切除与消融治疗肝细胞癌的比较：基于日本全国性调查的队列研究。

Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey.

机构信息

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.

出版信息

J Hepatol. 2013 Apr;58(4):724-9. doi: 10.1016/j.jhep.2012.11.009. Epub 2012 Nov 21.

DOI:10.1016/j.jhep.2012.11.009

PMID:23178708

Abstract

BACKGROUND & AIMS: The treatment of choice for early or moderately advanced hepatocellular carcinoma (HCC) with good liver function remains controversial. We evaluated the therapeutic impacts of surgical resection (SR), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) on long-term outcomes in patients with HCC.

METHODS

A database constructed on the basis of a Japanese nationwide survey of 28,510 patients with HCC treated by SR, PEI, or RFA between 2000 and 2005 was used to identify 12,968 patients who had no more than 3 tumors (≤ 3 cm) and liver damage of class A or B. The patients were divided into SR (n=5361), RFA (n=5548), and PEI groups (n=2059). Overall survival and time to recurrence were compared among them.

RESULTS

Median follow-up was 2.16 years. Overall survival at 3 and 5 years was respectively 85.3%/71.1% in the SR group, 81.0%/61.1% in the RFA, and 78.9%/56.3% in the PEI. Time to recurrence at 3 and 5 years was 43.3%/63.8%, 57.2%/71.7%, and 64.3%/76.9%, respectively. On multivariate analysis, the hazard ratio for death was significantly lower in the SR group than in the RFA (SR vs. RFA:0.84, 95% confidence interval, 0.74-0.95; p=0.006) and PEI groups (SR vs. PEI:0.75, 0.64-0.86; p=0.0001). The hazard ratios for recurrence were also lower in the SR group than in the RFA (SR vs. RFA:0.74, 0.68-0.79; p=0.0001) and PEI groups (SR vs. PEI:0.59, 0.54-0.65; p=0.0001).

CONCLUSIONS

Our findings suggest that surgical resection results in longer overall survival and time to recurrence than either RFA or PEIin patients with HCC [corrected].

摘要

背景与目的

对于肝功能良好的早期或中期进展性肝细胞癌（HCC），其首选治疗方法仍存在争议。我们评估了手术切除（SR）、经皮乙醇注射（PEI）和射频消融（RFA）对 HCC 患者长期预后的治疗影响。

方法

利用基于 2000 年至 2005 年期间接受 SR、PEI 或 RFA 治疗的 28510 例 HCC 患者的日本全国性调查建立的数据库，确定了 12968 例无 3 个以上肿瘤（≤3cm）且肝功能为 A 级或 B 级的患者。将患者分为 SR（n=5361）、RFA（n=5548）和 PEI 组（n=2059）。比较它们之间的总生存时间和复发时间。

结果

中位随访时间为 2.16 年。SR 组的 3 年和 5 年总生存率分别为 85.3%/71.1%，RFA 组分别为 81.0%/61.1%，PEI 组分别为 78.9%/56.3%。3 年和 5 年的复发时间分别为 43.3%/63.8%、57.2%/71.7%和 64.3%/76.9%。多变量分析显示，SR 组的死亡风险显著低于 RFA 组（SR 与 RFA：0.84，95%置信区间，0.74-0.95；p=0.006）和 PEI 组（SR 与 PEI：0.75，0.64-0.86；p=0.0001）。SR 组的复发风险也低于 RFA 组（SR 与 RFA：0.74，0.68-0.79；p=0.0001）和 PEI 组（SR 与 PEI：0.59，0.54-0.65；p=0.0001）。