Minimally Invasive Liver Resection for Early-Stage Hepatocellular Carcinoma: Inconsistent Outcomes from Matched or Weighted Cohorts
Minimally Invasive Liver Resection for Early-Stage Hepatocellular Carcinoma: Inconsistent Outcomes from Matched or Weighted Cohorts
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DOI：
10.1007/s11605-019-04221-0
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发表时间：
2020-03-01
影响因子：
3.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Wu, Lu;Tsilimigras, Diamantis, I;Pawlik, Timothy M.
背景本研究的目的是重新评估微创肝切除术（MILR）在接受部分肝切除术的早期（I 期或 II 期）肝细胞癌（HCC）患者中的作用。方法 对国家癌症数据库 (NCDB) 进行回顾性分析，以确定 2010 年至 2013 年在美国接受部分肝切除术的早期 HCC 患者。稳定的治疗倾向得分加权逆概率（IPTW）；和倾向得分匹配（PSM）。结果 在该研究纳入的 4027 名患者中，只有 11.7% (n = 473) 接受了 MILR。在稳定的 IPTW 队列中，接受 MILR 与开放切除的患者更有可能患有大于 3 cm 的肿瘤（63.9%，n = 285 vs. 51.4%，n = 228，p < 0.001）和低分化/未分化肿瘤（21.5%，n = 96 vs. 12.9%，n = 57，p < 0.001）。在粗略队列中，开放手术组患者 (67.8%) 的 5 年 OS 优于接受 MILR 的患者 (56.6%) (p < 0.001)。经过经典的 PSM 分析后，接受 MILR 和开放手术的患者的 5 年 OS 具有可比性（57.3% vs 63.8%，p = 0.17；HR 1.16，95% CI 0.92-1.45）。相比之下，应用 IPTW 后，接受 MILR 的患者 (55.5%) 的 5 年 OS 比接受开放切除的患者 (67.5%) 更差 (HR 1.46，95% CI 1.15-1.84；p < 0.001)。结论 根据标准 PSM 评估，接受 MILR 的患者的长期结局与接受开放手术的患者相当。 IPTW 的使用导致了更多不平衡的群体，从而导致残留的混杂和偏见。
Background The aim of the current study was to re-evaluate the role of minimally invasive liver resection (MILR) among patients with early-stage (stage I or II) hepatocellular carcinoma (HCC) undergoing partial hepatectomy. Methods A retrospective analysis of the National Cancer Database (NCDB) was conducted to identify patients with early-stage HCC who underwent partial hepatectomy in the USA from 2010 to 2013. Overall survival (OS) was compared in three cohorts: crude; stabilized inverse probability of treatment propensity score weighting (IPTW); and propensity score matching (PSM). Results Among 4027 patients included in the study, only 11.7%, (n = 473) underwent MILR. In the stabilized IPTW cohort, patients who underwent MILR versus open resection were more likely to have tumors greater than 3 cm (63.9%, n = 285 vs. 51.4%, n = 228, p < 0.001) and poorly/undifferentiated tumors (21.5%, n = 96 vs. 12.9%, n = 57, p < 0.001). Within the crude cohort, a 5-year OS was superior among patients in the open surgical group (67.8%) compared with patients who underwent MILR (56.6%) (p < 0.001). After classic PSM analysis, the 5-year OS of patients undergoing MILR and open surgery were noted to be comparable (57.3% vs 63.8%, p = 0.17; HR 1.16, 95% CI 0.92-1.45). In contrast, after applying IPTW, the 5-year OS of patients who underwent MILR (55.5%) was worse compared with patients who had an open resection (67.5%) (HR 1.46, 95% CI 1.15-1.84; p < 0.001). Conclusions Long-term outcomes of patients undergoing MILR were comparable with patients who had open surgery when assessed by standard PSM. The use of IPTW resulted in more unbalanced groups leading to residual confounding and bias.