Xiang Xin, Hu Daixing, Jin Zheng, Liu Pan, Lin Huapeng
Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Neijiang, China.
Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2020 Sep 29;10:540662. doi: 10.3389/fonc.2020.540662. eCollection 2020.
We aimed to compare the survival outcomes of radiofrequency ablation (RFA) and surgical resection (SR) for patients with small early-stage primary intrahepatic cholangiocarcinoma (ICC). Patients with small (≤5 cm) and early-stage ICC were screened from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) rates between the SR and RFA patients were evaluated. The results were verified using an inverse probability-weighting model (IPTW). In total, 184 patients with small T1 stage ICC that received RFA or SR treatment were identified. The OS rates at 1, 3, and 5 years were 87.4, 73.3, and 61.5% for patients who underwent SR, respectively, and 89.9, 42.4, and 23.9%, respectively, for patients who received RFA. CSS rates at 1, 3, and 5 years were 91.5, 73.8, and 66.1%, respectively, for the SR group and 93.5, 53.4, and 30.0%, respectively, for the RFA group. The OS and CSS rates were evaluated to be significantly better in the SR group than in the RFA group after the multivariate Cox regression and IPTW analysis. Subsequently, the survival benefit of SR was also observed in the subgroup of patients with <4.5 or <4 cm early-stage ICC when compared with RFA. Our results indicated that the SR provided a significantly better prognosis than RFA in patients with small and early-stage ICC. SR as the first-line treatment of primary early-stage ICC is still recommended. However, prospective randomized controlled trials with larger sample sizes are required to compare these modalities in the treatment of ICC.
我们旨在比较射频消融（RFA）和手术切除（SR）治疗早期小原发性肝内胆管癌（ICC）患者的生存结果。从监测、流行病学和最终结果（SEER）数据库中筛选出小（≤5 cm）且早期ICC患者。评估了SR组和RFA组患者的总生存期（OS）和癌症特异性生存期（CSS）率。结果使用逆概率加权模型（IPTW）进行验证。总共确定了184例接受RFA或SR治疗的T1期小ICC患者。接受SR治疗的患者1年、3年和5年的OS率分别为87.4%、73.3%和61.5%，接受RFA治疗的患者分别为89.9%、42.4%和23.9%。SR组1年、3年和5年的CSS率分别为91.5%、73.8%和66.1%，RFA组分别为93.5%、53.4%和30.0%。多变量Cox回归和IPTW分析后，评估SR组的OS和CSS率显著优于RFA组。随后，与RFA相比，在早期ICC <4.5 cm或<4 cm的患者亚组中也观察到SR的生存获益。我们的结果表明，对于早期小ICC患者，SR的预后明显优于RFA。仍推荐SR作为原发性早期ICC的一线治疗方法。然而，需要更大样本量的前瞻性随机对照试验来比较这些方式在ICC治疗中的效果。
