肝细胞癌右半肝切除术中前入路与传统入路的比较：倾向评分加权逆分析

Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis.

作者信息

Rhaiem Rami, Sommacale Daniele, Zimmermann Perrine, Amroun Koceila, Tashkandi Ahmad, Laurent Alexis, Amaddeo Giuliana, Calderaro Julien, Luciani Alain, Heurgue Alexandra, Thiefin Gérard, Piardi Tullio, Kianmanesh Reza, Brustia Raffaele

机构信息

Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France.

Reims Champagne-Ardenne University, Reims, France.

出版信息

J Gastrointest Surg. 2023 Oct;27(10):2092-2102. doi: 10.1007/s11605-023-05741-6. Epub 2023 Jul 5.

DOI:10.1007/s11605-023-05741-6

PMID:37407897

Abstract

BACKGROUND

Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce. In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared.

METHODS

A retrospective inverse propensity score-weighted fashion (IPTW) case-control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed.

RESULTS

Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62-1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54-2.6, p = 0.66). After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence.

CONCLUSION

AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.

摘要

背景

东方的数据凸显了在肝细胞癌（HCC）的右半肝切除术（RH）中采用前入路（AA）的肿瘤学益处。然而，据我们所知，此前西方关于这一主题的数据稀缺。在本研究中，我们比较了在HCC的RH中AA和经典入路（CA）的肿瘤学结局。

方法

在法国的两个肝胆外科科室进行了一项回顾性逆概率加权法（IPTW）病例对照研究。分析了总生存期（OS）、无病生存期（DFS）和早期复发率（术后2年内）。

结果

对114例患者进行了生存分析（CA组60例患者；AA组54例患者）。在IPTW调整前，3年DFS率分别为29.4%（AA组）和44%（CA组）。DFS（HR = 1.1，95%CI：0.62 - 1.9，p = 0.7）和OS（HR = 1.2，95%CI：0.54 - 2.6，p = 0.66）无显著差异。IPTW后，DFS和OS分析显示两组间无差异（p分别为0.77和0.46）。IPTW前后早期复发率相似。卫星结节是复发的唯一显著独立危险因素。