Liver Transplantation vs Partial Hepatectomy for Stage T2 Multifocal Hepatocellular Carcinoma <3 cm Without Vascular Invasion: A Propensity Score-Matched Survival Analysis.
Liver Transplantation vs Partial Hepatectomy for Stage T2 Multifocal Hepatocellular Carcinoma <3 cm Without Vascular Invasion: A Propensity Score-Matched Survival Analysis.
复制标题
肝移植与部分肝切除术治疗 T2 期多灶性肝细胞癌 <3 厘米无血管侵犯：倾向评分匹配生存分析。
DOI：
10.1097/xcs.0000000000000725
复制
发表时间：
2023
影响因子：
5.2
通讯作者：
Kwee,SandiA
中科院分区：
文献类型：
--
作者：
Wong,LindaL;Landsittel,DouglasP;Kwee,SandiA
背景：多灶性肝细胞癌在生物学和免疫学上不同于单结节型肝癌。亚洲和欧洲的指南认为肝移植(LT)和部分肝切除(PH)对于T2多灶性肝癌是有效的，优先于LT，但很少有美国研究直接比较这些治疗方法。这项基于倾向性评分的观察性研究使用已建立的国家癌症结果登记系统来比较接受PH和LT治疗的多灶性肝癌患者的总存活率。STUDY设计：2020年国家癌症数据库中的数据来自于在米兰标准范围内、没有血管侵犯的多灶性2期肝癌接受LT或PH的患者。根据年龄、性别、治疗设施类型、治疗年限、凝血酶原时间、α-胎蛋白、合并症、肝纤维化严重程度、治疗前肌酐和胆红素水平，采用倾向评分匹配和COX回归分析来评估总体生存率。结果：在21,248例T2肝癌患者中，6,744例肿瘤直径最大且直径为3 cm且无大血管侵犯，其中1,267例和181例分别接受了肝移植和肝切除术。倾向评分匹配的COX回归分析显示，相对于PH，LT的危险比为0.39(95%可信区间0.30~0.50)。里程碑式的分析说明肝移植间隔时间较长，可获得相似程度的生存益处。结论：虽然早期肝细胞癌可以有效地接受肝移植或PH治疗，但倾向评分匹配分析显示，在符合米兰标准的多灶性肝细胞癌患者中，肝移植可获得生存益处。
BACKGROUND:Multifocal hepatocellular carcinoma (HCC) differs biologically and immunologically from single-nodule HCC. Asian and European guidelines consider liver transplantation (LT) and partial hepatectomy (PH) as effective for T2 multifocal HCC, with preference toward LT, but few US studies compare these treatments directly. This propensity score–based observational study uses an established national cancer outcomes registry to compare overall survival in patients undergoing PH and LT for multifocal HCC.STUDY DESIGN:Data from the 2020 National Cancer Database were obtained on patients who underwent LT or PH for multifocal stage 2 HCC within Milan criteria and without vascular invasion. Propensity score matching and Cox regression analysis was applied to evaluate overall survival in an observational cohort balanced by age, sex, treatment facility type, treatment year, prothrombin time, α-fetoprotein, comorbidity burden, liver fibrosis severity, and pretreatment creatinine and bilirubin levels.RESULTS:Of 21,248 T2 HCC patients identified, 6,744 had multifocal tumors with largest tumor diameter< 3 cm without major vascular invasion, with 1,267 and 181 having undergone LT and PH, respectively. Propensity score–matched Cox regression analysis associated LT with a hazard ratio of 0.39 (95% CI 0.30 to 0.50) relative to PH. Landmark analyses to account for a longer interval to LT demonstrated survival benefits of similar magnitude.CONCLUSIONS:Although early-stage HCC can be effectively treated with either LT or PH, propensity score–matched analysis comparatively shows a survival benefit for LT in patients with multifocal HCC who are within the Milan criteria.