腹腔镜肝切除术与射频消融术治疗尾状叶单发肝细胞癌的比较：一项倾向评分匹配研究。
Laparoscopic liver resection versus radiofrequency ablation for caudate lobe solitary hepatocellular carcinoma: A propensity score matching study.
机构信息
Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
出版信息
Cancer Med. 2024 Feb;13(4):e7068. doi: 10.1002/cam4.7068.
OBJECTIVE
This study aimed to compare the clinical efficacy of laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) in treating solitary hepatocellular carcinoma (HCC) of the hepatic caudate lobe.
METHODS
Patients with hepatic caudate lobe HCC who underwent LLR or RFA at three hospitals in China between February 2015 and February 2021 were included. In total, 112 patients met the inclusion criteria, of whom 52 underwent RFA and 60 underwent LLR. The outcomes of the two groups were compared and analyzed using propensity score matching (PSM) method.
RESULTS
There were no significant differences between the two groups in terms of sex, HBV/HCV positivity, AFP positivity (>100 ng/mL), tumor position, Child-Pugh score, or preoperative liver function tests (ALT, AST, TBIL, ALB, and PT) (p > 0.05). Compared to the LLR group, the RFA group had a shorter operation time, less intraoperative bleeding, and shorter postoperative hospital stay (p < 0.05). There was no statistically significant difference in overall postoperative complications between the two groups (p > 0.05). Despite the larger tumor size, the LLR group had better postoperative recurrence-free survival (RFS) (p = 0.00027) and overall survival (OS) (p = 0.0023) than the RFA group. After one-to-one PSM, 31 LLR patients and 31 RFA patients were selected for further analyses. The advantages of LLR over RFA were observed in terms of RFS (p < 0.0001) and OS (p = 0.00029).
CONCLUSION
LLR should probably be recommended as the preferred method for solitary caudate lobe HCC.
目的
本研究旨在比较腹腔镜肝切除术（LLR）和射频消融（RFA）治疗肝尾状叶单发肝细胞癌（HCC）的临床疗效。
方法
纳入 2015 年 2 月至 2021 年 2 月期间在中国三家医院接受 LLR 或 RFA 治疗的肝尾状叶 HCC 患者。共有 112 例患者符合纳入标准，其中 52 例行 RFA，60 例行 LLR。采用倾向性评分匹配（PSM）法比较两组患者的治疗效果。
结果
两组患者的性别、HBV/HCV 阳性、AFP 阳性（>100ng/ml）、肿瘤位置、Child-Pugh 评分和术前肝功能检查（ALT、AST、TBIL、ALB 和 PT）无统计学差异（p>0.05）。与 LLR 组相比，RFA 组手术时间更短、术中出血量更少、术后住院时间更短（p<0.05）。两组患者的总术后并发症发生率无统计学差异（p>0.05）。尽管 RFA 组肿瘤较大，但 LLR 组术后无复发生存（RFS）（p=0.00027）和总生存（OS）（p=0.0023）均优于 RFA 组。经 1:1 PSM 后，选择 31 例 LLR 患者和 31 例 RFA 患者进行进一步分析。与 RFA 相比，LRR 在 RFS（p<0.0001）和 OS（p=0.00029）方面具有优势。
结论
LRR 可能应作为治疗单发肝尾状叶 HCC 的首选方法。
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