The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?
The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?
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亚厘米肝细胞癌的最佳治疗：治愈性治疗还是随访？
DOI：
10.12659/msm.916451
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发表时间：
2019-07
期刊：
影响因子：
--
通讯作者：
Ming Zhao
中科院分区：
文献类型：
--
作者：
Xuqi Sun;Yaojun Zhang;Ning Lyu;Xiaoxian Li;Minshan Chen;Ming Zhao
背景处理亚厘米肝结节的最佳策略尚未确定。本研究旨在评估是否有必要为高假阳性风险的亚厘米肝细胞癌（HCCs）患者提供根治性治疗。材料/方法我们从2004年至2015年的监测、流行病学和最终结果（SEER）数据库中筛选出原发病理诊断为≤2 cm的HCC患者。他们根据接受的干预措施进行分类：局部消融、手术切除或肝移植。在每组中，总生存期和癌症特异性生存期作为终点，通过Kaplan-Meier比较亚厘米HCC患者和1至2厘米HCC患者的预后。进行倾向评分匹配以减少偏倚。我们还比较了不同肿瘤大小组的原发性单发HCC患者的生存率。进行引导以验证研究结果。结果：总体而言，10.4%的患者（197 / 1894）hcc <1 cm， 89.6%的患者（1697 / 1894）hcc在1 ~ 2 cm范围内。在所有治疗组中，hcc <1 cm和hcc在1 - 2 cm范围内的患者的总生存率和癌症特异性生存率无显著差异。调整混杂因素后，发现肿瘤大小与生存时间无显著相关性。在hcc≤2 cm的患者中，肝移植的总生存率和肿瘤特异性生存率优于手术切除和局部消融。手术切除比局部消融提供更好的生存。结论与1 ~ 2 cm hcc患者相比，亚cm hcc患者的治愈性治疗并没有提高患者的生存率，存在较高的假阳性风险。
Background The optimal strategy for dealing with sub-centimeter hepatic nodules has not yet been established. This study aimed to assess whether there was a need to provide curative treatments for sub-centimeter hepatocellular carcinomas (HCCs) to patients at risk for high false positives. Material/Methods We identified patients with primary pathologically diagnosed HCC ≤2 cm from 2004 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database. They were divided according to the interventions they received: local ablation, surgical resection, or liver transplantation. In each group, overall survival and cancer-specific survival were used as endpoints to compare the prognoses between patients with sub-centimeter HCC and patients with HCC measuring 1 to 2 cm by Kaplan-Meier. Propensity score matching was performed to reduce bias. We also compared the survival of patients with a primary solitary HCC based on interventions, in the different tumor size groups. Bootstrapping was performed to validate the findings. Results Overall, 10.4% of patients (197 out of 1894) had HCCs <1 cm, and 89.6% of patients (1697 out of 1894) had HCCs in the 1 to 2 cm range. There was no significant difference in overall and cancer-specific survival between patients with HCCs <1 cm and those with HCCs in the 1 to 2 cm range, in all treatment groups. After adjusting confounding factors, no significant correlation was found between tumor size and survival time. In patients with HCCs measuring ≤2 cm, overall survival and cancer-specific survival were superior in liver transplantation compared with surgical resection and local ablation. Surgical resection provided better survival than local ablation. Conclusions Compared to patients with HCCs measuring 1 to 2 cm, the survival rates of patients with sub-centimeter HCCs was not improved through curative treatments, risking high false positives.
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影响因子：
13.5
作者：
Roayaie, Sasan;Obeidat, Khaled;Sposito, Carlo;Mariani, Luigi;Bhoori, Sherrie;Pellegrinelli, Alessandro;Labow, Daniel;Llovet, Josep M.;Schwartz, Myron;Mazzaferro, Vincenzo
通讯作者：
Mazzaferro, Vincenzo
影响因子：
5.1
作者：
T. Roskams
通讯作者：
T. Roskams
影响因子：
13.5
作者：
Kojiro, Masamichi;Wanless, Ian R.;Toniakos, Dina
通讯作者：
Toniakos, Dina
影响因子：
25.7
作者：
Cucchetti, Alessandro;Piscaglia, Fabio;Pinna, Antonio D.
通讯作者：
Pinna, Antonio D.
影响因子：
3.7
作者：
Choi YR;Chung JW;Yu MH;Lee M;Kim JH
通讯作者：
Kim JH