Lu Liang-He, Mei Jie, Kan Anna, Ling Yi-Hong, Li Shao-Hua, Wei Wei, Chen Min-Shan, Zhang Yong-Fa, Guo Rong-Ping
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Guangzhou, China.
Cancer Med. 2020 May;9(9):2997-3005. doi: 10.1002/cam4.2951. Epub 2020 Feb 28.
The optimal treatment strategy for recurrent hepatocellular carcinoma (HCC) remains unclear. Therefore, we aimed to compare the outcomes of repeat hepatic resection (RHR) and radiofrequency ablation (RFA) for recurrent HCC.
From December 2004 to December 2015, 138 patients who underwent RHR and 194 patients who underwent RFA were enrolled. Propensity score matching (PSM) was performed to establish 1:1 RHR-RFA group matching. Clinical outcomes were compared before and after matching.
Before matching, the 1-, 3-, and 5-year postrecurrence survival (PRS) rates were 91.8%, 82.0%, and 72.9% for the RHR group (n = 138) and 94.4%, 75.4%, and 61.7% for the RFA group (n = 194), respectively (P = .380). After matching, the PRS rates at 1, 3, and 5 years were 90.5%, 81.5%, and 71.8% for the RHR group (n = 120) and 91.0%, 61.0%, and 41.7% for the RFA group (n = 120), respectively (P = .002). In the subgroup analysis, the PRS rates for the RHR group were better than those for the RFA group for patients who relapsed within 2 years (P = .004) or patients with primary tumor burden beyond the Milan criteria (P = .004). Multivariate analysis showed that treatment allocation was identified as an independent prognostic factor for PRS.
Compared with RFA, RHR provided a survival advantage for recurrent HCC, especially for patients who relapsed within 2 years and those with primary tumor burden beyond the Milan criteria.
复发性肝细胞癌（HCC）的最佳治疗策略仍不明确。因此，我们旨在比较复发性HCC行再次肝切除（RHR）与射频消融（RFA）的疗效。
纳入2004年12月至2015年12月期间接受RHR的138例患者和接受RFA的194例患者。采用倾向评分匹配（PSM）建立1:1的RHR-RFA组匹配。比较匹配前后的临床疗效。
匹配前，RHR组（n = 138）的1年、3年和5年复发后生存率（PRS）分别为91.8%、82.0%和72.9%，RFA组（n = 194）分别为94.4%、75.4%和61.7%（P = 0.380）。匹配后，RHR组（n = 120）的1年、3年和5年PRS分别为90.5%、81.5%和71.8%，RFA组（n = 120）分别为91.0%、61.0%和41.7%（P = 0.002）。亚组分析显示，对于2年内复发的患者（P = 0.004）或原发肿瘤负荷超过米兰标准的患者（P = 0.004），RHR组的PRS率优于RFA组。多因素分析显示，治疗方式是PRS的独立预后因素。
与RFA相比，RHR为复发性HCC患者带来生存优势，尤其是对于2年内复发的患者以及原发肿瘤负荷超过米兰标准的患者。
