Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, South Korea.
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
Medicine (Baltimore). 2021 Oct 29;100(43):e27470. doi: 10.1097/MD.0000000000027470.
Data from a direct comparison of the long-term survival outcomes of surgical resection (SR) or radiofrequency ablation (RFA) versus transarterial therapy in Child-Turcotte-Pugh (CTP)-class A patients with a single small T1/T2 stage hepatocellular carcinoma (HCC) (≤3 cm) are still lacking. This study retrospectively compared the therapeutic outcomes of these treatment types for CTP-A patients with a single small HCC.Using a nationwide Korean registry, we identified 2314 CTP-A patients with SR (n = 722), RFA (n = 731), or transarterial therapy (n = 861) for a single (≤3 cm) T1/T2 stage HCC from 2008 to 2014. The posttreatment overall survival (OS) of transarterial therapy with either SR or RFA were compared using the Inverse Probability of treatment Weighting (IPW). The median follow-up period was 50 months (range 1-107 months).After IPW, the cumulative OS rates after SR or RFA were significantly higher than those after transarterial therapy in all subjects (all P values < .05). The OS rates after SR or RFA were better than those after transarterial therapy in patients with the hepatitis B or C virus (all P values < .05), and in patients aged <65 years (all P values < .05). The cumulative OSs between RFA and transarterial therapy were statistically comparable in patients with a 2 to 3 cm HCC and aged ≥65 years, respectively. For all subjects, the weighted Cox proportional hazards model using IPW provided the adjusted hazard ratios (95% confidence interval) for the OS after SR versus transarterial therapy and after RFA versus transarterial therapy of 0.42 (0.30-0.60) (P < .001) and 0.78 (0.61-0.99) (P = .044), respectively.In CTP-A patients with a single (≤3 cm) T1/T2 HCC, SR or RFA provides a better OS than transarterial therapy, regardless of the HCC etiology (hepatitis B virus or hepatitis C virus), especially in patients with HCC of <2 cm and aged <65 years.
目前仍缺乏直接比较手术切除 (SR) 或射频消融 (RFA) 与经动脉治疗对单个小 T1/T2 期肝细胞癌 (HCC) (≤3cm) 且 Child-Turcotte-Pugh (CTP) 分级为 A 的患者的长期生存结果的数据。本研究回顾性比较了这些治疗类型对单个小 HCC 的 CTP-A 患者的治疗结果。
我们使用全国性的韩国登记处，从 2008 年至 2014 年，确定了 2314 名接受 SR (n=722)、RFA (n=731) 或经动脉治疗 (n=861) 的 CTP-A 患者，这些患者均患有单个 (≤3cm) T1/T2 期 HCC。采用逆概率治疗加权法 (IPW) 比较经动脉治疗后 SR 或 RFA 的治疗后总生存 (OS)。中位随访时间为 50 个月(1-107 个月)。
经 IPW 校正后，在所有患者中，SR 或 RFA 后累积 OS 率均明显高于经动脉治疗组(所有 P 值均<0.05)。在乙型肝炎或丙型肝炎病毒患者(所有 P 值均<0.05)和年龄<65 岁患者(所有 P 值均<0.05)中，SR 或 RFA 后 OS 率优于经动脉治疗组。在 2-3cm HCC 患者和年龄≥65 岁患者中，RFA 与经动脉治疗的累积 OS 率分别具有统计学可比性。在所有患者中，采用 IPW 的加权 Cox 比例风险模型，SR 与经动脉治疗和 RFA 与经动脉治疗的 OS 调整后风险比 (95%置信区间) 分别为 0.42(0.30-0.60)(P<0.001)和 0.78(0.61-0.99)(P=0.044)。
在 CTP-A 患者中，对于单个 (≤3cm) T1/T2 HCC，SR 或 RFA 可提供优于经动脉治疗的 OS，无论 HCC 的病因(乙型肝炎病毒或丙型肝炎病毒)如何，特别是在 HCC 直径<2cm 和年龄<65 岁的患者中。
