Understanding surgical decision making in early hepatocellular carcinoma.
Understanding surgical decision making in early hepatocellular carcinoma.
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DOI：
10.1200/jco.2010.30.8650
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发表时间：
2011-02-20
期刊：
影响因子：
--
通讯作者：
Pawlik TM
中科院分区：
文献类型：
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作者：
Nathan H;Bridges JF;Schulick RD;Cameron AM;Hirose K;Edil BH;Wolfgang CL;Segev DL;Choti MA;Pawlik TM
肝移植（LT）、肝切除（LR）和射频消融（RFA）作为早期肝细胞癌（HCC）的初始治疗方法的选择是有争议的，但对于外科医生如何为个体患者选择治疗方法知之甚少。我们试图通过联合分析来量化临床因素和外科医生专业对早期HCC手术决策的影响。对肝脏手术感兴趣的外科医生被邀请完成一项基于网络的调查，其中包括10个案例。然后使用回归模型分析治疗选择，回归模型包括临床因素和外科医生专业（非LT vs LT）。在评估早期HCC发生率时，非LT外科医生（50% LR; 41% LT; 9% RFA）的建议与LT外科医生（63% LT; 31% LR; 6% RFA; P < 0.001）相比有显著不同。临床因素，包括肿瘤的数量和大小、需要切除的类型和血小板计数，对LR、LT和RFA的选择有显著影响。在调整临床因素后，非LT外科医生仍然比LT外科医生更倾向于选择LR而不是LT（相对风险比[RRR]， 2.67）。当允许每个临床因素的权重随外科医生专业而变化时，外科医生专业对LR和LT决策的剩余独立影响可以忽略不计（RRR, 0.93）。外科医生专业对早期HCC治疗选择的影响大于某些临床因素。然而，外科医生专业的影响并不仅仅反映了对一种治疗方法的全面偏好。相反，不同专业的外科医生对某些临床因素的权衡是不同的。
The choice between liver transplantation (LT), liver resection (LR), and radiofrequency ablation (RFA) as initial therapy for early hepatocellular carcinoma (HCC) is controversial, yet little is known about how surgeons choose therapy for individual patients. We sought to quantify the impact of both clinical factors and surgeon specialty on surgical decision making in early HCC by using conjoint analysis. Surgeons with an interest in liver surgery were invited to complete a Web-based survey including 10 case scenarios. Choice of therapy was then analyzed by using regression models that included both clinical factors and surgeon specialty (non-LT v LT). When assessing early HCC occurrences, non-LT surgeons (50% LR; 41% LT; 9% RFA) made significantly different recommendations compared with LT surgeons (63% LT; 31% LR; 6% RFA; P < .001). Clinical factors, including tumor number and size, type of resection required, and platelet count, had significant effects on the choice between LR, LT, and RFA. After adjusting for clinical factors, non-LT surgeons remained more likely than LT surgeons to choose LR compared with LT (relative risk ratio [RRR], 2.67). When the weight of each clinical factor was allowed to vary by surgeon specialty, the residual independent effect of surgeon specialty on the decision between LR and LT was negligible (RRR, 0.93). The impact of surgeon specialty on choice of therapy for early HCC is stronger than that of some clinical factors. However, the influence of surgeon specialty does not merely reflect an across-the-board preference for one therapy over another. Rather, certain clinical factors are weighed differently by surgeons in different specialties.