Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, United States; Newton Wellesley Hospital, Newton, MA, 02462, United States.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States.
Am J Surg. 2019 Jul;218(1):157-163. doi: 10.1016/j.amjsurg.2018.12.067. Epub 2019 Jan 3.
The most appropriate treatment for early-stage hepatocellular carcinoma (HCC) remains unclear. This study compared the association of resection versus ablation with overall survival (OS) in patients with early-stage HCC.
Using the National Cancer Database (NCDB), patients diagnosed with stage I/II HCC between 2004 and 2014 were identified. Cox analysis was used to determine predictors of OS.
We identified 53,161 patients, of whom 15.9% underwent ablation and 14.5% underwent resection. Patients with fewer comorbidities, larger tumors, and private insurance were more likely to undergo resection. Resection was associated with significantly improved OS compared to ablation (HR 0.58, 95% CI 0.54-0.61, p < 0.001), at all tumor sizes (p < 0.05) and any degree of liver fibrosis (p < 0.05).
Resection of HCC tumors of all sizes and any degree of underlying fibrosis was associated with significantly improved OS compared with ablation. There was pronounced variability in the use of ablation versus resection for early-stage HCC.
This study found that patients with early-stage hepatocellular carcinoma (HCC) have improved overall survival (OS) after surgical resection, compared to ablation, at all tumor sizes and any extent of liver disease. There were also marked variations in treatment patterns for early-stage HCC.
早期肝细胞癌（HCC）的最佳治疗方法仍不清楚。本研究比较了手术切除与消融治疗早期 HCC 患者的总生存期（OS）。
利用国家癌症数据库（NCDB），确定了 2004 年至 2014 年间诊断为 I/II 期 HCC 的患者。采用 Cox 分析确定 OS 的预测因素。
共纳入 53161 例患者，其中 15.9%接受消融治疗，14.5%接受手术切除。合并症较少、肿瘤较大、有私人保险的患者更倾向于接受手术切除。与消融治疗相比，手术切除显著改善了 OS（HR 0.58，95%CI 0.54-0.61，p < 0.001），且在所有肿瘤大小（p < 0.05）和任何程度的肝纤维化（p < 0.05）均如此。
与消融治疗相比，所有大小的 HCC 肿瘤和任何程度的基础纤维化的手术切除与显著改善的 OS 相关。早期 HCC 的消融与手术切除的使用存在明显差异。
本研究发现，与消融治疗相比，早期 HCC 患者的手术切除可显著改善 OS，且在所有肿瘤大小和任何程度的肝病中均如此。早期 HCC 的治疗模式也存在显著差异。
