Resection vs. ablation for alpha-fetoprotein positive hepatocellular carcinoma within the Milan criteria: a propensity score analysis
Resection vs. ablation for alpha-fetoprotein positive hepatocellular carcinoma within the Milan criteria: a propensity score analysis
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米兰标准内甲胎蛋白阳性肝细胞癌的切除与消融：倾向评分分析
DOI：
10.1111/liv.13166
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发表时间：
2016-11-01
影响因子：
6.7
通讯作者：
Yuan, Yunfei
中科院分区：
文献类型：
--
作者：
He, Wei;Li, Binkui;Yuan, Yunfei
背景与目的肝细胞癌（HCC）消融治疗中由于缺乏组织病理学确诊，有时会将良性肝结节误诊为HCC，导致治疗效果不佳。这个被低估的问题是为什么与肝切除术相比，消融术的疗效仍然不确定的原因之一。我们的目的是比较消融术和切除术的疗效为肝癌米兰标准后，排除误诊的影响。MethodsAlpha-fetoprotein > 200 ng/ml作为一个纳入标准，以提高诊断准确性。共入组435例符合米兰标准且无门脉高压的HCC患者（切除310例;消融125例）。倾向分数匹配分析确定了259个（切除术，150;结果匹配前，切除组5年生存率为77.6%，优于消融组的53.8%，两组比较差异有上级意义5年无复发生存率（RFS）分别为57.2%和29.1%（P < 0.001）。匹配后，两组之间的基线平衡良好。切除组和消融组的5年OS率分别为71.5%和51.3%（P < 0.001），5年RFS率分别为56.1%和25.6%（P < 0.001）。考克斯回归分析确定消融术作为死亡率和肿瘤复发的独立预测因子（HR：2.123和2.308，分别为P < 0.01）。结论肝切除术提供了更好的OS和RFS比消融术甲胎蛋白阳性肝癌患者在米兰标准，没有门静脉高压症。
Background & AimsThe lack of histopathological confirmation of hepatocellular carcinoma (HCC) diagnosis for patients receiving ablation may result in misdiagnosis of benign liver nodule as HCC occasionally, contributing to false treatment efficacy. This underestimated issue is one reason why the ablation efficacy remains undetermined compared with hepatic resection. Our aim is to compare the efficacy of ablation and resection for HCC within the Milan criteria after excluding the impact of misdiagnosis.MethodsAlpha-fetoprotein > 200 ng/ml was introduced as an inclusion criterion to improve diagnosis accuracy. A total of 435 (resection, 310; ablation, 125) HCC patients within the Milan criteria and without portal hypertension were enrolled. Propensity score matching analysis identified 259 (resection, 150; ablation, 109) patients to compare treatment efficacy.ResultsBefore matching, the survival of resection group were superior to ablation group with 5-year overall survival (OS) rate of 77.6% vs. 53.8% (P < 0.001), respectively, and 5-year recurrence-free survival (RFS) rate of 57.2% vs. 29.1% (P < 0.001) respectively. After matching, the baseline was well-balanced between the two groups. The 5-year OS rates were 71.5% vs. 51.3% (P < 0.001), and 5-year RFS rates were 56.1% vs. 25.6% (P < 0.001) for the resection and ablation groups respectively. Cox regression analysis identified ablation as an independent predictor for mortality and tumour recurrence (HR: 2.123 and 2.308, respectively; both P < 0.01).ConclusionsHepatic resection provides better OS and RFS than ablation for alpha-fetoprotein positive HCC patients within the Milan criteria and without portal hypertension.