Chen Hung-Kai, Chang Kai-Cheng, Shao Shih-Chieh, Soong Ruey-Shyang, Chen Yi-Chan, Wu Chun-Feng, Wu Tsung-Han, Chou Tien-Shin, Chan Siu-Cheung, Lai Edward Chia-Cheng
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Hepatocell Carcinoma. 2025 May 7;12:879-890. doi: 10.2147/JHC.S485171. eCollection 2025.
Minimally invasive hepatectomy (MIH) has been increasingly applied for patients with hepatocellular carcinoma (HCC). However, the effectiveness of MIH has yet to be well established.
This retrospective cohort study included patients aged 20 years and older, newly receiving MIH for HCC with Barcelona Clinic Liver Cancer (BCLC) classification stage 0, A or B from 2010 to 2019. Two 1:1 propensity score-matched cohorts of those receiving open hepatectomy (OH) and those receiving radiofrequency ablation (RFA) were selected as comparison groups. As a control analysis, we compared patients receiving OH with those receiving RFA under the hypothesis that the OH group had better survival outcomes than the RFA group.
We included a total of 555 matched patients receiving MIH or OH, and 382 matched patients receiving MIH or RFA. Compared to the OH group, MIH group was associated with better overall survival (OS) (Hazard ratios (HR): 0.62; 95% CI: 0.43-0.88) and similar PFS (HR: 0.92; 0.74-1.16). Compared to the RFA group, we found the MIH group was associated with better OS (0.46; 0.32-0.67) and better PFS (0.48; 0.38-0.61). We found consistent results from a series of subgroup analyses (eg, age groups, BCLC stages and hospital levels) and sensitivity analyses (eg, study period restricted to the most recent 5 years (2015-2019)). The control analysis (OH group vs RFA group) confirmed the robustness of main analyses.
Our study suggested that MIH had better survival outcomes for patients with early or resectable intermediate-stage HCC, compared to RFA or OH.
微创肝切除术（MIH）已越来越多地应用于肝细胞癌（HCC）患者。然而，MIH的有效性尚未得到充分证实。
这项回顾性队列研究纳入了2010年至2019年期间年龄在20岁及以上、新接受MIH治疗的HCC患者，其巴塞罗那临床肝癌（BCLC）分期为0、A或B期。选择两个1:1倾向评分匹配队列，分别为接受开放性肝切除术（OH）的患者和接受射频消融（RFA）的患者作为比较组。作为对照分析，我们在假设OH组生存结局优于RFA组的前提下，比较了接受OH的患者与接受RFA的患者。
我们共纳入了555例接受MIH或OH的匹配患者，以及382例接受MIH或RFA的匹配患者。与OH组相比，MIH组的总生存期（OS）更好（风险比（HR）：0.62；95%置信区间：0.43 - 0.88），无进展生存期（PFS）相似（HR：0.92；0.74 - 1.16）。与RFA组相比，我们发现MIH组的OS更好（0.46；0.32 - 0.67），PFS也更好（0.48；0.38 - 0.61）。我们从一系列亚组分析（如年龄组、BCLC分期和医院级别）和敏感性分析（如将研究期限制在最近5年（2015 - 2019年））中得到了一致的结果。对照分析（OH组与RFA组）证实了主要分析结果的稳健性。
我们的研究表明，对于早期或可切除的中期HCC患者，与RFA或OH相比，MIH具有更好的生存结局。
