Min J H, Kang T W, Cha D I, Song K D, Lee M W, Rhim H, Sinn D H, Kim J M, Sohn I
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Radiol. 2018 Jul;73(7):676.e15-676.e24. doi: 10.1016/j.crad.2018.02.007. Epub 2018 Apr 27.
To assess the long-term therapeutic outcomes of radiofrequency ablation (RFA) versus surgical resection (SR) as a first-line treatment for patients meeting the Milan criteria with multiple hepatocellular carcinomas (HCCs).
This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. Between January 2004 and December 2009, among 3,441 patients with treatment-naive HCCs, 88 patients meeting the Milan criteria with multiple HCCs (Barcelona Clinic Liver Cancer [BCLC] A stage) who underwent either RFA (n=62) or SR (n=26) were included. Recurrence-free survival (RFS) and overall survival (OS) rates were compared by using propensity score matching. In addition, multivariate analysis was performed for assess the prognostic factor.
Matching yielded 20 matched pairs of patients. In the two matched groups, the RFS rates were 30% and 30% at 5- and 10-years, respectively, in the RFA group and 60% and 48.6% in the SR group (p=0.054). The corresponding OS rates were 63.3% and 46.1% in the RFA group and 100% and 73.6% in the SR group, respectively (p=0.061). In multivariate analysis, treatment type was independently associated with RFS (hazard ratio [HR]=0.51; p=0.043) whereas it was not a statistically significant factor for OS (HR=0.50; p=0.088).
In patients meeting the Milan criteria with multiple HCCs (BCLC A stage), SR may provide better RFS compared to RFA.
评估射频消融（RFA）与手术切除（SR）作为符合米兰标准的多发性肝细胞癌（HCC）患者一线治疗的长期治疗效果。
本回顾性研究经机构审查委员会批准，无需知情同意。2004年1月至2009年12月期间，在3441例未经治疗的HCC患者中，纳入了88例符合米兰标准的多发性HCC（巴塞罗那临床肝癌[BCLC] A期）患者，他们接受了RFA（n = 62）或SR（n = 26）治疗。采用倾向评分匹配法比较无复发生存率（RFS）和总生存率（OS）。此外，进行多因素分析以评估预后因素。
匹配产生了20对匹配患者。在两个匹配组中，RFA组5年和10年的RFS率分别为30%和30%，SR组分别为60%和48.6%（p = 0.054）。相应的OS率在RFA组中分别为63.3%和46.1%，在SR组中分别为100%和73.6%（p = 0.061）。在多因素分析中，治疗类型与RFS独立相关（风险比[HR]=0.51；p = 0.043），而对于OS不是统计学显著因素（HR = 0.50；p = 0.088）。
在符合米兰标准的多发性HCC（BCLC A期）患者中，与RFA相比，SR可能提供更好的RFS。
