Wakai Toshifumi, Shirai Yoshio, Suda Takeshi, Yokoyama Naoyuki, Sakata Jun, Cruz Pauldion V, Kawai Hirokazu, Matsuda Yasunobu, Watanabe Masashi, Aoyagi Yutaka, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
World J Gastroenterol. 2006 Jan 28;12(4):546-52. doi: 10.3748/wjg.v12.i4.546.
To determine which treatment modality--hepatectomy or percutaneous ablation--is more beneficial for patients with small hepatocellular carcinoma (HCC) (< or =4 cm) in terms of long-term outcomes.
A retrospective analysis of 149 patients with HCC < or =4 cm was conducted. Eighty-five patients underwent partial hepatectomy (anatomic in 47 and non-anatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6). The median follow-up period was 69 mo.
Hepatectomy was associated with larger tumor size (P<0.001), whereas percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent following hepatectomy (P<0.0001). Survival was better following hepatectomy (median survival time: 122 mo) than following percutaneous ablation (median survival time: 66 mo; P=0.0123). When tumor size was divided into < or =2 cm vs >2 cm, the favorable effects of hepatectomy on long-term survival was seen only in patients with tumors>2 cm (P=0.0001). The Cox proportional hazards regression model revealed that hepatectomy (P=0.006) and tumors < or =2 cm (P=0.017) were independently associated with better survival.
Hepatectomy provides both better local control and better long-term survival for patients with HCC < or =4 cm compared with percutaneous ablation. Of the patients with HCC < or =4 cm, those with tumors >2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits resection.
从长期预后角度确定哪种治疗方式——肝切除术或经皮消融术——对小肝细胞癌（HCC）（≤4 cm）患者更有益。
对149例HCC≤4 cm的患者进行回顾性分析。85例患者接受了部分肝切除术（47例为解剖性肝切除，38例为非解剖性肝切除），64例接受了经皮消融术（37例为经皮乙醇注射，21例为射频消融，6例为微波凝固）。中位随访期为69个月。
肝切除术与更大的肿瘤大小相关（P<0.001），而经皮消融术与肝功能储备受损显著相关。肝切除术后局部复发较少见（P<0.0001）。肝切除术后的生存率更好（中位生存时间：122个月），优于经皮消融术（中位生存时间：66个月；P=0.0123）。当将肿瘤大小分为≤2 cm与>2 cm时，肝切除术对长期生存的有利影响仅在肿瘤>2 cm的患者中可见（P=0.0001）。Cox比例风险回归模型显示，肝切除术（P=0.006）和肿瘤≤2 cm（P=0.017）与更好的生存率独立相关。
与经皮消融术相比，肝切除术为HCC≤4 cm的患者提供了更好的局部控制和更长的长期生存率。在HCC≤4 cm的患者中，肿瘤>2 cm的患者是肝切除术的良好候选者，前提是患者的肝功能储备允许进行切除。
