Division of Gastroenterology, Oregon Health and Science University, Portland, OR; and Portland VA Medical Center, Portland, OR 97239, USA.
Liver Transpl. 2010 Oct;16(10):1186-94. doi: 10.1002/lt.22129.
The aim of the present study is to compare the survival rates and cost-effectiveness of different treatment strategies for small (<2 cm) hepatocellular carcinoma (HCC). Markov chains are developed to model different management strategies for patients with compensated cirrhosis and small HCC. Probabilities of progression and survival and the likelihood of orthotopic liver transplantation are taken from the literature and incorporated into the models. As a starting population, 1000 patients are followed over a period of 10 years. Patients treated immediately with transarterial chemoembolization (TACE) or radiofrequency ablation (RFA) live as long as or longer than patients who are monitored expectantly with the intention of liver transplantation once the HCC has grown larger than 2 cm and a higher transplant priority score becomes available. With TACE, immediate treatment results in an average survival time of 4.269 years versus 4.324 years with the monitoring strategy. With RFA, immediate treatment results in an average survival time of 5.273 years versus 5.236 years with the monitoring strategy. In addition, the cost analysis shows that immediate treatment with either TACE or RFA is less expensive than monitoring. The better cost-effectiveness of immediate therapy versus the monitoring strategy remains robust and unaffected by variations of the assumptions built into the model. In conclusion, in patients with compensated cirrhosis and small HCC, a strategy of immediate treatment with either TACE or RFA prevails over a strategy of expectant monitoring with the intention of transplantation.
本研究旨在比较不同治疗策略对小肝癌（HCC）患者的生存率和成本效益。采用马尔可夫链对代偿性肝硬化和小 HCC 患者的不同管理策略进行建模。进展和生存的概率以及原位肝移植的可能性均来自文献，并纳入模型中。作为起始人群，对 1000 名患者进行了 10 年的随访。立即接受经动脉化疗栓塞（TACE）或射频消融（RFA）治疗的患者与期望监测的患者一样长寿，监测策略是在 HCC 增大至 2 cm 以上且移植优先级评分更高时进行。采用 TACE，即刻治疗的平均生存时间为 4.269 年，而监测策略为 4.324 年。采用 RFA，即刻治疗的平均生存时间为 5.273 年，而监测策略为 5.236 年。此外，成本分析表明，TACE 或 RFA 即刻治疗比监测更便宜。即刻治疗与监测策略相比的更好成本效益仍然稳健，不受模型中内置假设变化的影响。总之，对于代偿性肝硬化和小 HCC 患者，TACE 或 RFA 的即刻治疗策略优于移植意向的期望监测策略。
