Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
Eur J Gastroenterol Hepatol. 2014 Mar;26(3):339-44. doi: 10.1097/MEG.0000000000000012.
The aim of our study was to compare the short-term and long-term outcomes of resection and radiofrequency ablation (RFA) in cases of very early hepatocellular carcinoma (HCC) (tumors<2 cm in diameter).
Between July 2003 and August 2008, 52 patients were diagnosed as very early HCC (≤2 cm), of whom 21 received a liver resection and 31 underwent RFA. We compared the baseline characteristics, the intraoperative data, and the recovery metrics between these two groups including postoperative complications and the 1-, 3-, and 5-year overall and tumor-free survival rates.
No statistically significant differences were observed in the baseline characteristics between very early HCC patients allocated to the liver resection group and those in the RFA group. The liver function in the liver resection group was better than that of the RFA group with respect to the Child score (P=0.004), but not the model for end-stage liver disease score (P=0.066). More tumor targets were located in the center of the liver (compared with the periphery) in the RFA group (P=0.003). The RFA patients showed much shorter operative times, less blood loss, and had shorter hospital stays than the resection group but had a much higher overall cost (all P=0.000). The 1-, 3-, and 5-year overall survival rates were 95.2, 85.7, and 81.0%, respectively, for the liver resection group, and 93.5, 90.3, and 80.6%, respectively, for the RFA group (P=0.976). The 1-, 3-, and 5-year tumor-free survival rates were 90.5, 81.0, and 76.2%, respectively, in the resection group and 90.3, 83.9, and 71.0%, respectively, in the RFA group (P=0.830).
With comparable short-term and long-term effects on overall survival and tumor recurrence rate and with a shorter operative time, less blood loss, and a shorter hospital stay, RFA should be considered as the first choice for the treatment for very early HCCs as it presents an efficacious and economic option.
本研究旨在比较早期肝细胞癌（HCC）（肿瘤直径<2cm）患者行切除术与射频消融术（RFA）的短期和长期疗效。
2003 年 7 月至 2008 年 8 月，52 例患者被诊断为非常早期 HCC（≤2cm），其中 21 例行肝切除术，31 例行 RFA。我们比较了两组患者的基线特征、术中数据和恢复指标，包括术后并发症以及 1、3 和 5 年的总生存率和无瘤生存率。
行肝切除术组与 RFA 组患者的基线特征无统计学差异。肝功能方面，Child 评分（P=0.004）优于 RFA 组，而模型终末期肝病评分（P=0.066）无差异。RFA 组更多的肿瘤靶病灶位于肝脏中央（与外周相比）（P=0.003）。RFA 组的手术时间更短、术中出血量更少、住院时间更短，但总费用更高（均 P=0.000）。肝切除术组的 1、3 和 5 年总生存率分别为 95.2%、85.7%和 81.0%，RFA 组分别为 93.5%、90.3%和 80.6%（P=0.976）。肝切除术组的 1、3 和 5 年无瘤生存率分别为 90.5%、81.0%和 76.2%，RFA 组分别为 90.3%、83.9%和 71.0%（P=0.830）。
RFA 在短期和长期的总体生存率和肿瘤复发率方面具有可比性，且手术时间更短、术中出血量更少、住院时间更短，作为治疗非常早期 HCC 的首选方法，RFA 是一种有效且经济的选择。
