EASL2020[LBP32] 重复肝切除术和 射频消融治疗复发性患者 肝细

StephenW

LBP32
Long-term survival of repeat hepatic resection and
radiofrequency ablation for patients with recurrent
hepatocellular carcinoma: a multicentric study
Jian-Hong Zhong1, Yan-Yan Wang2, Wan-Guang Zhang3,
Anthony Wing-Hung Chan4, Charing C.N. Chong5, Matteo Serenari6,
Ning Peng7, Tao Huang8, Shi-Dong Lu9, Zhi-Yin Liang10, Bao-Cai Xing2,
Matteo Cescon6, Tian-Qi Tliu8, Lin Li9, Le-Qun Li1, Matteo Ravaioli6,
Jacopo Neri6, Alessandro Cucchetti6, Philip Johnson11,
Bang-De Xiang1. 1Guangxi Medical University Cancer Hospital,
Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and
Treatment Engineering and Technology Research Center, Nanning,
China; 2Key Laboratory of Carcinogenesis and Translational Research,
Ministry of Education, Peking University School of Oncology, Beijing
Cancer Hospital and Institute, Hepatopancreatobiliary Surgery
Department I, Beijing, China; 3Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Hepatic Surgery Center;
4State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for
Cancer, Department of Anatomical & Cellular Pathology, and
Department of Surgery, The Chinese University of Hong Kong; 5Division
of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince
ofWales Hospital, The Chinese University of Hong Kong; 6Department of
Medical and Surgical Sciences, University of Bologna; 7Department of
Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical
University; 8Department of Hepatobiliary Surgery, the People’s Hospital
of Guangxi Zhuang Autonomous Region; 9Department of Hepatobiliary
Surgery, the Third Affiliated Hospital of Guangxi Medical University;
10Department of Hepatobiliary Surgery, the First People’s Hospital of
Nanning, Nanning, China; 11Department of Molecular and Clinical
Cancer Medicine, University of Liverpool
Email: [email protected].
Background and aims: The long-term survival of repeat hepatic
resection (rHR) and radiofrequency ablation (RFA) for patients with
recurrent hepatocellular carcinoma (HCC) is still unknown. We did a
multicentric study to assess the long-term survival of rHR and RFA for
patients with recurrent HCC.
Method: Between January 01, 2006, and December 31,2017, 940
patients with recurrent HCC received rHR orRFA. Only those with
recurrent HCC within Milan criteria (with a solitary nodule diameter
of ≤5 cm; 3 or fewer nodules, each ≤3 cm in diameter; and no
macrovascular invasion or distant metastasis) after initial hepatic
resection and had Child-Pugh liver function class A or B (7 score)
werer included. The median (range) follow-up time was 65.6 (1.3–
152.8) months.
Results: 847 patients from 9 centres in mainland China, Hongkong,
and Italy were enrolled in the study. Of these, 307 patients received
rHR while 540 received RFA. Median overall survivalwas 73.5 months
in patients treated with rHR, compared with 66.3 months in those
who received RFA (hazard ratio [HR] 0.99 [95% CI 0.80–1.24]; p =
0.969). The corresponding 10-years overall survival of the two groups
were 34.8% and 28.3%. Median recurrence-free survival was significantly
longer in rHR group when compared with the RFA group (24.1
months vs 15.2 months; HR 0.75 [0.63–0.88]; p < 0.001). The
corresponding 10-years recurrence-free survival of the two groups
were 13.1% and 6.0%. However, patients in the RFA group were with
lower perioperative mortality and morbidity rates, and shorter
hospital stay. Subgroup analyses based on each center and propensity
score analysis found similar findings.Figure 1. Overall survival (A) and recurrence-free survival (B) after repeat
hepatic resection (rHR) or radiofrequency ablation (RFA) for recurrent HCC
within Milan Criteria in total population.
Conclusion: rHR is associated with better recurrence-free survival for
patients with recurrent HCC within Milan criteria. However, RFA is
associated with lower mortality and morbidity rates with similar
long-term overall survival. It could be considered as a reasonable
alternative in patients with high risk for rHR.

StephenW

LBP32
重复肝切除术和
射频消融治疗复发性患者
肝细胞癌：多中心研究
钟建宏1，王艳艳2，张万光3，
陈永雄4，Charing C.N. Chong5，Matteo Serenari6，
宁鹏7，陶煌8，陆世东9，梁志银10，邢宝才2，
Matteo Cescon6，Tian-Qi Tliu8，Lin Li9，Le-Qun Li1，Matteo Ravaioli6，
Jacopo Neri6，Alessandro Cucchetti6，Philip Johnson11，
邦德乡1。 1广西医科大学附属肿瘤医院
广西肝癌肝胆外科
南宁处理工程技术研究中心
中国; 2致癌和转化研究重点实验室，
北京大学肿瘤学院教育部，北京
癌症医院和研究所，肝胰胆管外科
第一部门，中国北京； 3同济医学院附属同济医院
华中科技大学肝脏外科中心；
4华南地区肿瘤学国家重点实验室包玉Sir中心
癌症，解剖与细胞病理学系，以及
香港中文大学外科5师
王子外科，肝胆胰外科
香港中文大学威尔士医院6系
博洛尼亚大学医学与外科科学； 7系
广西医科大学附属第一医院肝胆外科
大学; 8人民医院肝胆外科
广西壮族自治区9肝胆科
广西医科大学第三附属医院外科；
10重庆市第一人民医院肝胆外科
中国南宁市南宁; 11分子与临床系
利物浦大学癌症医学
电子邮件：[email protected]。
背景与目的：重复性肝的长期生存
切除术（rHR）和射频消融术（RFA）
复发性肝细胞癌（HCC）仍是未知的。我们做了一个
多中心研究评估rHR和RFA的长期生存
肝癌复发患者。
方法：2006年1月1日至2017年12月31日之间为940
复发性HCC患者接受了rHR或RFA。只有那些
符合米兰标准的复发性肝癌（结节直径单个）
≤5厘米3个或更少的结节，每个结节的直径≤3厘米；和不
初次肝移植后大血管浸润或远处转移）
切除并具有Child-Pugh肝功能A级或B级（7分）
包括arer。中位（范围）随访时间为65.6（1.3–
152.8）个月。
结果：来自中国大陆，香港，香港，香港，中国
和意大利参加了这项研究。其中，有307名患者接受了治疗
rHR，而540个接受RFA。平均总生存时间为73.5个月
在接受rHR治疗的患者中，则为66.3个月
谁接受过RFA（危险比[HR] 0.99 [95％CI 0.80–1.24]； p =
0.969）。两组相应的10年总生存时间
分别为34.8％和28.3％。中位无复发生存期显着
与RFA组相比，rHR组的时间更长（24.1
月和15.2个月； HR 0.75 [0.63-0.88]； p <0.001）。的
两组相应的10年无复发生存率
分别为13.1％和6.0％。但是，RFA组的患者
降低围手术期死亡率和发病率，并缩短手术时间
住院。根据每个中心和倾向进行子组分析
得分分析发现了相似的发现。图1.重复后的总生存期（A）和无复发生存期（B）
肝切除术（rHR）或射频消融术（RFA）用于复发性HCC
符合米兰标准的总人口。
结论：rHR与以下患者更好的无复发生存率相关：
米兰标准内复发性HCC患者。但是，RFA是
与较低的死亡率和发病率相关
长期总体生存。可以认为是合理的
rHR高危患者的替代治疗。