Liver transplantation versus surgical resection for HCC meeting the Milan criteria: A propensity score analysis.
Liver transplantation versus surgical resection for HCC meeting the Milan criteria: A propensity score analysis.
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DOI：
10.1097/md.0000000000005756
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发表时间：
2016-12
期刊：
影响因子：
1.6
通讯作者：
Nazar Highness T
中科院分区：
文献类型：
--
作者：
Shen JY;Li C;Wen TF;Yan LN;Li B;Wang WT;Yang JY;Xu MQ;Nazar Highness T
早期肝细胞癌（HCC）的最佳治疗方法（肝移植[LT]还是手术切除[SR]）仍存在争议。在我院共发现209例SR患者和129例LT患者。在排除27例Child-Pugh C患者后，使用倾向评分匹配（PSM）模型分析209例SR患者和102例LT患者的数据。总共产生了46对。根据甲胎蛋白（AFP）水平或血小板计数（PLT）进行亚组分析。采用Kaplan-Meier法进行生存分析。性别、伴发病变和治疗方法是HCC复发的预测因素。Ishak评分和治疗方法与术后长期生存相关。在PSM之前，LT患者的预后比接受SR治疗的患者更好。在儿童期a /B肝硬化的HCC患者中，PSM后，SR与LT相比获得了相似的总生存结果。无论有无血小板减少患者，LT和SR的长期生存率相当。AFP≥400 ng/mL的患者可能从lt中获得更多的生存益处。我们的倾向评分模型提供的证据表明，与移植相比，手术切除可导致可切除的早期HCC患者的长期生存率相当，但AFP≥400 ng/mL的HCC亚组除外。手术切除可能不是早期HCC合并血小板减少患者的禁忌症，因为他们在移植后的预后相似。
The optimal treatment (liver transplantation [LT] vs surgical resection [SR]) for early-stage hepatocellular carcinoma (HCC) remains controversial. A total of 209 SR patients and 129 LT patients were identified at our institution. After eliminating 27 patients with Child–Pugh C, the data from 209 SR patients and 102 LT patients were analyzed using a propensity score matching (PSM) model. Forty-six pairs were generated. A subgroup analysis was conducted based on the alpha-fetoprotein (AFP) level or platelet count (PLT). A survival analysis was performed using the Kaplan–Meier method. Gender, satellite lesions, and the treatment method were predictors of HCC recurrence. The Ishak score and treatment methods were associated with long-term survival after surgery. Before PSM, LT patients had a better prognosis than those treated by SR. Among HCC patients with childhood A/B cirrhosis, after PSM, SR achieved similar overall survival outcomes compared with LT. LT and SR resulted in comparable long-term survival for patients with or without thrombocytopenia. Patients with an AFP ≥ 400 ng/mL might achieve more survival benefits from LT. Our propensity score model provided evidence that, compared with transplantation, surgical resection could result in comparable long-term survival for resectable early-stage HCC patients, except for the AFP ≥ 400 ng/mL HCC subgroup. Surgical resection might not be a contraindication for early-stage HCC patients with thrombocytopenia due to their similar prognosis after transplantation.