射频消融与重复肝切除术治疗包膜下位置复发性肝细胞癌的疗效比较：一项回顾性队列研究。
Radiofrequency ablation versus repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma in subcapsular location: a retrospective cohort study.
机构信息
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, Fujian, China.
Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
出版信息
World J Surg Oncol. 2021 Jun 14;19(1):175. doi: 10.1186/s12957-021-02277-4.
BACKGROUND
Repeat hepatectomy and radiofrequency ablation (RFA) are widely used to treat early recurrent hepatocellular carcinoma (RHCC) located in the subcapsular region, but the optimal treatment strategy remains to be controversial.
METHODS
A total of 126 RHCC patients in the subcapsular location after initial radical hepatectomy were included in this study between Dec 2014 and Jan 2018. These patients were divided into the RFA group (46 cases) and the repeat hepatectomy group (80 cases). The primary endpoints include repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. The propensity-score matching (PSM) was conducted to minimize the bias. Complications were evaluated using the Clavien-Dindo classification, and severe complications were defined as classification of complications of ≥grade 3.
RESULTS
There were no significant differences in the incidence of severe complications were observed between RFA group and repeat hepatectomy group in rRFS and OS both before (1-, 2-, and 3-year rRFS rates were 65.2%, 47.5%, and 33.3% vs 72.5%, 51.2%, and 39.2%, respectively, P = 0.48; 1-, 2-, and 3-year OS rates were 93.5%, 80.2%, and 67.9% vs 93.7%, 75.8%, and 64.2%, respectively, P = 0.92) and after PSM (1-, 2-, and 3-year rRFS rates were 68.6%, 51.0%, and 34.0% vs 71.4%, 42.9%, and 32.3%, respectively, P = 0.78; 1-, 2-, and 3-year OS rates were 94.3%, 82.9%, and 71.4% vs 88.6%, 73.8%, and 59.0%, respectively, P = 0.36). Moreover, no significant differences in the incidence of severe complications were observed between the RFA group and repeat hepatectomy group.
CONCLUSION
Both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of RHCC located in the subcapsular region.
背景
对于位于肝包膜下区域的早期复发性肝细胞癌（RHCC），重复肝切除术和射频消融（RFA）被广泛用于治疗，但最佳治疗策略仍存在争议。
方法
本研究纳入了 2014 年 12 月至 2018 年 1 月期间初次根治性肝切除术后位于肝包膜下位置的 126 例 RHCC 患者。这些患者被分为 RFA 组（46 例）和重复肝切除术组（80 例）。主要终点包括重复无复发生存率（rRFS）和总生存率（OS），次要终点是并发症。采用倾向评分匹配（PSM）以最小化偏倚。采用 Clavien-Dindo 分类评估并发症，严重并发症定义为≥3 级并发症。
结果
rRFS 和 OS 方面，RFA 组与重复肝切除术组之间的严重并发症发生率均无显著差异（rRFS 为 1、2、3 年的无复发生存率分别为 65.2%、47.5%和 33.3%，72.5%、51.2%和 39.2%，P=0.48；OS 为 1、2、3 年的总生存率分别为 93.5%、80.2%和 67.9%，93.7%、75.8%和 64.2%，P=0.92）和 PSM 后（rRFS 为 1、2、3 年的无复发生存率分别为 68.6%、51.0%和 34.0%，71.4%、42.9%和 32.3%，P=0.78；OS 为 1、2、3 年的总生存率分别为 94.3%、82.9%和 71.4%，88.6%、73.8%和 59.0%，P=0.36）。此外，RFA 组与重复肝切除术组之间严重并发症的发生率也无显著差异。
结论
对于位于肝包膜下区域的 RHCC，重复肝切除术和 RFA 均显示出有效且安全。
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