Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Academia Level 5, 20 College Road, Singapore, 169856, Singapore.
Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.
Ann Surg Oncol. 2021 Nov;28(12):7731-7740. doi: 10.1245/s10434-021-09948-2. Epub 2021 May 9.
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver with high rates of recurrence post-resection. Repeat hepatectomy (RH) and radiofrequency ablation (RFA) are the mainstays for managing recurrent HCC following initial curative resection. This retrospective study aims to determine the average treatment effect of RH and RFA in patients with recurrent HCC.
From 2000 to 2016, a total of 219 consecutive patients with recurrent HCC who underwent either RH or RFA were included in the study. The analysis was performed using inverse probability of treatment weighting (IPTW), and propensity score-matched (PSM) methods.
The minor and major post-operative morbidity after propensity score-matched analysis for the RH group was 30.0% and 6.0%, respectively, and 19.2% and 0.0% (p = 0.1006), respectively, for the RFA group. After propensity score matching, the median OS for RH and RFA was 85.5 (IQR, 33.5-not reached) and 53.3 months (IQR, 27.5-not reached) (p = 0.8474), respectively. There was no significant difference in 90-day mortality between both groups (p = 0.1287). RH showed improved long-term overall survival over RFA at the third [71.3% versus 65.7% (p = 0.0432)], fifth [59.9% versus 45.4% (p = 0.0271)] and tenth [35.4% versus 32.2% (p = 0.0132)] year follow-up, respectively. Median time to recurrence was 11.1 (IQR, 5.0-33.2) and 28.0 months (IQR, 9.1-not reached) (p = 0.0225) for the RFA and RH group, respectively.
RH confers a late survival benefit compared with RFA for patients with recurrent HCC despite a higher morbidity rate.
肝细胞癌（HCC）是肝脏最常见的原发性恶性肿瘤，其切除术后复发率很高。再次肝切除术（RH）和射频消融术（RFA）是治疗初始根治性切除术后复发性 HCC 的主要方法。本回顾性研究旨在确定 RH 和 RFA 治疗复发性 HCC 患者的平均治疗效果。
2000 年至 2016 年，共有 219 例接受 RH 或 RFA 治疗的复发性 HCC 患者纳入本研究。采用逆概率治疗加权（IPTW）和倾向评分匹配（PSM）方法进行分析。
经过倾向评分匹配分析，RH 组术后轻微和主要并发症的发生率分别为 30.0%和 6.0%，RFA 组分别为 19.2%和 0.0%（p=0.1006）。倾向评分匹配后，RH 和 RFA 的中位 OS 分别为 85.5（IQR，33.5-未达到）和 53.3 个月（IQR，27.5-未达到）（p=0.8474）。两组 90 天死亡率无显著差异（p=0.1287）。RH 在第三个[71.3%比 65.7%（p=0.0432）]、第五个[59.9%比 45.4%（p=0.0271）]和第十个[35.4%比 32.2%（p=0.0132）]年随访时，总体生存率均高于 RFA。RFA 和 RH 组的中位复发时间分别为 11.1（IQR，5.0-33.2）和 28.0 个月（IQR，9.1-未达到）（p=0.0225）。
尽管 RH 术后并发症发生率较高，但与 RFA 相比，RH 可为复发性 HCC 患者带来生存获益。
