Cheng Kai-Chi, Ho Kit-Man
Department of Surgery, Kwong Wah Hospital, Hong Kong, China.
Transl Cancer Res. 2022 Jan;11(1):43-51. doi: 10.21037/tcr-21-1045.
In treatment of hepatocellular carcinoma (HCC), both laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) provided similar short-term advantages. However, there was no robust clinical trial comparing the efficacy of LLR and RFA especially for small HCC. This study aimed to compare the short-term and long-term outcomes of LLR and RFA for patients with small HCC using a propensity score matching analysis to minimize potential selection bias. Factors affecting survival were then identified with multivariate analysis.
All patients underwent RFA or LLR for small HCC [defined as Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, size ≤3 cm, ≤3 nodules on contrast CT scan or MRI with no evidence of macrovascular invasion] from April 2005 to August 2020 were included. Propensity score matching was conducted to match patients in the LLR group and RFA group. Prognostic indicators, i.e., age, gender, tumor size, tumor number, Child's grading, albumin, bilirubin, platelet count, international normalized ratio, alpha-fetoprotein level and presence of cirrhosis on imaging were chosen for propensity score calculation. The demographic data, tumor characteristics, operative data, post-operative outcomes and survival data of the two groups were compared. A multivariate analysis based on Cox regression was used to identify factors associated with survival.
Median follow-up was 34 months. LLR and RFA had similar overall survival (91.8% 79.2% at 5-year, P=0.060); while the LLR had a significantly better disease-free survival (49.0% 30.3% at 5-year, P=0.002) and local recurrence-free survival (96.0% 63.7% at 5-year, P<0.001) when compared with the RFA. Multivariate analysis showed that treatment received by patient (LLR RFA), prothrombin time and platelet counts were significantly associated with disease-free survival. On the other hand, the only factor associated with local recurrence-free survival was the treatment received by patient.
Both RFA and LLR are safe and feasible treatment options for patients with small HCC. LLR should be considered for patients with preserved liver function with a better disease-free survival; while RFA offered a comparable overall survival with less surgical trauma and shorter hospital stay.
在肝细胞癌（HCC）的治疗中，腹腔镜肝切除术（LLR）和射频消融术（RFA）都具有相似的短期优势。然而，尚无有力的临床试验比较LLR和RFA的疗效，尤其是对于小肝癌。本研究旨在通过倾向评分匹配分析比较LLR和RFA治疗小肝癌患者的短期和长期结局，以尽量减少潜在的选择偏倚。然后通过多因素分析确定影响生存的因素。
纳入2005年4月至2020年8月期间所有因小肝癌（定义为巴塞罗那临床肝癌（BCLC）0期或A期，大小≤3 cm，对比增强CT扫描或MRI显示≤3个结节且无大血管侵犯证据）接受RFA或LLR治疗的患者。进行倾向评分匹配以匹配LLR组和RFA组的患者。选择预后指标，即年龄、性别、肿瘤大小、肿瘤数量、Child分级、白蛋白、胆红素、血小板计数、国际标准化比值、甲胎蛋白水平以及影像学上肝硬化的存在情况用于倾向评分计算。比较两组的人口统计学数据、肿瘤特征、手术数据、术后结局和生存数据。采用基于Cox回归的多因素分析确定与生存相关的因素。
中位随访时间为34个月。LLR和RFA的总生存率相似（5年时分别为91.8%和79.2%，P = 0.060）；而与RFA相比，LLR的无病生存率（5年时分别为49.0%和30.3%，P = 0.002）和局部无复发生存率（5年时分别为96.0%和63.7%，P < 0.001）显著更好。多因素分析显示，患者接受的治疗（LLR与RFA）、凝血酶原时间和血小板计数与无病生存率显著相关。另一方面，与局部无复发生存率相关的唯一因素是患者接受的治疗。
RFA和LLR都是治疗小肝癌患者安全可行的选择。对于肝功能良好且无病生存率较好的患者应考虑LLR；而RFA提供了相当的总生存率，手术创伤较小且住院时间较短。
