射频消融与围手术治疗血管周围肝细胞癌：长期结果的倾向

StephenW

Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: Propensity score analyses of long-term outcomes
Sunyoung Lee
, Tae Wook Kang 'Correspondence information about the author Tae Wook KangEmail the author Tae Wook KangEmail the author Tae Wook Kang
, Dong Ik Cha
, Kyoung Doo Song
, Min Woo Lee
, Hyunchul Rhim
, Hyo Keun Lim
, Dong Hyun Sinn
, Jong Man Kim
, Kyunga Kim

DOI:            https://doi.org/10.1016/j.jhep.2018.02.026 |

• Graphical abstract
  

Highlights

• •Surgery provided better PFS and OS compared to RFA for small periportal HCCs.
• •There was significant interaction between treatment and vessel types for outcomes.
• •Evaluating type of peritumoral vessel may determine treatment strategy for HCCs.
  

Background & Aims The therapeutic outcomes of surgical resection (SR) or radiofrequency ablation (RFA) for perivascular hepatocellular carcinoma (HCC) have not been compared. The aim of this study was to compare SR with RFA as first-line treatment in patients with perivascular HCC and to evaluate the long-term outcomes of both therapies.


Methods This retrospective study was approved by the institutional review board. The requirement for informed consent was waived. Between January 2006 and December 2010, a total of 283 consecutive patients with small perivascular HCCs (≤3 cm, Barcelona Clinic Liver Cancer stage 0 or A) underwent SR (n = 182) or RFA (n = 101) as a first-line treatment. The progression-free survival (PFS) and overall survival (OS) rates were compared by propensity score matching. Subgroup analysis of these outcomes was conducted according to the type of hepatic vessels.


Results The median follow-up was 7.8 years. Matching yielded 62 pairs of patients. In the two matched groups, the PFS rates at 5 and 10 years were 58.0% and 17.8%, respectively, in the SR group, and 25.4% and 14.1%, respectively, in the RFA group (p <0.001). The corresponding OS rates at 5 and 10 years were 93.5% and 91.9% in the SR group and 82.3% and 74.1% in the RFA group, respectively (p <0.001). In contrast to those in patients with perivenous HCCs, subgroup analysis indicated that extrahepatic recurrence and OS were significantly different according to the treatment modality in patients with periportal HCCs (p = 0.004 and p <0.001, respectively).


Conclusions In patients with small perivascular HCCs, SR provided better long-term tumor control and OS than RFA, particularly for periportal tumors.


Lay summary Surgical resection and radiofrequency ablation are both treatment options for perivascular hepatocellular carcinoma. We compared outcomes in patients treated with either method. Surgical resection provided better long-term tumor control and overall survival than radiofrequency ablation for patients with a small perivascular hepatocellular carcinoma (≤3 cm) as a first-line treatment, particularly for periportal tumors. The location of the tumor and the type of peritumoral hepatic vessels need to be considered when choosing between surgical resection and radiofrequency ablation for small HCCs.

Keywords:
Liver, Hepatocellular carcinoma, Surgery, Radiofrequency ablation, Treatment outcome




searchScope=series&searchText=Treatment outcome&seriesISSN=0168-8278]Treatment outcome[/url]

StephenW

射频消融与围手术治疗血管周围肝细胞癌：长期结果的倾向评分分析
Sunyoung李
，Tae Wook Kang'关于作者的通信信息Tae Wook KangEmail作者Tae Wook KangEmail作者Tae Wook Kang
Dong Ik Cha
，Kyoung Doo Song
，Min Woo Lee
，Hyunchul Rhim
，Hyo Keun Lim
Dong Hyun Sinn
Jong Man Kim
，Kyunga Kim
PlumX指标
DOI：https：//doi.org/10.1016/j.jhep.2018.02.026 |


    •与小型门静脉期HCC的RFA相比，手术提供了更好的PFS和OS。
    治疗结果与血管类型之间存在显着的相互作用。
    •评估瘤周血管的类型可以确定HCC的治疗策略。

背景和目的

尚未比较手术切除（SR）或射频消融（RFA）治疗血管周围肝细胞癌（HCC）的疗效。本研究的目的是比较SR与RFA作为血管周围HCC患者的一线治疗，并评估两种治疗的长期结果。
方法

这项回顾性研究得到了机构审查委员会的批准。放弃知情同意的要求。 2006年1月至2010年12月期间，连续283例小血管周围HCC（≤3cm，巴塞罗那临床肝癌0或A期）患者接受SR（n = 182）或RFA（n = 101）作为第一线治疗。通过倾向评分匹配来比较无进展生存期（PFS）和总生存期（OS）率。根据肝血管的类型进行这些结果的亚组分析。
结果

中位随访时间为7.8年。匹配产生了62对患者。在两组匹配组中，5年和10年的PFS率在SR组分别为58.0％和17.8％，RFA组分别为25.4％和14.1％（p <0.001）。 5年和10年相应的OS率在SR组分别为93.5％和91.9％，RFA组分别为82.3％和74.1％（p <0.001）。与肝静脉肝癌患者相比，亚组分析表明，根据肝门部癌患者的治疗方式，肝外复发和OS有显着差异（分别为p = 0.004和p <0.001）。
结论

在小血管周围HCC患者中，SR比RFA提供更好的长期肿瘤控制和OS，特别是对于门静脉周围肿瘤。
总结

手术切除和射频消融是血管周肝细胞癌的治疗选择。我们比较了用这两种方法治疗的患者的结局。作为一线治疗的小血管周围肝细胞癌（≤3cm）的患者，手术切除比射频消融提供了更好的长期肿瘤控制和总生存期，特别是对于门静脉周围肿瘤。在选择手术切除和射频消融治疗小肝癌时，需要考虑肿瘤的位置和瘤周肝血管的类型。
关键词：
肝，肝细胞癌，手术，射频消融，治疗结果