Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Second General Surgical Unit, Padova Teaching Hospital, Padua, Italy.
Department of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
JAMA Surg. 2024 Aug 1;159(8):881-889. doi: 10.1001/jamasurg.2024.1184.
The 2022 Barcelona Clinic Liver Cancer algorithm currently discourages liver resection (LR) for patients with multinodular hepatocellular carcinoma (HCC) presenting with 2 or 3 nodules that are each 3 cm or smaller.
To compare the efficacy of liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE) in patients with multinodular HCC.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study is a retrospective analysis conducted using data from the HE.RC.O.LE.S register (n = 5331) for LR patients and the ITA.LI.CA database (n = 7056) for PRFA and TACE patients. A matching-adjusted indirect comparison (MAIC) method was applied to balance data and potential confounding factors between the 3 groups. Included were patients from multiple centers from 2008 to 2020; data were analyzed from January to December 2023.
LR, PRFA, or TACE.
Survival rates at 1, 3, and 5 years were calculated. Cox MAIC-weighted multivariable analysis and competing risk analysis were used to assess outcomes.
A total of 720 patients with early multinodular HCC were included, 543 males (75.4%), 177 females (24.6%), and 350 individuals older than 70 years (48.6%). There were 296 patients in the LR group, 240 who underwent PRFA, and 184 who underwent TACE. After MAIC, LR exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE.
For patients with early multinodular HCC who are ineligible for transplant, LR should be prioritized as the primary therapeutic option, followed by PRFA and TACE when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population.
2022 年巴塞罗那临床肝癌算法目前不建议对 2 或 3 个直径均为 3cm 或更小的结节的多结节肝细胞癌（HCC）患者进行肝切除术（LR）。
比较多结节 HCC 患者行肝切除术（LR）、经皮射频消融术（PRFA）和经肝动脉化疗栓塞术（TACE）的疗效。
设计、地点和参与者：这是一项使用来自 2008 年至 2020 年的 LR 患者的 HE.RC.O.LE.S 登记处（n=5331）和 PRFA 和 TACE 患者的 ITA.LI.CA 数据库（n=7056）的数据进行的回顾性分析。采用匹配调整间接比较（MAIC）方法来平衡 3 组之间的数据和潜在混杂因素。纳入了来自多个中心的患者；数据分析于 2023 年 1 月至 12 月进行。
LR、PRFA 或 TACE。
计算了 1、3 和 5 年的生存率。使用 Cox MAIC 加权多变量分析和竞争风险分析评估结局。
共纳入 720 例早期多结节 HCC 患者，其中男性 543 例（75.4%），女性 177 例（24.6%），年龄>70 岁 350 例（48.6%）。LR 组 296 例，行 PRFA 240 例，行 TACE 184 例。经过 MAIC 后，LR 的 1 年、3 年和 5 年生存率分别为 89.11%、70.98%和 56.44%。PRFA 分别为 94.01%、65.20%和 39.93%，而 TACE 分别为 90.88%、48.95%和 29.24%。加权人群中的多变量 Cox 生存分析显示，替代治疗的生存获益（PRFA 与 LR：风险比[HR]，1.41；95%CI，1.07-1.86；P=0.01；TACE 与 LR：HR，1.86；95%CI，1.29-2.68；P=0.001）。竞争风险分析证实 LR 组的癌症相关死亡风险低于 PRFA 和 TACE 组。
对于不符合移植条件的早期多结节 HCC 患者，LR 应作为主要治疗选择，当 LR 不可行时，应优先选择 PRFA 和 TACE。这些发现为该患者人群的临床决策提供了有价值的信息。
