Outcomes of early-stage hepatocellular carcinoma patients treated by resection or ablation: real-life data from the French Administrative Health Care database.

Background/Aims: Surgical resection and percutaneous ablation are considered curative treatments for hepatocellular carcinoma (HCC). However, both approaches are associated with a high risk of recurrence. Real-world data on outcomes and post-curative management remain scarce. This study aimed to assess survival and healthcare pathways of patients with HCC treated with resection or ablation in routine clinical practice. Methods: We conducted a retrospective analysis using the French National Health Data System. Patients who underwent resection or percutaneous ablation as first-line treatment for HCC between January 2014 and December 2021 were included. The primary endpoint was overall survival (OS); secondary endpoints focused on subsequent treatment sequences and healthcare pathways. Results: Among 10,810 patients included, 5,488 underwent ablation and 5,322 resection as first-line treatment. One- and 2-year OS rates were 90% and 78% after ablation (median OS [mOS], 56 months; 95% confidence interval [CI], 54-58) and 88% and 80% after resection (mOS, 75 months; 95% CI, 72-79). Median time to next treatment or death was 20 months (95% CI, 18-21) after ablation and 29 months (95% CI, 27-30) after resection. Following initial treatment, 27% of patients in the ablation group and 39% in the resection group received no further therapy. Conclusions: This nationwide real-world study provides comprehensive data on survival and treatment sequences after curative-intent therapy for HCC in France. Despite frequent recurrence, survival outcomes remained favourable, reflecting access to repeated and effective subsequent treatments, underscoring the importance of long-term follow-up in routine care.