Ivanics T, Rajendran L, Abreu P A, Claasen M P A W, Shwaartz C, Patel M S, Choi W J, Doyle A, Muaddi H, McGilvray I D, Selzner M, Beecroft R, Kachura J, Bhat M, Selzner N, Ghanekar A, Cattral M, Sayed B, Reichman T, Lilly L, Sapisochin G
Multi-Organ Transplant Program, Division of General Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
Ann Med Surg (Lond). 2022 Apr 20;77:103645. doi: 10.1016/j.amsu.2022.103645. eCollection 2022 May.
Curative-intent therapies for hepatocellular carcinoma (HCC) include radiofrequency ablation (RFA), liver resection (LR), and liver transplantation (LT). Controversy exists in treatment selection for early-stage tumours. We sought to evaluate the oncologic outcomes of patients who received either RFA, LR, or LT as first-line treatment for solitary HCC ≤ 3 cm in an intention-to-treat analysis.
All patients with solitary HCC ≤ 3 cm who underwent RFA, LR, or were listed for LT between Feb-2000 and Nov-2018 were analyzed. Cox regression analysis was then performed to compare intention-to-treat (ITT) survival by initial treatment allocation and disease-free survival (DFS) by treatment received in patients eligible for all three treatments.
A total of 119 patients were identified (RFA n = 83; LR n = 25; LT n = 11). The overall intention-to-treat survival was similar between the three groups. The overall DFS was highest for the LT group. This was significantly higher than RFA (p = 0.02), but not statistically significantly different from LR (p = 0.14). After multivariable adjustment, ITT survival was similar in the LR and LT groups relative to RFA (LR HR:1.13, 95%CI 0.33-3.82; p = 0.80; LT HR:1.39, 95%CI 0.35-5.44; p = 0.60). On multivariable DFS analysis, only LT was better relative to RFA (LR HR:0.52, 95%CI 0.26-1.02; p = 0.06; LT HR:0.15, 95%CI 0.03-0.67; p = 0.01). Compared to LR, LT was associated with a numerically lower hazard on multivariable DFS analysis, though this did not reach statistical significance (HR 0.30, 95%CI 0.06-1.43; p = 0.13).
For treatment-naïve patients with solitary HCC ≤ 3 cm who are eligible for RFA, LR, and LT, adjusted ITT survival is equivalent amongst the treatment modalities, however, DFS is better with LR and LT, compared with RFA. Differences in recurrence between treatment modalities and equipoise in ITT survival provides support for a future prospective trial in this setting.
肝细胞癌（HCC）的根治性治疗方法包括射频消融（RFA）、肝切除术（LR）和肝移植（LT）。早期肿瘤的治疗选择存在争议。我们试图在一项意向性分析中评估接受RFA、LR或LT作为≤3 cm孤立性HCC一线治疗的患者的肿瘤学结局。
分析了2000年2月至2018年11月期间接受RFA、LR或被列入LT名单的所有≤3 cm孤立性HCC患者。然后进行Cox回归分析，以比较初始治疗分配的意向性（ITT）生存率和所有三种治疗均适用的患者接受治疗后的无病生存率（DFS）。
共确定119例患者（RFA组n = 83；LR组n = 25；LT组n = 11）。三组的总体意向性生存率相似。LT组的总体DFS最高。这显著高于RFA组（p = 0.02），但与LR组无统计学显著差异（p = 0.14）。多变量调整后，LR组和LT组相对于RFA组的ITT生存率相似（LR风险比：1.13，95%置信区间0.33 - 3.82；p = 0.80；LT风险比：1.39，95%置信区间0.35 - 5.44；p = 0.60）。在多变量DFS分析中，只有LT组相对于RFA组更好（LR风险比：0.52，95%置信区间0.26 - 1.02；p = 0.06；LT风险比：0.15，95%置信区间0.03 - 0.67；p = 0.01）。与LR组相比，在多变量DFS分析中，LT组的风险数值较低，尽管未达到统计学显著性（风险比0.30，95%置信区间0.06 - 1.43；p = 0.13）。
对于符合RFA、LR和LT条件的初治≤3 cm孤立性HCC患者，调整后的ITT生存率在各治疗方式中相当，然而，与RFA相比，LR和LT的DFS更好。治疗方式之间的复发差异和ITT生存率的平衡为未来在这种情况下进行前瞻性试验提供了支持。
