Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, Italy.
HPB (Oxford). 2007;9(6):429-34. doi: 10.1080/13651820701713758.
The optimal therapy for hepatocellular carcinoma (HCC) is transplantation. For all those patients not eligible for transplantation (or on the waiting list) among the treatments of choice used more frequently in recent years are resection (RES) and radiofrequency ablation (RFA). RFA is less efficacious for HCC ranging over 3 cm. The aim of this study was to compare RFA to RES in a restricted cohort of patients with a single naive HCC ranging from 3 to 5 cm in size and without end-stage liver disease. PATIENTS AND METHODS. A total of 102 patients who had never been treated before were enrolled. Those patients whose HCC position would have required too much parenchymal loss at RES (central or close to main vascular structures) were treated with RFA (n=60), and the others underwent RES (n=42). The two groups were similar for HCC size and liver disease status. The outcome was considered in terms of overall survival (OS) and disease-free survival (DFS) calculated by the Kaplan-Meier method. Differences among groups were validated by log-rank test.
The RES group seemed to present a better long-term OS (91%, 57%, and 43% vs 96%, 53%, and 32% at 1, 3, and 5 years, respectively) and DFS (74%, 35%, and 14% vs 68%, 18%, and 0%, respectively) but there was no statistical significance. Age, gender, virus etiology, HCC size and alpha-fetoprotein levels did not correlate with survival. Patients with recurrence within the first 12 months after treatment showed a worse long-term survival (p=0.011). Patients in Child-Pugh class B had poor prognoses compared with those in class A (p=0.047).
Even if RES seemed to promise better long-term results, in the medium term this difference had no statistical significance. Survival in this series was more closely related to the stage of the underlying liver disease than to treatment (RES/RFA).
肝细胞癌（HCC）的最佳治疗方法是移植。对于近年来选择使用的治疗方法中不适合移植（或在等待名单上）的所有患者，切除（RES）和射频消融（RFA）更为常见。对于直径超过 3 厘米的 HCC，RFA 的效果较差。本研究的目的是在一组大小为 3 至 5 厘米且无终末期肝病的单一初发 HCC 受限患者中比较 RFA 与 RES。
患者和方法。共纳入 102 例从未接受过治疗的患者。那些 HCC 位置需要在 RES 中切除过多实质（中央或靠近主要血管结构）的患者接受 RFA 治疗（n=60），而其他患者接受 RES 治疗（n=42）。两组 HCC 大小和肝病状况相似。通过 Kaplan-Meier 法计算总生存（OS）和无病生存（DFS）来评估结果。通过对数秩检验验证组间差异。
RES 组的长期 OS（1、3 和 5 年时分别为 91%、57%和 43%与 96%、53%和 32%）和 DFS（74%、35%和 14%与 68%、18%和 0%）似乎更好，但无统计学意义。年龄、性别、病毒病因、HCC 大小和甲胎蛋白水平与生存无关。治疗后 12 个月内复发的患者长期生存率较差（p=0.011）。Child-Pugh 分级为 B 的患者预后较 A 级患者差（p=0.047）。
即使 RES 似乎预示着更好的长期结果，但在中期，这种差异无统计学意义。本系列的生存与潜在肝病的阶段更密切相关，而与治疗（RES/RFA）关系不大。
