy of resection and local ablation for HCC have mainly focused on OS, which remains the ultimate treatment goal in oncology. However, we believe that RFS, or even early recurrence-­free­survival­(within­2 years),­would­be­a­better­endpoint­