评估肝脏影像报告和数据系统（LI-RADS）分类与小单发肝细胞癌（HCC）在手术切除（SR）和射频消融（RFA）后的治疗结果是否相关。本回顾性研究纳入了2014年至2016年间接受SR（n = 209）或RFA（n = 148）治疗 ≤ 3厘米单发HCC的357名患者。给予患者LI-RADS分类，并根据LI-RADS分类（LR-4/5 vs. LR-M），在倾向评分匹配（PSM）前后比较治疗后的总生存（OS）、无复发生存（RFS）和局部肿瘤进展（LTP）率。评估治疗结果的预后因素。总计纳入357例患者（平均年龄59岁；男性272例），共357个HCC（294个LR-4/5和63个LR-M）。在PSM后（每个治疗组n = 78），SR组和RFA组分别有10个和11个LR-M HCC。在OS和RFS方面没有显著差异。但是，SR组的5年LTP率低于RFA组（1.4% vs. 14.9%，p = 0.001）。SR组在LR-M HCCs（0% vs. 34.4%，p = 0.062）和LR-4/5 HCCs（1.5% vs. 12.0%，p = 0.008）中提供了比RFA组更低的5年LTP率。 LI-RADS分类是与不良OS（风险比[HR] 3.79，p = 0.004）、RFS（HR 2.12，p = 0.001）和LTP（HR 2.89，p = 0.032）相关的唯一风险因素。LI-RADS分类与HCC的治疗结果相关，支持SR对于LTP的有利结果优于RFA，特别是对于被分类为LR-M的HCC。SR对于LR-M HCCs（0% vs. 34.4%，p = 0.062）和LR-4/5 HCCs（1.5% vs. 12.0%，p = 0.008）的5年LTP率低于RFA。 LR-M HCCs在RFA治疗后的1年内存在明显增加的LTP风险，与SR相比。LI-RADS分类是在接受SR或RFA治疗的 ≤ 3 cm HCC患者中与不良OS（HR 3.79，p = 0.004）、RFS（HR 2.12，p = 0.001）和LTP（HR 2.89，p = 0.032）相关的唯一风险因素。© 2023. 作者，授予欧洲放射学会独家许可。

To assess whether the Liver Imaging Reporting and Data System (LI-RADS) category is associated with the treatment outcomes of small single hepatocellular carcinoma (HCC) after surgical resection (SR) and radiofrequency ablation (RFA).This retrospective study included 357 patients who underwent SR (n = 209) or RFA (n = 148) for a single HCC of ≤ 3 cm between 2014 and 2016. LI-RADS categories were assigned. Overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP) rates after treatment were compared according to the LI-RADS category (LR-4/5 vs. LR-M) before and after propensity score matching (PSM). Prognostic factors for treatment outcomes were assessed.In total, 357 patients (mean age, 59 years; men, 272) with 357 HCCs (294 LR-4/5 and 63 LR-M) were included. After PSM (n = 78 in each treatment group), there were 10 and 11 LR-M HCCs in the SR and RFA group, respectively. There were no significant differences in OS or RFS. However, SR provided a lower 5-year LTP rate than RFA (1.4% vs. 14.9%, p = 0.001). SR provided a lower 5-year LTP rate than RFA for LR-M HCCs (0% vs. 34.4%, p = 0.062) and LR-4/5 HCCs (1.5% vs. 12.0%, p = 0.008). The LI-RADS category was the sole risk factor associated with poor OS (hazard ratio [HR] 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032).LI-RADS classification is associated with the treatment outcome of HCC, supporting favorable outcomes of SR over RFA for LTP, especially for HCCs categorized as LR-M.Liver Imaging Reporting and Data System category has a potential prognostic role, supporting favorable outcomes of surgical resection over radiofrequency ablation for local tumor progression, especially for hepatocellular carcinoma categorized as LR-M.• SR provided a lower 5-year LTP rate than RFA for HCCs categorized as LR-M (0% vs. 34.4%, p = 0.062) and HCCs categorized as LR-4/5 (1.5% vs. 12.0%, p = 0.008). • There is a steeply increased risk of LTP within 1 year after RFA for LR-M HCCs, compared to SR. • The LI-RADS category was the sole risk factor associated with poor OS (HR 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032) in patients with HCC of ≤ 3 cm treated with SR or RFA.© 2023. The Author(s), under exclusive licence to European Society of Radiology.