Division of Surgical Oncology, Department of Surgery, Medical College of WI, Milwaukee, WI, USA.
Ann Surg Oncol. 2013 Oct;20(11):3591-5. doi: 10.1245/s10434-013-3031-5. Epub 2013 May 30.
Although many previous studies on local ablation outcomes for hepatocellular carcinoma (HCC) have dichotomized tumor size with a 3-cm cutoff to determine prognostic significance, a growing number of reports describe excellent outcomes for larger tumors. To address the logic of this 3-cm cutoff beyond small single-center experiences, we stratified patients by 1-cm tumor size intervals and hypothesized that disease-specific survival (DSS) would not vary significantly between adjacent groups.
Patients treated with local ablation for T1 HCC (≤8 cm) were identified from the surveillance, epidemiology, and end results database (2004-2008). Log-rank tests and multivariable Cox proportional hazards models were used to compare DSS curves of adjacent study groups.
There were 1,083 patients included in the study (26 % female, median age: 62 years). The 3-year DSS was significantly lower in patients with 3- to 4-cm tumors compared to 2- to 3-cm tumors (58 vs. 72 %, p = 0.002). In adjusted models, DSS did not vary significantly between any size intervals up to 3 cm. Patients with 3- to 4-cm tumors, however, had a poorer prognosis compared with patients with 2- to 3-cm tumors (hazard ratio: 1.6, 95 % confidence interval: 1.18-2.18, p = 0.002). DSS also fell when tumor size increased from 5-6 to 6-7 cm (53 vs. 21 %, 0.006).
This study emphasizes the 3-cm size, and possibly the 6-cm size, as informative predictive thresholds when ablating HCC, because variability of DSS occurred specifically at these tumor sizes. Future research in this field should either adopt a 3-cm breakpoint or provide evidence for alternative thresholds.
虽然许多先前关于肝细胞癌（HCC）局部消融治疗结果的研究将肿瘤大小分为 3cm 作为截断值以确定预后意义，但越来越多的报告描述了较大肿瘤的优异结果。为了解决这个 3cm 截断值的逻辑问题，我们不仅限于小的单一中心经验，而是根据肿瘤大小每隔 1cm 进行分层，并假设疾病特异性生存率（DSS）在相邻组之间不会有显著差异。
从监测、流行病学和最终结果数据库（2004-2008 年）中确定接受局部消融治疗 T1 HCC（≤8cm）的患者。采用对数秩检验和多变量 Cox 比例风险模型比较相邻研究组的 DSS 曲线。
研究共纳入 1083 例患者（26%为女性，中位年龄为 62 岁）。与 2-3cm 肿瘤相比，3-4cm 肿瘤患者的 3 年 DSS 显著降低（58% vs. 72%，p=0.002）。在调整后的模型中，DSS 在任何大小间隔至 3cm 之间均无显著差异。然而，3-4cm 肿瘤患者的预后明显不如 2-3cm 肿瘤患者（风险比：1.6，95%置信区间：1.18-2.18，p=0.002）。当肿瘤大小从 5-6cm 增加到 6-7cm 时，DSS 也下降（53% vs. 21%，0.006）。
这项研究强调了 3cm 大小，可能还有 6cm 大小，作为消融 HCC 时的信息预测阈值，因为 DSS 的变化仅发生在这些肿瘤大小。该领域的未来研究应采用 3cm 截断值或提供替代阈值的证据。
