老年早期肝细胞癌患者器官短缺时的射频消融与手术切除

StephenW

Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage

Bin Yu1, Youming Ding1, Xiaofeng Liao2, Changhua Wang3, Bin Wang1, Xiaoyan Chen1
1 Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
2 Department of General Surgery, Xiangyang Central Hospital, Xiangyang, China
3 Department of Pathology and Pathophysiology, Wuhan University School of Basic Medical Sciences, Wuhan, China

Correspondence Address:
Prof. Youming Ding
Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province
China

Source of Support: None, Conflict of Interest: None
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DOI: 10.4103/sjg.SJG_261_18
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Background/Aims: To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm. Patients and Methods: Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM).Results: Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65–75, >75 years) and tumor size (≤3.0, 3.1–5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM. Conclusion: Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those >75 years with single HCC ≤3 cm.

StephenW

老年早期肝细胞癌患者器官短缺时的射频消融与手术切除

Bin Yu 1，丁有明1，廖晓峰2，王昌华3，王斌1，陈晓燕1
1武汉大学人民医院肝胆外科，武汉，中国
2襄阳市中心医院普外科，襄阳
3武汉大学基础医学院病理学与病理生理学系，武汉

通讯地址：
丁友明教授
武汉大学人民医院肝胆外科，湖北武汉430060
中国
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DOI：10.4103 / sjg.SJG_261_18
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背景/目的：比较单个肝细胞癌（HCC）≤5cm的老年患者（≥65岁）手术切除（SR）与射频消融（RFA）的生存获益。患者和方法：使用监测，流行病学和最终结果数据库，共有461名接受SR的患者和575名接受RFA的患者从2004年至2012年入组。总生存（OS）和肝癌特异性生存（LCSS）两组患者在倾向评分匹配（PSM）前后进行比较。结果：老年早期HCC患者肝移植利用率较低，他们更有可能首次接受SR或RFA治疗。与年轻患者相比，线性治疗（P <0.05）。在整个队列中，SR组具有明显更好的OS [RFA，风险比（HR）= 1.680（1.390,2.031），P <0.001]和LCSS（RFA，HR = 1.658（1.327,2.070），P <0.001）比RFA小组。 PSM后，进一步证实SR组的存活率提高（均P <0.001）。在亚组分析中，根据患者年龄（65-75岁，> 75岁）和肿瘤大小（≤3.0,3.1-5.0cm），SR组仍然表现出比RFA组更好的OS和LCSS（均P <0.05） ），除PSM前后肿瘤≤3.0cm（均P> 0.05）的75岁以上者外。结论：单个HCC≤5cm的老年患者（≥65岁）的治疗策略应强调SR作为主要治疗方法，而对于单个HCC≤3cm的> 75岁的患者，RFA可替代SR。

StephenW

http://www.saudijgastro.com/arti ... epage=325;aulast=Yu