Skip Navigation
Skip to contents

JLC : Journal of Liver Cancer



Page Path
HOME > J Liver Cancer > Volume 24(1); 2024 > Article
Radiofrequency for hepatocellular carcinoma larger than 3 cm: potential for applications in daily practice
Ji Hoon Kim1,2orcid, Pil Soo Sung1,3orcid
Journal of Liver Cancer 2024;24(1):1-2.
Published online: March 14, 2024

1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

2Department of Internal Medicine, The Catholic University of Korea Uijeongbu St. Mary’s Hospital, Uijeongbu, Korea

3Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea

Corresponding author: Pil Soo Sung, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, 222 Banpodaero, Seocho-gu, Seoul 06591, Korea E-mail:
• Received: February 10, 2024   • Accepted: February 13, 2024

© 2024 The Korean Liver Cancer Association.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

See the article "Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs. ablation: a multicenter retrospective study" on page 71.
Radiofrequency ablation (RFA) represents an alternative for the treatment of hepatocellular carcinoma (HCC) in cases where resection or transplantation is not possible. Owing to the natural advantage of its effective treatment for small tumors with no skin incision and the associated reduction in complications and treatment time, ablation is currently the mainstay of treatment for very early-and early-stage HCC.1 The recent Barcelona clinic liver cancer (BCLC) strategy update and many published studies suggest that the survival outcomes of patients with HCC with lesions ≤3 cm are comparable to those of patients treated with resection. In 2013, Cucchetti et al.2 performed a meta-analysis comparing RFA and hepatic resection. They found that for patients with single HCC lesions <2 cm and patients with two or three HCC lesions ≤3 cm, RFA was more cost-effective than hepatic resection. The 2017 prospective randomized controlled trial by Ng et al.,3 in which the outcomes of patients with early HCC (solitary tumor ≤5 cm or no more than three lesions, each ≤3 cm) treated with hepatic resection and RFA were compared, revealed no significant difference in overall survival and disease-free survival between the two groups. Additionally, the findings of the recent multicenter, randomized, phase 3 SURF trial by Takayama et al.4 also revealed no significant difference in overall survival and recurrence-free survival between patients with small HCCs treated with surgery and those treated with RFA for lesions ≤3 cm and three nodules.
In this issue of Journal of Liver Cancer, Kariyama et al.5 sought to clarify the efficacy of hepatic resection and RFA in patients with HCC. They conducted a retrospective study using the real-life practice experts for HCC (REPLEC) study group database. After thorough analysis via propensity score matching, no significant differences in overall and recurrence-free survival were observed in groups with lesions ≤3 cm. In the group with lesions >3 cm but ≤5 cm, no significant difference was observed in overall survival either. However, a significant difference was observed in recurrence-free survival, wherein hepatic resection was superior to RFA.
Hepatologists worldwide would concur that RFA is as effective as hepatic resection when the lesion is ≤3 cm.6 The BCLC strategy also addresses this issue. Further, as the article mentions, the Korean and Japanese guidelines recommend ablation for patients with lesions ≤3 cm, while the Taiwanese guideline recommend ablation for patients with lesions <5 cm.7-9
A recent study on the safety of hepatectomy for HCC in elderly patients demonstrated that age ≥70 years, male sex, low hospital volume, and surgical procedures were independent predictors of mortality.10 Moreover, considering the disadvantages of surgical treatment, including postoperative complications, such as infection, bleeding, and increased admission days, and the absence of significant differences in the overall survival between RFA and hepatic resection, RFA may be considered a superior choice, especially in older patients or those with comorbid conditions.

Conflict of Interest

Pil Soo Sung is an editorial board member of Journal of Liver Cancer, and was not involved in the review process of this article. Otherwise, the authors have no conflicts of interest to disclose.

Ethics Statement

This editorial is fully based on the articles which were already published and did not involve additional patient participants. Therefore, IRB approval is not necessary.

Funding Statement

This report was supported by the research fund of the Seoul St. Mary’s Hospital (PSS).

Data Availability

Not applicable.

Author Contribution

Conceptualization: JHK, PSS

Writing - original draft: JHK

Writing - reviewing & editing: JHK, PSS

  • 1. Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022;76:681−693.ArticlePubMedPMC
  • 2. Cucchetti A, Piscaglia F, Cescon M, Colecchia A, Ercolani G, Bolondi L, et al. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol 2013;59:300−307.ArticlePubMed
  • 3. Ng KKC, Chok KSH, Chan ACY, Cheung TT, Wong TCL, Fung JYY, et al. Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg 2017;104:1775−1784.ArticlePubMedPDF
  • 4. Takayama T, Hasegawa K, Izumi N, Kudo M, Shimada M, Yamanaka N, et al. Surgery versus radiofrequency ablation for small hepatocellular carcinoma: a randomized controlled trial (SURF Trial). Liver Cancer 2021;11:209−218.ArticlePubMedPMCPDF
  • 5. Kariyama K, Nouso K, Hiraoka A, Toyoda H, Tada T, Tsuji K, et al. Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs ablation: a multicenter retrospective study. J Liver Cancer 2023;Nov 6 doi: 10.17998/jlc.2023.09.11. [Epub ahead of print].
  • 6. Yoon JH, Choi SK. Management of early-stage hepatocellular carcinoma: challenges and strategies for optimal outcomes. J Liver Cancer 2023;23:300−315.ArticlePubMedPMCPDF
  • 7. Korean Liver Cancer Association (KLCA), National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022;28:583−705.ArticlePubMedPMCPDF
  • 8. Hasegawa K, Takemura N, Yamashita T, Watadani T, Kaibori M, Kubo S, et al. Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2021 version (5th JSH-HCC guidelines). Hepatol Res 2023;53:383−390.ArticlePubMedPDF
  • 9. Shao YY, Wang SY, Lin SM; Diagnosis Group, Systemic Therapy Group. Management consensus guideline for hepatocellular carcinoma: 2020 update on surveillance, diagnosis, and systemic treatment by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2021;120:1051−1060.ArticlePubMed
  • 10. Okinaga H, Yasunaga H, Hasegawa K, Fushimi K, Kokudo N. Short-term outcomes following hepatectomy in elderly patients with hepatocellular carcinoma: an analysis of 10,805 septuagenarians and 2,381 octo- and nonagenarians in Japan. Liver Cancer 2018;7:55−64.ArticlePubMedPMCPDF

Figure & Data



    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • XML DownloadDownload Citation
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        • Citation for the content below
        Radiofrequency for hepatocellular carcinoma larger than 3 cm: potential for applications in daily practice
        J Liver Cancer. 2024;24(1):1-2.   Published online March 14, 2024
      • XML DownloadXML Download
      Related articles

      JLC : Journal of Liver Cancer