Resection vs Ablation for Multifocal Hepatocellular Carcinomas meeting the Barcelona-Clinic Liver Cancer A Classification: A Propensity Score Matching Study
Resection vs Ablation for Multifocal Hepatocellular Carcinomas meeting the Barcelona-Clinic Liver Cancer A Classification: A Propensity Score Matching Study
复制标题
符合巴塞罗那临床肝癌 A 分类的多灶性肝细胞癌的切除与消融：倾向评分匹配研究
DOI：
10.7150/jca.31246
复制
发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Yuan, Yunfei
中科院分区：
文献类型：
--
作者：
Liu, Wenwu;Yang, Zhiwen;Yuan, Yunfei
随着外科技术的发展，我们的目的是研究切除术是否可以挑战标准治疗，消融术，在治疗多灶性肝癌符合临床肝癌A期。从2005年1月至2017年1月，使用倾向评分匹配对接受切除术（n = 72）或消融术（n = 63）的患者的肿瘤结局进行了回顾性分析。在基线时，消融组患者的三灶性病变（30.2% vs. 6.9%，P = 0.001）和较小的肿瘤（2.00 cm vs. 2.50 cm，P = 0.002）多于切除组。匹配后，两种治疗的基线平衡良好（n = 46对）;切除术提供了与消融术相当的5年总生存率（77.0% vs. 83.6，P = 0.790）和上级5年无复发生存率（40.4% vs. 16.9%，P = 0.022）。多变量考克斯模型证实消融术与总生存率降低无关（HR = 0.89; 95% CI，0.33 - 2.42，P = 0.819），但消融术是无复发生存率的不利预测因素（HR = 2.13; 95% CI，1.27 - 3.57，P <0.001）。对于位于不同节段的多灶性肿瘤亚组患者，两种治疗提供了相似的5年总生存率（74.3% vs. 95.5%，P = 0.190）和5年无复发生存率（42.9 vs. 25.9%，P = 0.170）。此外，消融术导致的严重并发症少于切除术（3.2% vs 13.9%，P = 0.035）。与消融术相比，切除术获得了相当的总生存率，对于符合BCLC A期的多灶性肝细胞癌患者，甚至获得了上级无复发生存率。
With development of surgical technology, we aimed to investigate whether resection could challenge the standard treatment, ablation, in treating multifocal hepatocellular carcinomas meeting the Barcelona-Clinic Liver Cancer A stage. From January 2005 to January 2017, the oncological outcomes of patients undergoing resection (n = 72) or ablation (n = 63) were retrospectively analysed using propensity score matching. At baseline, patients in the ablation group had more tri-focal lesions (30.2% vs. 6.9%, P = 0.001) and smaller tumours (2.00 cm vs. 2.50 cm, P = 0.002) than resection group. After matching, the baseline was well-balanced between treatments (n = 46 pairs); resection provided comparable 5-year overall survival (77.0% vs. 83.6, P = 0.790) and superior 5-year recurrence-free survival (40.4% vs. 16.9%, P = 0.022) to ablation. The multivariate Cox model confirmed that ablation was not associated with worse overall survival (HR = 0.89; 95% CI, 0.33 - 2.42, P = 0.819), but identified ablation as an unfavourable predictor of recurrence-free survival (HR = 2.13; 95% CI, 1.27 - 3.57, P <0.001). For subgroup patients with multifocal tumours located in different segments, both treatments offered similar 5-year overall survival (74.3% vs. 95.5%, P = 0.190) and 5-year recurrence-free survival (42.9 vs. 25.9%, P = 0.170). Additionally, ablation resulted in less major complications than resection (3.2% vs 13.9%, P = 0.035). Compared with ablation, resection achieved comparable overall survival and even superior recurrence-free survival for patients with multifocal hepatocellular carcinomas meeting the BCLC A stage.