射频消融术对切除的早期肝癌治疗的多中心澳大利亚的研究

StephenW

Original Article
Radiofrequency ablation versus resection for the treatment of early stage hepatocellular carcinoma: a multicenter Australian study

Posted online on January 23, 2015.

   
Ilana Gory, Michael Fink, Sally Bell, Paul Gow, Amanda Nicoll, Virginia Knight, Anouk Dev, Anthony Rode, Michael Bailey, Wa Cheung, William Kemp, and Stuart K. Roberts
1The Alfred Hospital,Melbourne, Australia
2University of Melbourne Department of Surgery, Austin Health,Melbourne, Australia
3St. Vincent’s Hospital,Melbourne, Australia
4Royal Melbourne Hospital,Melbourne, Australia
5Monash Medical Centre, Monash University,Melbourne, Australia
6Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
Correspondence: Stuart Roberts, Department of Gastroenterology, The Alfred Hospital,
55 Commercial Rd, Melbourne, 3004, Australia. +61 3 9076 3375. +61 3 9076 2194. [email protected]


Abstract

Objectives. It remains unclear whether radiofrequency ablation (RFA) provides comparable outcomes to surgical resection (SR). We, therefore, compared survival outcomes of RFA to SR in patients with early stage and very early stage hepatocellular carcinoma (HCC). Methods. A multicenter retrospective analysis was performed in patients from five academic hospitals with Barcelona Cancer of the Liver Clinic (BCLC) stages 0–A HCC having RFA or SR as primary therapy. Results. From 2000–2010, 146 patients who received treatment with RFA (n = 96) or SR (n = 52) were identified. In BCLC A patients with ≤5 cm HCC, there was a trend of lower overall survival after RFA compared with SR (3- and 5-year survival: 62% and 37% vs. 66% and 62% respectively; p = 0.11). By multivariate analysis, RFA was an independent predictor of poor survival (hazard ratio = 2.26; 95% confidence interval: 1.02–5.03; p = 0.04). In ≤3 cm HCC (n = 109), the 3- and 5-year survivals in RFA and SR groups were 66% and 39%, and 69% and 59%, respectively, with no difference in the median survival (p = 0.41). Local recurrence was significantly higher after RFA compared to SR in HCC ≤5 cm (p = 0.006) with a trend of lower recurrence-free survival (p = 0.06) after RFA in HCC ≤3 cm. There were fewer major complications after RFA (2% vs. 8%).
Conclusion. While SR is superior to RFA for the management of early stage BCLC A disease with ≤5 cm HCC, both appear effective as first-line treatment options for Western patients with small ≤3 cm tumors. Although safer than SR, RFA is associated with higher rates of tumor recurrence and local disease progression. Further prospective randomized controlled trials are warranted to compare these two modalities.
Keywords
Hepatocellular carcinoma, radiofrequency ablation, surgical resection, survival

   

StephenW

射频消融术对切除的早期肝癌治疗的多中心澳大利亚的研究

在线发表于2015年1月23日。

   
Ilana盖瑞，迈克尔·芬克，莎莉·贝尔，保罗牌九，阿曼达·尼科尔，弗吉尼亚骑士，阿努克开发，安东尼骑着，迈克尔·贝里，祥华，威廉·肯普，和斯图尔特K.罗伯茨
1The阿尔弗雷德医院，墨尔本，澳大利亚
外科墨尔本系，奥斯汀健康，墨尔本，澳大利亚2University
3ST。文森特医院，墨尔本，澳大利亚
4Royal墨尔本医院，墨尔本，澳大利亚
5Monash医疗中心，莫纳什大学，墨尔本，澳大利亚
6Department流行病学和预防医学，莫纳什大学，
澳大利亚墨尔本
函授：斯图尔特·罗伯茨，消化内科，阿尔弗雷德医院部，
55商业路，墨尔本，3004澳大利亚。 +61390763375.+61390762194 [email protected]


摘要

目标。目前还不清楚是否射频消融（RFA）提供相媲美的成果，以手术切除（SR）。因此，我们RFA相比生存结果到SR患者的初期阶段，非常初期的阶段肝细胞癌（HCC）。方法。从五个学术医院肝诊所巴塞罗那癌（BCLC）患者进行的多中心回顾性分析阶段0-A有RFA或SR作为主要治疗肝癌。结果。从谁收到治疗RFA2000-2010，146患者（n=96）或SR（N =52）进行了鉴定。在BCLC一个患者≤5厘米的肝癌，有较低的总体生存RFA后一种趋势与SR相比（3年和5年生存率：分别为62％和37％对66％和62％; P=0.11） 。通过多变量分析，RFA是穷人生存的独立预测因子（风险比=2.26;95％置信区间：1.02-5.03; P =0.04）。在≤3厘米肝癌（N =109），3-和5年生存率在消融和SR组分别为66％和39％，以及69％和59％，与在中位生存（无差异p值= 0.41）。局部复发是显著高于RFA后较SR在HCC≤5厘米（P = 0.006），较低的无复发生存率RFA后HCC≤3厘米的趋势（P =0.06）。有RFA（2％和8％）后，人少主要并发症。
结论。而SR优于RFA对于早期BCLC管理甲病≤5厘米肝癌，同时出现有效作为用于西方例小≤3厘米瘤的一线治疗方案。虽然比SR更安全，RFA与肿瘤复发和当地疾病进展的比率较高有关。进一步的前瞻性随机对照试验是必要的，以比较这两种方式。
关键词
肝癌，射频消融，手术切除，生存

tingz1103

这个翻译的大家估计看不懂。其实就是说射频与切除都是一线治疗手段。但是从调查结果来看射频的复发率是高于手术切除的。

wumayken

这也和国内指南的结论差不多，3年的生存率差异并不大，146个人，差别就1-2个人左右。但是远期生存率是手术更优，不过3公分以下的，其实差别不大的。所以RFA还是3公分以下最好，超过了能手术最好手术。