Lanari Jacopo, Caregari Silvia, Billato Ilaria, Gringeri Enrico, D'Amico Francesco, Gemo Giancarlo, Bassi Domenico, D'Amico Francesco Enrico, Boetto Riccardo, Bertacco Alessandra, Marchini Andrea, Lazzari Sara, Brolese Marco, Ballo Mattia, Vitale Alessandro, Cillo Umberto
Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, 35128 Padua, Italy.
General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy.
Cancers (Basel). 2023 Jan 10;15(2):436. doi: 10.3390/cancers15020436.
In the context of spreading interest in textbook outcome (TO) evaluation in different fields, we aimed to investigate an uncharted procedure, that is, laparoscopic microwave ablation (MWA) for hepatocellular carcinoma (HCC). Absence of post-MWA complications, a hospital stay of three days, no mortality nor readmission within 30 days, and complete response of the target lesion at post-MWA CT scan defined TO achievement. Patients treated between January 2014 and March 2021 were retrospectively reviewed, and of the 521 patients eligible for the study, 337 (64.7%) fulfilled all the quality indicators to achieve the TO. The absence of complications was the main limiting factor for accomplishing TO. At multivariable analysis, Child-Pugh B cirrhosis, age of more than 70 years old, three nodules, and MELD score ≥ 15 were associated with decreased probabilities of TO achievement. A score based on these factors was derived from multivariable analysis, and patients were divided into three risk groups for TO achievement. At survival analysis, overall survival (OS) was significantly ( = 0.001) higher in patients who achieved TO than those who did not. Moreover, OS evaluation in the three risk groups showed a trend coherent with TO achievement probability. The present study, having assessed the first TO for laparoscopic MWA for HCC, encourages further broader consensus on its definition and, on its basis, on the development of clinically relevant tools for managing treatment allocation.
在不同领域对教科书式结局（TO）评估的兴趣不断蔓延的背景下，我们旨在研究一种未知的程序，即用于肝细胞癌（HCC）的腹腔镜微波消融（MWA）。MWA后无并发症、住院三天、30天内无死亡或再入院，以及MWA后CT扫描时靶病灶完全缓解定义为TO达成。对2014年1月至2021年3月期间接受治疗的患者进行回顾性分析，在符合研究条件的521例患者中，337例（64.7%）满足所有质量指标以实现TO。无并发症是实现TO的主要限制因素。在多变量分析中，Child-Pugh B级肝硬化、年龄超过70岁、三个结节以及终末期肝病模型（MELD）评分≥15与TO达成概率降低相关。基于这些因素的评分通过多变量分析得出，患者被分为TO达成的三个风险组。在生存分析中，实现TO的患者的总生存期（OS）显著高于未实现TO的患者（P = 0.001）。此外，三个风险组的OS评估显示出与TO达成概率一致的趋势。本研究评估了HCC腹腔镜MWA的首个TO，鼓励就其定义以及在此基础上开发用于管理治疗分配的临床相关工具达成更广泛的共识。
