Chen Shuanggang, Ma Weimei, Shen Lujun, Wu Ying, Qi Han, Cao Fei, Huang Tao, Fan Weijun
Department of Oncology, Yuebei People's Hospital, Shantou University Medical College, Shaoguan, China.
Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Oncol. 2021 Oct 18;11:757149. doi: 10.3389/fonc.2021.757149. eCollection 2021.
Comparison of patterns of early hepatocellular carcinoma (HCC) recurrence beyond the Milan criteria (HRBM) and identification of the independent risk factors of time to recurrence beyond the Milan criteria (TRBM) after resection or ablation can develop an optimal first-line treatment and provide more opportunities and waiting time for salvage transplantation.
The patterns of HRBM after first-line resection or ablation in 384 patients with single-nodule HBV-associated HCC of 2-3 cm were retrospectively analyzed by one-to-one propensity score matching (PSM) between December 2008 and December 2017. The median TRBM between the resection group and the ablation group was estimated by Kaplan-Meier curves. The Cox regression analysis and binary logistic regression were used for the identification of the independent risk factors of TRBM and the occurrence of HRBM, respectively. The abilities of HRBM and the recurrence to predict overall survival (OS) were compared by the time-dependent receiver operating characteristic curves and estimated area under the curve.
Of 384 patients enrolled in our study, 260 (67.7%) received resection (resection group) and 124 (32.3%) underwent ablation (ablation group). The median TRBM in the resection group was significantly longer than that in the ablation group before PSM (median, not available . 101.4 months, < 0.001) and after PSM (median, not available . 85.7 months, < 0.001). Cox regression showed ablation, older age, CRP ≥1.81 mg/L, and PLT ≤80 × 10/L were the independent risk factors of TRBM. Binary logistic regression also showed that ablation, CRP ≥1.81 mg/L, and PLT ≤80 × 10/L were the independent risk factors of the occurrence of HRBM. The incidences of various phenotypes of HRBM were not significantly different between the two groups, but the incidence of HRBM at the first recurrence in the ablation group was significantly higher than that in the resection group ( < 0.05). Besides, compared with recurrence, HRBM was a better predictor of OS ( < 0.05).
Compared with ablation, resection should be considered as a more appropriate first-line option for patients with single-nodule HBV-associated HCC of 2-3 cm and a more promising bridge for liver transplantation in those patients.
比较米兰标准以外的早期肝细胞癌（HCC）复发模式（HRBM），并确定切除或消融术后米兰标准以外的复发时间（TRBM）的独立危险因素，可为制定最佳一线治疗方案提供依据，并为挽救性移植提供更多机会和等待时间。
回顾性分析2008年12月至2017年12月期间384例2 - 3 cm单结节HBV相关HCC患者一线切除或消融术后的HRBM模式。通过一对一倾向评分匹配（PSM）进行分析。采用Kaplan-Meier曲线估计切除组和消融组的中位TRBM。分别采用Cox回归分析和二元逻辑回归确定TRBM和HRBM发生的独立危险因素。通过时间依赖性受试者工作特征曲线和曲线下面积估计比较HRBM和复发对总生存（OS）的预测能力。
在本研究纳入的384例患者中，260例（67.7%）接受了切除（切除组），124例（32.3%）接受了消融（消融组）。在PSM前，切除组的中位TRBM显著长于消融组（中位值，不可用. 101.4个月，<0.001）；PSM后也是如此（中位值，不可用. 85.7个月，<0.001）。Cox回归显示，消融、年龄较大、CRP≥1.81 mg/L和PLT≤80×10⁹/L是TRBM的独立危险因素。二元逻辑回归还显示，消融、CRP≥1.81 mg/L和PLT≤80×10⁹/L是HRBM发生的独立危险因素。两组间HRBM各表型的发生率无显著差异，但消融组首次复发时HRBM的发生率显著高于切除组（<0.05）。此外，与复发相比，HRBM是OS的更好预测指标（<0.05）。
对于2 - 3 cm单结节HBV相关HCC患者，与消融相比，切除应被视为更合适的一线治疗选择，并且是这些患者肝移植更有前景的桥梁。
