Orimo Tatsuya, Kamiyama Toshiya, Yokoo Hideki, Wakayama Kenji, Shimada Shingo, Einama Takahiro, Kamachi Hirofumi, Taketomi Akinobu
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Dig Surg. 2018;35(5):427-434. doi: 10.1159/000480521. Epub 2017 Sep 14.
AIM: We aimed to evaluate the short- and long-term surgical outcomes of salvage hepatectomy for recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) and/or transcatheter arterial chemoembolization (TACE). METHODS: We reviewed the surgical outcomes of 90 recurrent HCC patients after RFA and/or TACE (salvage group) and 490 HCC patients without preoperative treatment (primary group). We performed 1:1 propensity score matching (PSM) between the 2 groups and matched 87 patients in each group. RESULTS: Before PSM, the salvage group was pathologically more advanced than the primary group. After PSM, there were no significant differences in the clinicopathological features between the groups. The outcomes of propensity score-matched groups were compared and there was no statistically significant difference between the 2 groups regarding perioperative outcomes and survival. Univariate and multivariate analyses of propensity score-matched HCC patients revealed that stage, tumor size, differentiation, and portal vein invasion were independent prognostic factors for survival. Preoperative RFA and/or TACE was not a prognostic factor in a propensity score-matched cohort. CONCLUSIONS: The short- and long-term surgical outcomes of the primary and salvage groups were similar under the matched clinicopathological background. Salvage hepatectomy might be an acceptable treatment for recurrent HCC patients after RFA and/or TACE.
目的:我们旨在评估经射频消融(RFA)和/或经动脉化疗栓塞(TACE)后复发肝细胞癌(HCC)挽救性肝切除的短期和长期手术效果。 方法:我们回顾了90例RFA和/或TACE术后复发HCC患者(挽救组)以及490例未接受术前治疗的HCC患者(原发组)的手术效果。我们在两组之间进行了1:1倾向评分匹配(PSM),每组匹配87例患者。 结果:在PSM之前,挽救组在病理上比原发组更晚期。PSM之后,两组之间的临床病理特征无显著差异。比较倾向评分匹配组的结果,两组在围手术期结局和生存率方面无统计学显著差异。对倾向评分匹配的HCC患者进行单因素和多因素分析显示,分期、肿瘤大小、分化程度和门静脉侵犯是生存的独立预后因素。术前RFA和/或TACE在倾向评分匹配队列中不是预后因素。 结论:在匹配的临床病理背景下,原发组和挽救组的短期和长期手术效果相似。挽救性肝切除可能是RFA和/或TACE术后复发HCC患者的一种可接受的治疗方法。
World J Gastrointest Surg. 2024-6-27