Guan Tian-Pei, Fang Chi-Hua, Yang Jian, Xiang Nan, Chen Qing-Shan, Zhong Shi-Zhen
Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
The Clinical Anatomy Institute, Southern Medical University, Guangzhou, Guangdong 510515, China.
Biomed Res Int. 2016;2016:8931732. doi: 10.1155/2016/8931732. Epub 2016 May 12.
Background. Treatment selection for small hepatocellular carcinoma (sHCC) is controversial. We aimed to compare the outcomes of medical imaging three-dimensional visualization system (MI-3DVS) guided surgical resection (SR) and ultrasonography guided radiofrequency ablation (RFA) for sHCC. Methods. In total, 194 patients who underwent SR or RFA in our hospital between January 2006 and May 2010 were retrospectively enrolled. Overall survival (OS), recurrence-free survival (RFS), and postoperative complications were compared. Cox regression was used to estimate the benefits of MI-3DVS-guided SR on OS and RFS. Results. Ninety-two patients underwent SR and 102 underwent RFA. The SR group experienced more complications (41.3% versus 19.6%) and longer hospital stay (18.04 ± 7.11 versus 13.06 ± 5.59) (both p < 0.05). The 1-, 2-, 3-, 4-, and 5-year OS was 96.7%, 95.7%, 93.5%, 83.5%, and 61.1% in the SR group and 95.0%, 88.1%, 72.7%, 56.9%, and 39.5% in the RFA group. Corresponding RFS was 95.7%, 94.6%, 84.7%, 59.8%, and 40.2% in SR group and 91.2%, 80.3%, 60.5%, 32.3%, and 22.3% in RFA group. The 5-year OS and RFS were higher in SR group (both p < 0.001). Interestingly, there was no significance in OS and RFS among subgroups aged >60 years. Independent predictors of OS and RFS, respectively, were intervention (HR, 2.769 and 1.933), tumor number (HR, 5.128 and 3.903), and serum alpha-fetoprotein (AFP) (HR, 1.871 and 1.474) (all p < 0.05). Conclusions. MI-3DVS based hepatectomy should be considered primary treatment while RFA can be treated as alternative therapy for older patients. Intervention, tumor number, and AFP are independent predictors for both survival and recurrence.
背景。小肝细胞癌（sHCC）的治疗选择存在争议。我们旨在比较医学影像三维可视化系统（MI-3DVS）引导下的手术切除（SR）与超声引导下的射频消融（RFA）治疗sHCC的疗效。方法。回顾性纳入2006年1月至2010年5月间在我院接受SR或RFA治疗的194例患者。比较总生存期（OS）、无复发生存期（RFS）和术后并发症。采用Cox回归分析评估MI-3DVS引导下的SR对OS和RFS的益处。结果。92例患者接受了SR，102例接受了RFA。SR组并发症更多（41.3%对19.6%），住院时间更长（18.04±7.11对13.06±5.59）（均p<0.05）。SR组1年、2年、3年、4年和5年的OS分别为96.7%、95.7%、93.5%、83.5%和61.1%，RFA组分别为95.0%、88.1%、72.7%、56.9%和39.5%。SR组相应的RFS分别为95.7%、94.6%、84.7%、59.8%和40.2%，RFA组分别为91.2%、80.3%、60.5%、32.3%和22.3%。SR组的5年OS和RFS更高（均p<0.001）。有趣的是，年龄>60岁的亚组在OS和RFS方面无显著差异。OS和RFS的独立预测因素分别为治疗方式（HR分别为2.769和1.933）、肿瘤数量（HR分别为5.128和3.903）和血清甲胎蛋白（AFP）（HR分别为1.871和1.474）（均p<0.05）。结论。基于MI-3DVS的肝切除术应被视为主要治疗方法，而RFA可作为老年患者的替代治疗。治疗方式、肿瘤数量和AFP是生存和复发的独立预测因素。
