Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis
Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis
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DOI：
10.1245/s10434-011-2060-1
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发表时间：
2012-03-01
影响因子：
3.7
通讯作者：
Lee, Shou-Dong
中科院分区：
文献类型：
--
作者：
Hsu, Chia-Yang;Hsia, Cheng-Yuan;Lee, Shou-Dong
中期肝细胞癌（HCC）患者的治疗存在争议。这项研究比较了超过米兰标准的患者接受手术切除（SR）或经动脉化疗栓塞（TACE）的长期生存率。共有268例和455例超出米兰标准的HCC患者分别接受了SR和TACE回顾性评估。经过倾向评分分析以调整基线差异，从每个治疗组中选择146对匹配的患者。采用Kaplan-Meier法比较长期生存率。独立预后预测因子由Cox比例风险模型确定。单因素生存分析显示，SR组的长期生存率显著高于对照组（P < 0.001）。在Cox模型中，SR被确定为预后较好的独立预测因子（风险比= 0.3,95%可信区间[95% CI]: 0.23-0.4; P < .001）。尽管倾向评分模型的基线特征相似，但接受SR治疗的患者的生存率明显高于接受TACE治疗的患者（P < 0.001）。在倾向模型中，接受TACE治疗的患者长期死亡风险增加2.56倍（95% CI: 1.73-3.78）。SR组和TACE组治疗后30天和90天的死亡率相当。Cox模型一致显示，在倾向评分模型中，SR在长期生存方面具有显著优势（P < 0.001）。对于超出米兰标准的HCC患者，SR被认为与TACE同样安全，并提供更好的长期生存期。SR可作为这些患者的优先治疗。
Treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) is controversial. This study compared the long-term survival of patients beyond the Milan criteria who received surgical resection (SR) or transarterial chemoembolization (TACE).A total of 268 and 455 HCC patients beyond the Milan criteria undergoing SR and TACE, respectively, were retrospectively evaluated. After propensity score analysis to adjust for baseline differences, 146 pairs of matched patients were selected from each treatment arm. Long-term survival was compared by the Kaplan-Meier method. Independent prognostic predictors were determined by the Cox proportional hazards model.Long-term survival was significantly better for the SR group by univariate survival analysis (P < .001). In the Cox model, SR was identified as an independent predictor of better prognosis (hazard ratio = 0.3, 95% confidence interval [95% CI]: 0.23-0.4; P < .001). Despite similar baseline characteristics in the propensity score model, patients who underwent SR had significantly better survival than patients who underwent TACE (P < .001). Patients receiving TACE had 2.56-fold increased risk of long-term mortality in the propensity model (95% CI: 1.73-3.78). The SR and TACE groups had comparable 30- and 90-day posttreatment mortality. The Cox model consistently disclosed the significant superiority of SR in terms of long-term survival in the propensity score model (P < .001).For HCC patients beyond the Milan criteria, SR is considered equally safe as TACE and provides better long-term survival. SR may be regarded as the priority treatment for these patients.