Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
J Formos Med Assoc. 2021 May;120(5):1249-1258. doi: 10.1016/j.jfma.2020.11.010. Epub 2020 Dec 4.
BACKGROUND/PURPOSE: Radiofrequency ablation (RFA) is increasingly being used instead of surgical resection for the treatment of hepatocellular carcinoma (HCC) tumor measuring ≦2 cm. However, the long-term outcomes of RFA, especially in comparison to surgical resection, are still debated. We compared the outcomes of surgical resection and RFA in patients with a solitary HCC tumor measuring ≦2 cm from a 10-year cohort study.
From Jan 2006 to Dec 2016, 156 patients with a resectable HCC measuring ≦2 cm who underwent surgical resection (n = 83) or RFA (n = 73) at the Buddhist Tzu Chi Medical Foundation were enrolled. Patient characteristics, overall survival (OS), and recurrence-free survival (RFS) were retrospectively examined, and comparisons were made between the two groups and through subgroup analyses.
The 1-year, 3-year, 5-year, and 7-year OS outcomes were comparable between the surgical resection group and the RFA group (P = 0.193), but the surgical resection group had significantly higher 1-year, 3-year, 5-year, 7-year, and 10-year RFS than the RFA group (P = 0.018). Multivariate analysis revealed that patients with lower age, Child-Turcotte-Pugh score, or albumin-bilirubin score before treatment had better OS, and patients with an HCV infection or receiving RFA treatment had higher HCC recurrence rates.
The liver reserve determined the long-term OS of patients with an HCC tumor ≦ 2 cm, and surgical resection offered better RFS than RFA (ClinicalTrials.gov number, NCT04525833.).
背景/目的：射频消融术（RFA）越来越多地用于治疗直径≦2cm 的肝细胞癌（HCC）肿瘤，而非手术切除。然而，RFA 的长期疗效，尤其是与手术切除的比较，仍存在争议。我们通过一项 10 年队列研究，比较了手术切除和 RFA 治疗直径≦2cm 的单发 HCC 肿瘤患者的疗效。
2006 年 1 月至 2016 年 12 月，在佛教慈济医疗基金会，对 156 名接受手术切除（n=83）或 RFA（n=73）治疗的可切除 HCC 直径≦2cm 的患者进行了回顾性研究。回顾性分析了患者的特征、总生存期（OS）和无复发生存期（RFS），并对两组患者进行了比较，并进行了亚组分析。
手术切除组和 RFA 组的 1 年、3 年、5 年和 7 年 OS 结果相当（P=0.193），但手术切除组的 1 年、3 年、5 年、7 年和 10 年 RFS 显著高于 RFA 组（P=0.018）。多因素分析显示，治疗前年龄较小、Child-Turcotte-Pugh 评分或白蛋白-胆红素评分较低的患者 OS 较好，而 HCV 感染或接受 RFA 治疗的患者 HCC 复发率较高。
肝脏储备决定了 HCC 肿瘤≦2cm 患者的长期 OS，手术切除比 RFA 具有更好的 RFS（ClinicalTrials.gov 编号：NCT04525833）。
