米兰标准内肝细胞癌患者射频消融联合经动脉化疗栓塞术与肝切除术的比较：一项回顾性病例对照研究
Radiofrequency ablation combined with transarterial chemoembolization versus hepatectomy for patients with hepatocellular carcinoma within Milan criteria: a retrospective case-control study.
作者信息
Bholee A K, Peng K, Zhou Z, Chen J, Xu L, Zhang Y, Chen M
机构信息
Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
出版信息
Clin Transl Oncol. 2017 Jul;19(7):844-852. doi: 10.1007/s12094-016-1611-0. Epub 2017 Jan 9.
PROPOSAL
To compare the effectiveness of TACE + RFA with hepatectomy in patients with HCC within Milan criteria.
METHODS
It is a retrospective matched case-control study from January 2006 to December 2010 in a tertiary cancer center. 74 patients with HCC within Milan criteria initially treated with TACE + RFA were identified and compared with 148 matched controls selected from a pool of 782 patients who received hepatectomy. Patients were matched with respect to age, gender, tumor size and number, AFP and liver function test.
RESULTS
The 1, 3, and 5 years overall survival (OS) was 94.6, 75.1 and 55.3%, respectively, in the combination group, and 91.2, 64.4, and 47.7%, respectively, in the hepatectomy group (P = 0.488). The 1, 3, and 5 years disease-free survival (DFS) in the combination group was 87.8, 48.3, and 33.5%, respectively, and 68.9, 49.2, and 40.9%, respectively, in the hepatectomy group (P = 0.619). In subgroups analyses according to the tumor size and number, no significant difference was identified in either OS or DFS for patients with single tumor smaller than 3.0 cm, 3.0-5.0 cm, and multiple tumors. Multivariate analysis showed that tumor size, ALT, and CLIP score were significant prognostic factors for OS, and ALT and Child-Pugh class were significant prognostic factors for DFS.
CONCLUSION
TACE + RFA is safe and as effective as hepatectomy for patients with HCC within Milan criteria.
研究目的
比较经动脉化疗栓塞术（TACE）联合射频消融术（RFA）与肝切除术治疗符合米兰标准的肝癌患者的疗效。
方法
这是一项在某三级癌症中心进行的回顾性配对病例对照研究，研究时间为2006年1月至2010年12月。确定了74例最初接受TACE + RFA治疗且符合米兰标准的肝癌患者，并与从782例行肝切除术的患者中选出的148例配对对照进行比较。患者在年龄、性别、肿瘤大小和数量、甲胎蛋白（AFP）及肝功能检查方面进行了配对。
结果
联合治疗组1年、3年和5年总生存率（OS）分别为94.6%、75.1%和55.3%，肝切除组分别为91.2%、64.4%和47.7%（P = 0.488）。联合治疗组1年、3年和5年无病生存率（DFS）分别为87.8%、48.3%和33.5%，肝切除组分别为68.9%、49.2%和40.9%（P = 0.619）。在根据肿瘤大小和数量进行的亚组分析中，对于单个肿瘤小于3.0 cm、3.0 - 5.0 cm以及多个肿瘤的患者，OS和DFS均未发现显著差异。多因素分析显示，肿瘤大小、丙氨酸氨基转移酶（ALT）和癌症分期评分（CLIP）是OS的显著预后因素，ALT和Child-Pugh分级是DFS的显著预后因素。
结论
对于符合米兰标准的肝癌患者，TACE + RFA安全且与肝切除术疗效相当。
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