Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Surgery. 2019 Sep;166(3):254-262. doi: 10.1016/j.surg.2019.05.007. Epub 2019 Jul 3.
Little evidence exists regarding the perioperative and oncologic benefits of microwave ablation for hepatocellular carcinoma. The aim of this study was to compare the efficacy of hepatic resection and operative microwave ablation (microwave coagulo-necrotic therapy) for single hepatocellular carcinoma ≤5 cm.
Between 1994 and 2015, a total of 551 patients with a single hepatocellular carcinoma ≤5 cm were treated in our institution (hepatic resection: n = 128; microwave coagulo-necrotic therapy: n = 423). We compared overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy. Propensity score matching analysis identified 94 matched pairs of patients to compare outcomes.
After propensity score matching, baseline variables, including liver function and tumor size, were well-balanced between the 2 groups. The 5- and 10-year overall survival rates were 76% and 47% for hepatic resection and 77% and 48% for microwave coagulo-necrotic therapy, respectively (P = .865). The 5- and 10-year recurrence-free survival rates were 55% and 41% for hepatic resection and 47% and 32% for microwave coagulo-necrotic therapy, respectively (P = .377). In the subgroup analysis, the hepatic resection group had better recurrence-free survival than the microwave coagulo-necrotic therapy group in patients with tumor size >3 cm, with 5-year recurrence-free survival rates of 56.5% and 32.4% in the hepatic resection and microwave coagulo-necrotic therapy group, respectively (P = .029).
Our propensity score matching study confirmed no statistically significant differences in both overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy for single hepatocellular carcinoma ≤5 cm; however, hepatic resection is recommended for hepatocellular carcinoma with tumor size >3 cm when patients have good liver function.
微波消融治疗肝细胞癌的围手术期和肿瘤学获益的证据有限。本研究旨在比较肝切除术和手术微波消融（微波凝固坏死疗法）治疗单个直径≤5cm 肝细胞癌的疗效。
1994 年至 2015 年，我院共治疗了 551 例单个直径≤5cm 的肝细胞癌患者（肝切除术：n=128；微波凝固坏死疗法：n=423）。我们比较了肝切除术和微波凝固坏死疗法治疗后患者的总生存率和无复发生存率。采用倾向评分匹配分析确定了 94 对匹配的患者以比较结果。
在倾向评分匹配后，两组的基线变量，包括肝功能和肿瘤大小，均得到很好的平衡。肝切除术组的 5 年和 10 年总生存率分别为 76%和 47%，微波凝固坏死疗法组分别为 77%和 48%（P=0.865）。肝切除术组的 5 年和 10 年无复发生存率分别为 55%和 41%，微波凝固坏死疗法组分别为 47%和 32%（P=0.377）。在亚组分析中，对于肿瘤直径>3cm 的患者，肝切除术组的无复发生存率优于微波凝固坏死疗法组，肝切除术组和微波凝固坏死疗法组的 5 年无复发生存率分别为 56.5%和 32.4%（P=0.029）。
本倾向评分匹配研究证实，对于单个直径≤5cm 的肝细胞癌，肝切除术和微波凝固坏死疗法在总生存率和无复发生存率方面无统计学差异；然而，当患者肝功能良好时，对于肿瘤直径>3cm 的肝细胞癌，建议行肝切除术。
