ObjectiveTo compare the early efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of patients with hepatocellular carcinoma (HCC) complicated with liver cirrhosis. MethodsBased on a propensity score matching (PSM) method, a retrospective analysis was conducted on the clinical data of 199 patients with HCC complicated with liver cirrhosis who underwent ablation therapy at The 900 Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China from January 2017 to December 2023. The operation time, changes in liver function after surgery on day 1 and on month 1, postoperative complications, and recurrence-free survival (RFS) were compared between the MWA group and the RFA group. ResultsBefore PSM, there were 36 cases in the MWA group and 163 cases in the RFA group. After PSM, 35 patients were included in both the MWA group and the RFA group. And there were no statistically significant differences in baseline characteristics between the two groups (P>0.05). The operative time was shorter in the MWA group than that in the RFA group (P=0.002). On postoperative day 1, both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels increased both the MWA and RFA groups; however, the ALT and AST levels in the MWA group were lower than those in the RFA group (P<0.05). On postoperative month 1, no statistically significant differences were observed in liver function indicators between the two groups (P>0.05). The cumulative 1-year RFS rate was 51.4% for both the MWA group and the RFA group, with no statistically significant difference (P>0.05). The 1-year restricted mean survival time (RMST) was 8.89 months [95%CI (7.68, 10.11) months] in the MWA group and 9.41 months [95%CI (8.14, 10.69) months] in the RFA group, the intergroup difference in RMST was –0.52 months [95%CI (–2.28, 1.24) months], which was not statistically significant (P>0.05). ConclusionThe early efficacy of MWA and RFA for treatment of patients with HCC complicated with liver cirrhosis is comparable, but compared with RFA, MWA has the advantages of shorter operation time and milder acute liver function injury.