Resection versus ablation in hepatitis B virus-related hepatocellular carcinoma patients with portal hypertension: A propensity score matching study
Resection versus ablation in hepatitis B virus-related hepatocellular carcinoma patients with portal hypertension: A propensity score matching study
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乙型肝炎病毒相关性肝细胞癌合并门脉高压患者的切除与消融：倾向评分匹配研究
DOI：
10.1016/j.surg.2015.04.002
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发表时间：
2015
期刊：
影响因子：
3.8
通讯作者：
Yuan Yunfei
中科院分区：
文献类型：
--
作者：
Qiu Jiliang;Zheng Yun;Shen Jingxian;Zeng Qing-An;Zou Ruhai;Liao Yadi;He Wei;Li Qijiong;Chen Guihua;Li Binkui;Yuan Yunfei
背景近年来随着手术技术的改进，许多研究报道肝细胞癌（HCC）合并门静脉高压症（PHT）患者行肝切除术是安全的。然而，没有直接的证据存在比较切除术与消融术的患者与肝炎B病毒（HBV）相关PHT.MethodsOf 259 HBV相关PHT患者谁符合米兰标准，123例患者进行了切除术和136进行消融作为一个主要的治疗。结果与消融组相比，切除组肿瘤体积较大，白色细胞计数、血小板计数较高，γ-谷氨酰转移酶水平较低，终末期肝病模型评分较低（均P <0.05）。虽然切除组的并发症发生率更高（P<0.001），但I级并发症的差异有统计学意义，而II-V级并发症的差异无统计学意义。切除组的无复发生存率（RFS）和总生存率（OS）高于消融组（分别为P= 0.001和P = 0.010）。在一对一PSM后，选择了77例切除患者和77例消融患者进行进一步分析。在RFS（P= 0.002）和OS（P= 0.012）方面仍观察到切除优于消融。两组间I-V级并发症相似（均P> 0.100.Conclusion切除术是安全的，在HBV相关PHT患者中比消融术具有生存优势。手术切除可能是这些患者的最佳治疗方法。
BackgroundWith recent improvements in operative techniques, many studies have reported that resection is safe for hepatocellular carcinoma (HCC) patients with portal hypertension (PHT). However, no direct evidence exists to compare resection with ablation in patients with hepatitis B virus (HBV)-related PHT.MethodsOf 259 HBV-related PHT patients who met the Milan criteria, 123 patients underwent resection and 136 underwent ablation as a primary treatment. Complications were graded with the Clavien-Dindo system, and oncologic outcomes were analyzed with a propensity score matching (PSM) method.ResultsCompared with the ablation group, the resection group showed larger tumors, greater white blood cell counts, greater platelet counts, lower γ-glutamyltransferase levels, and lower model of end stage liver disease scores (allP< .05). Although more frequent complications occurred in the resection group (P< .001), the difference was significant for the Grade I complications but not for Grade II-V complications. The recurrence-free survival (RFS) and overall survival (OS) rates were greater in the resection group than in the ablation group (P= .001 andP= .010, respectively). After one-to-one PSM, 77 resection patients and 77 ablation patients were selected for further analyses. The advantages of resection over ablation were still observed in RFS (P= .002) and OS (P= .012). Grade I-V complications were comparable between the 2 groups (allP> .100).ConclusionResection is safe and confers a survival advantage over ablation in HBV-related PHT patients. Resection may be recommended as an optimal treatment for these patients.