Transplantation versus hepatectomy for HCC beyond the Milan criteria: A propensity score analysis
Transplantation versus hepatectomy for HCC beyond the Milan criteria: A propensity score analysis
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DOI：
10.1016/j.ijsu.2017.05.034
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发表时间：
2017-08-01
影响因子：
15.3
通讯作者：
Wen, Jun
中科院分区：
文献类型：
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作者：
Shen, Jun-yi;Li, Chuan;Wen, Jun
背景资料：越来越多的研究表明，手术切除（SR）或肝移植（LT）可以为米兰标准以外的肝细胞癌（HCC）患者带来生存益处。本研究比较了超过米兰标准的患者接受SR或LT的长期生存。材料和方法：共461例HCC患者进行了回顾性收集。采用倾向评分匹配（PSM）、Kaplan-Meier法和考克斯比例风险模型进行分析。结果：在PSM前后，LT组的预后均显著优于SR组（P < 0.001和P = 0.003）。在亚组分析中，对于AFP水平较低的患者，两组的1年、3年和5年OS率存在显著差异（LT组为86.7%、71.9%和71.9%，SR组为75.8%、48.1%和10.7%，P相似于0.003）。对于肿瘤尺寸较小的患者，LT组的1年、3年和5年OS率分别为78.3、66.7和66.7%，SR组为83.8、42.6和18.6%，p = 0.009）。结论：我们的倾向性模型提示，在PSM前后，对于米兰标准以外的HCC，LT的长期生存率明显优于SR。(C)2017由Elsevier Ltd代表IJS Publishing Group Ltd出版。
Background: Increasing studies have suggested that surgical resection (SR) or liver transplantation (LT) could bring survival benefits for patients with hepacelluar carcinoma (HCC) beyond Milan criteria. This study compared the long-term survival of patients beyond the Milan criteria who received SR or LT.Material and methods: A total of 461 HCC patients were retrospectively collected. Analysis was performed using propensity score matching (PSM), the Kaplan-Meier method and the Cox proportional hazards model.Results: Prognosis was significantly better for the LT group than the SR group before (P < 0.001) and after PSM(p = 0.003). In subgroup analysis, for patients with lower AFP level, the 1-, 3-, and 5-year OS rates for the two groups were significantly different (86.7, 71.9, and 71.9% for group LT vs. 75.8, 48.1, and 10.7% for group SR, P similar to 0.003). For patients with smaller tumor size, the 1-, 3-, and 5-year OS rates were 78.3, 66.7, and 66.7% for group LT, and 83.8, 42.6, and 18.6% for group SR, p = 0.009). Transplantation was a favorable factor associated with prognosis before and after propensity score matching (HR 2.643).Conclusion: Our propensity model suggested that LT provided significantly better long-term survival than SR for HCC beyond Milan criteria before and after PSM. (C) 2017 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.