Department of Interventional Ultrasound.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing.
Int J Surg. 2024 Mar 1;110(3):1356-1366. doi: 10.1097/JS9.0000000000000839.
There is currently a lack of convincing evidence for microwave ablation (MWA) and laparoscopic liver resection (LLR) for patients ≥60 years old with 3-5 cm hepatocellular carcinoma.
Patients were divided into three cohorts based on restricted cubic spline analysis: 60-64, 65-72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost.
Among 672 patients, the median age was 66 (IQR 62-71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4-52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P =0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P =0.007). The 60-64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P =0.370), MWA was associated with a higher recurrence rate (HR 1.94, P =0.004). A total of 146 patients were matched in the 65-72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P =0.900), DFS (HR 1.56, P =0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P =0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P =0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding ( P =0.032) and hypoproteinemia ( P =0.024).
MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3-5 cm hepatocellular carcinoma in capable elderly's.
目前对于年龄≥60 岁、肿瘤直径 3-5cm 的肝细胞癌患者，微波消融（MWA）和腹腔镜肝切除术（LLR）的疗效证据尚不充分。
基于限制性立方样条分析，将患者分为三组：60-64 岁、65-72 岁和≥73 岁。采用倾向评分匹配（PSM）以 1:1 比例平衡基线变量。评估总生存期（OS）和无病生存期（DFS），并比较并发症、住院时间和费用。
在 672 例患者中，中位年龄为 66（IQR 62-71）岁。PSM 后，每组各选择 210 例患者。在 36.0（20.4-52.4）个月的随访期间，MWA 组的 1 年、3 年和 5 年 OS 率分别为 97.6%、80.9%和 65.3%，LLR 组分别为 95.5%、78.7%和 60.4%（HR 0.98，P=0.900）。相应的 DFS 率分别为 78.6%、49.6%和 37.5%和 82.8%、67.8%和 52.9%（HR 1.52，P=0.007）。在 60-64 岁年龄组中，有 176 例患者，MWA 和 LLR 两组之间 OS 无显著差异（HR 1.25，P=0.370），MWA 组的复发率更高（HR 1.94，P=0.004）。在 65-72 岁年龄组中，共有 146 例患者进行了匹配，两组 OS 和 DFS 无显著差异（OS（HR 1.04，P=0.900），DFS（HR 1.56，P=0.110））。在 PSM 后≥73 岁的 76 例患者中，MWA 为患者提供了更好的 OS（HR 0.27，P=0.015），两组 DFS 无显著差异（HR 1.41，P=0.380）。总的来说，对于年龄大于 65 岁的患者，MWA 的复发率与 LLR 相当。安全性分析表明，LLR 与更多的术后出血（P=0.032）和低蛋白血症（P=0.024）相关。
MWA 在年龄≥65 岁的患者中与 LLR 相当。对于不能耐受 LLR 的最年长或体弱的患者，MWA 可以作为替代治疗方法，而对于有能力的老年患者，早期 3-5cm 肝细胞癌仍然首选 LLR 治疗。
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