Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Clin Mol Hepatol. 2022 Apr;28(2):207-218. doi: 10.3350/cmh.2021.0294. Epub 2021 Nov 24.
BACKGROUND/AIMS: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA).
We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2-3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment.
The median follow-up period was 64.8 months (interquartile range, 0.1-162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396-1.232) (P=0.215) and 1.698 (1.777-2.448) (P=0.005), respectively.
SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.
背景/目的：我们比较了 Child-Turcotte-Pugh（CTP）分级为 A 级和单个小（≤3cm）肝细胞癌（HCC）患者接受手术切除（SR）和射频消融（RFA）治疗后的治疗后总生存（OS）和无复发生存（RFS）。
我们回顾性分析了 391 例 CTP 分级为 A 级的 HCC 患者，他们接受了 SR（n=232）或 RFA（n=159）作为单个小（≤3cm）HCC 的一线治疗。根据肿瘤大小（≤2cm/2-3cm）和肝硬化的存在情况比较生存情况。采用逆概率治疗加权（IPW）方法估计治疗的平均因果效应。
中位随访时间为 64.8 个月（四分位距，0.1-162.6）。经过 IPW 后，SR 和 RFA 组的估计 OS 相似（P=0.215），甚至在 HCC 直径≤2cm 的患者（P=0.816）和无肝硬化的患者（P=0.195）中也是如此。SR 组的估计 RFS 优于 RFA 组（P=0.005），在无肝硬化的患者中更是如此（P<0.001），但在 HCC 直径≤2cm 的患者中则不然（P=0.234）。采用 IPW 的加权 Cox 比例风险模型提供了 RFA 后 OS 和 RFS 的调整后的危险比（95%置信区间），RFA 后 OS 与 SR 相比的危险比为 0.698（0.396-1.232）（P=0.215），RFS 的危险比为 1.698（1.777-2.448）（P=0.005）。
与 RFA 相比，SR 在 CTP 分级为 A 级和单个小（≤3cm）HCC 患者的 OS 相似，但在 RFS 方面更好。RFS 由肝硬化的存在与否决定。因此，在没有肝硬化的患者中，应考虑 SR 而不是 RFA 来延长 RFS，尽管 OS 没有差异。
