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This underestimated issue is one reason why the ablation efficacy remains undetermined compared with hepatic resection. Our aim is to compare the efficacy of ablation and resection for <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> within the Milan criteria after excluding the impact of misdiagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Alpha\u2010fetoprotein &gt; 200 ng\/ml was introduced as an inclusion criterion to improve diagnosis accuracy. A total of 435 (resection, 310; ablation, 125) <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> patients within the Milan criteria and without portal hypertension were enrolled. Propensity score matching analysis identified 259 (resection, 150; ablation, 109) patients to compare treatment efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Before matching, the survival of resection group were superior to ablation group with 5\u2010year overall survival (<jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content>) rate of 77.6% vs. 53.8% (<jats:italic>P<\/jats:italic> &lt; 0.001), respectively, and 5\u2010year recurrence\u2013free survival (<jats:styled-content style=\"fixed-case\">RFS<\/jats:styled-content>) rate of 57.2% vs. 29.1% (<jats:italic>P<\/jats:italic> &lt; 0.001) respectively. After matching, the baseline was well\u2010balanced between the two groups. The 5\u2010year <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> rates were 71.5% vs. 51.3% (<jats:italic>P<\/jats:italic> &lt; 0.001), and 5\u2010year <jats:styled-content style=\"fixed-case\">RFS<\/jats:styled-content> rates were 56.1% vs. 25.6% (<jats:italic>P<\/jats:italic> &lt; 0.001) for the resection and ablation groups respectively. Cox regression analysis identified ablation as an independent predictor for mortality and tumour recurrence (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 2.123 and 2.308, respectively; both <jats:italic>P<\/jats:italic> &lt; 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hepatic resection provides better <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RFS<\/jats:styled-content> than ablation for alpha\u2010fetoprotein positive <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> patients within the Milan criteria and without portal hypertension.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13166","type":"journal-article","created":{"date-parts":[[2016,5,17]],"date-time":"2016-05-17T14:12:45Z","timestamp":1463494365000},"page":"1677-1687","source":"Crossref","is-referenced-by-count":19,"title":["Resection vs. ablation for alpha\u2010fetoprotein 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