USD di Chirurgia Epato-bilio-pancreatica, Ospedale Classificato San Giuseppe, Milanocuore SpA, Milan, Italy.
Ann Surg Oncol. 2009 Dec;16(12):3289-98. doi: 10.1245/s10434-009-0678-z. Epub 2009 Sep 1.
This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis.
We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean +/- standard deviation, 36.2 +/- 23.5 months for HR vs. 38.2 +/- 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival.
Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor.
Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.
本研究比较了两组同质的患者，一组接受手术切除（HR），另一组接受腹腔镜射频消融（LRFA）治疗肝细胞癌（HCC）。当与肝功能储备兼容时，HR 仍然是 HCC 的治疗选择，而 LRFA 似乎是一种有前途的、创伤较小的替代方法。因此，我们比较了 HR 或 LRFA 治疗单个 HCC 结节和 Child-Pugh 分级 A 肝硬化患者的短期和长期结果。
我们从 372 例连续评估 HCC 的病例中纳入了 152 例肝硬化患者。具有相似基线特征的入组患者接受 HR（n=78）或 LRFA（n=74）治疗，两种情况下均进行术中超声检查，然后进行相似时间的随访（HR 为 36.2+/-23.5 个月，LRFA 为 38.2+/-28.4 个月）。结果包括短期和长期发病率、HCC 复发和总生存率。
HR 组的短期发病率明显更高，而在随访期间，LRFA 治疗的患者 HCC 复发（主要是局部）更为频繁。更重要的是，基线甲胎蛋白水平和治疗后 HCC 早期复发极大地影响了总生存率，而 HR 或 LRFA 的使用并不能预测它。另一方面，HCC 复发取决于手术方法和肿瘤的超声特征。
我们的数据来自大量 HCC 病例，支持在 Child-Pugh 分级 A 肝硬化的单个 HCC 结节中，HR 或 LRFA 治疗后具有相似的生存率，尽管 LRFA 后 HCC 复发率显著增加。
