Survival and recurrences after hepatic resection or radiofreauency for hepatocellular carcinoma in cirrhotic patients: A multivariate analysis
Survival and recurrences after hepatic resection or radiofreauency for hepatocellular carcinoma in cirrhotic patients: A multivariate analysis
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DOI：
10.1016/j.gassur.2004.10.003
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发表时间：
2005-01-01
影响因子：
3.2
通讯作者：
Costa, M
中科院分区：
文献类型：
--
作者：
Montorsi, M;Santambrogio, R;Costa, M
肝切除术仍被认为是治疗肝硬化合并肝癌的首选方法。射频消融是一种新兴的治疗方式。本研究的目的是比较两组均质的患者接受手术切除或腹腔镜射频，分析预测生存和肝内复发的因素与使用的多变量分析。从1997年2月至2003年4月，98例患者参加了这项前瞻性研究。入选标准为小于5 cm的单个结节，肝功能Child A-B级，既往无治疗：手术组40例患者，射频组58例患者。就术前特征而言，两组是同质的。手术死亡率为零，手术并发症发生率相似。术后4年生存率无显著差异（切除术后为61%，射频消融术后为45%）。射频治疗后肝内复发的发生率明显高于切除术后（53%比30%; P = 0.018）。这主要是由于局部复发，而两组其他肝段出现的复发相似。多因素分析显示甲胎蛋白水平、肝硬化病因和治疗方式是肝内复发的重要预测因素。另一方面，多因素生存分析表明，只有甲胎蛋白水平是一个独立的预测生存。我们的研究结果显示，切除术后肝内复发的发生率明显低于射频消融术后。这似乎对总生存率没有显著影响，可能是因为复发本身得到了及时有效的治疗。(C)2005年消化道外科学会
Hepatic resection is still considered the treatment of choice for hepatocellular carcinoma in patients with liver cirrhosis. Radiofrequency ablation is a new emerging modality. The aim of this study was to compare two homogeneous groups of patients who underwent either surgical resection or laparoscopic radiofrequency, analyzing the factors predicting survival and intrahepatic recurrences with use of a multivariate analysis. From February 1997 to April 2003, 98 patients were enrolled in this prospective study. Inclusion criteria were a single nodule of less than 5 cm, Child A-B class of liver function, and no previous treatment: 40 patients were in the surgical group and 58 patients were in the radiofrequency group. The two groups were homogeneous as far as preoperative characteristics were concerned. Operative mortality was zero, and the rates of operative morbidity were similar. Actuarial survival at 4 years was not significantly different (61% after resection and 45% after radiofrequency). There was a significant higher incidence of intrahepatic recurrences after radiofrequency than after resection (53% versus 30%; P = 0.018). This was mainly due to local recurrences, whereas those appearing in other liver segments were similar in both groups. A multivariate analysis showed that the significant factors predictive of an intrahepatic recurrence were the level of a-fetoprotein, the etiology of cirrhosis, and the type of the treatment. On the other hand, multivariate analysis of the survival showed that only the level of alpha-fetoprotein was an independent predictor of survival. The results of our study showed a significant lower incidence of intrahepatic recurrences after resection compared with after radiofrequency. This seems not to significantly influence the overall survival, probably because of a prompt and effective treatment of the recurrences themselves. (C) 2005 The Society for Surgery of the Alimentary Tract