射频消融术是≤5cm 无肝硬化单发肝细胞癌的次选治疗方法，不如肝切除术：一项基于人群的研究，按肿瘤大小分层。

Radiofrequency ablation is an inferior option to liver resection for solitary hepatocellular carcinoma ≤ 5 cm without cirrhosis: A population-based study with stratification by tumor size.

机构信息

Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China; Department of Hepatobiliary Surgery, The First Clinical College, Dalian Medical University, Dalian 116000, China.

Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2023 Dec;22(6):605-614. doi: 10.1016/j.hbpd.2022.08.001. Epub 2022 Aug 8.

DOI:10.1016/j.hbpd.2022.08.001

PMID:35977873

Abstract

BACKGROUND

About 10%-20% of all individuals who develop hepatocellular carcinoma (HCC) do not have cirrhosis. Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation (RFA) and liver resection (LR) in survival of HCC without cirrhosis and stratification by tumor size ≤ 5 cm.

METHODS

We used the Surveillance, Epidemiology, and End Results (SEER) database and identified 1505 patients with a solitary HCC tumor ≤ 5 cm who underwent RFA or LR during 2004-2015. Patients were classified into non-cirrhosis and cirrhosis groups and each group was categorized into three subgroups, according to tumor size (≤ 30 mm, 31-40 mm, 41-50 mm).

RESULTS

In patients without cirrhosis, LR showed better 5-year HCC cancer-specific survival than RFA in all tumor size subgroups (≤ 30 mm: 82.51% vs. 56.42%; 31-40 mm: 71.31% vs. 46.83%; 41-50 mm: 74.7% vs. 37.5%; all P < 0.05). Compared with RFA, LR was an independent protective factor for HCC cancer-specific survival in multivariate Cox analysis [≤ 30 mm: hazard ratio (HR) = 0.533, 95% confidence interval (CI): 0.313-0.908; 31-40 mm: HR = 0.439, 95% CI: 0.201-0.957; 41-50 mm: HR = 0.382; 95% CI: 0.159-0.916; all P < 0.05]. In patients with cirrhosis, for both tumor size ≤ 30 mm and 31-40 mm groups, there were no significant survival differences between RFA and LR in multivariate analysis (all P > 0.05). However, in those with tumor size 41-50 mm, LR showed significantly better 5-year HCC cancer-specific survival than RFA in both univariate (54.72% vs. 23.06%; P < 0.001) and multivariate analyses (HR = 0.297; 95% CI: 0.136-0.648; P = 0.002).

CONCLUSIONS

RFA is an inferior treatment option to LR for patients without cirrhosis who have a solitary HCC tumor ≤ 5 cm.

摘要

背景

约 10%-20%发生肝细胞癌（HCC）的个体没有肝硬化。关于无肝硬化的 HCC 患者，射频消融（RFA）和肝切除术（LR）在生存方面的有效性比较，以及按肿瘤大小≤5cm 进行分层的比较很少有报道。

方法

我们使用监测、流行病学和最终结果（SEER）数据库，确定了在 2004-2015 年期间接受 RFA 或 LR 治疗的 1505 名单发 HCC 肿瘤≤5cm 的患者。患者分为无肝硬化组和肝硬化组，每组根据肿瘤大小（≤30mm、31-40mm、41-50mm）分为三个亚组。

结果

在无肝硬化患者中，LR 在所有肿瘤大小亚组中均显示出比 RFA 更好的 5 年 HCC 癌症特异性生存率（≤30mm：82.51% vs. 56.42%；31-40mm：71.31% vs. 46.83%；41-50mm：74.7% vs. 37.5%；均 P<0.05）。在多因素 Cox 分析中，LR 是 HCC 癌症特异性生存的独立保护因素，与 RFA 相比[≤30mm：风险比（HR）=0.533，95%置信区间（CI）：0.313-0.908；31-40mm：HR=0.439，95% CI：0.201-0.957；41-50mm：HR=0.382；95% CI：0.159-0.916；均 P<0.05]。在肝硬化患者中，对于肿瘤大小≤30mm 和 31-40mm 两组，多因素分析中 RFA 和 LR 之间的生存差异均无统计学意义（均 P>0.05）。然而，在肿瘤大小为 41-50mm 的患者中，LR 在单因素（54.72% vs. 23.06%；P<0.001）和多因素分析（HR=0.297；95% CI：0.136-0.648；P=0.002）中均显示出明显优于 RFA 的 5 年 HCC 癌症特异性生存率。