Stereotactic body radiotherapy versus laparoscopic liver resection for single hepatocellular carcinoma ≤ 5 cm: a retrospective, multicenter, cohort study.

To compare the efficacy of stereotactic body radiotherapy (SBRT) and laparoscopic liver resection (LLR) for patients with single hepatocellular carcinoma (HCC) ≤ 5 cm. A retrospective analysis was conducted on a cohort of patients with HCC who underwent either LLR or SBRT at our centers. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. To reduce selection bias, propensity score matching (PSM) was applied. Subgroup analyses were also performed to explore outcomes across different clinical and tumor-related characteristics. This retrospective cohort study included 383 patients from four hospitals between January 2017 and December 2019, with 268 patients in the LLR group and 115 in the SBRT group. After PSM adjustment, 98 patients were selected from each group for further analysis. The 1-, 3-, and 5-year OS rates were 94.9%, 88.8%, and 85.7% in the LLR group and 94.9%, 74.5%, and 67.3% in the SBRT group, respectively (p = 0.005). The 1-, 3-, and 5-year RFS rates were 86.7%, 71.4%, and 70.4% in the LLR group and 83.7%, 61.2%, and 53.1% in the SBRT group, respectively (p = 0.011). LLR provided better OS and RFS than SBRT. However, SBRT showed comparable OS and RFS outcomes with LLR for tumors ≤ 3 cm (p = 0.158; p = 0.418), and perivascular tumors (p = 0.082; p = 0.166). LLR is the first choice for treating single HCC ≤ 5 cm, while SBRT may be a favorable alternative for small and perivascular lesions.