立体定向放疗与肝切除术治疗肝细胞癌（≤5 cm）：倾向评分

StephenW

Stereotactic body radiotherapy versus hepatic resection for hepatocellular carcinoma (≤ 5 cm): a propensity score analysis

    Jing Sun, Quan Wang, Zhi-Xian Hong, Wen-Gang Li, Wei-Ping He, Tao Zhang, Ai-Min Zhang, Yu-Ze Fan, Ying-Zhe Sun, Li Zheng & Xue-Zhang Duan

Hepatology International volume 14, pages788–797(2020)Cite this article

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Abstract
Background

CyberKnife stereotactic body radiation therapy (CK-SBRT) has been applied to hepatocellular carcinoma (HCC) patients for several years. The study aim was to compare the efficacy of hepatic resection (HR) and CK-SBRT in naive small hepatocellular carcinoma (sHCC) patients with hepatitis virus-related cirrhosis using a 5-year follow-up study.
Materials and methods

This retrospective cohort study included 317 naive sHCC patients (246 men and 71 women) with hepatitis B or C virus cirrhosis who were treated with HR (n = 195) or CK-SBRT (n = 122) from November 2011 to December 2015. Cumulative overall survival (OS) rates and progression-free survival (PFS) rates were calculated using Kaplan–Meier method.
Results

After the propensity score-matched analysis, 104 patients were selected from each group for further analysis. The 1-, 2-, 3-, and 5-year OS rates were 96.2%, 89.4%, 85.5% and 70.7% in the HR group and 93.3%, 89.4%, 83.7% and 71.0% in the CK-SBRT group, respectively. The 1-, 2-, 3-, and 5-year PFS rates were 78.8%, 64.3%, 56.4% and 47.3% in the HR group and 84.5%, 67.8%, 58.9% and 49.0% in the CK-SBRT group, respectively. No significant difference was found between the two groups in the OS and PFS rates (OS, p = 0.673; PFS, p = 0.350). No death occurred due to the toxicity or complications of HR or CK-SBRT.
Conclusion

CK-SBRT could be an effective alternative to HR for sHCC naive patients with hepatitis-related cirrhosis, especially if patients have higher CP scores and lower PLT counts. PLT counts should be factored into survival evaluation of HCC treatment.

StephenW

立体定向放疗与肝切除术治疗肝细胞癌（≤5 cm）：倾向评分分析

    孙静，王全，洪志贤，李文刚，何卫平，张涛，张爱民，范玉泽，孙应哲，李正＆段学章

《国际肝病学》第14卷，第788–797页（2020年）

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抽象
背景

射波刀立体定向放射疗法（CK-SBRT）已应用于肝细胞癌（HCC）患者已有数年。该研究的目的是通过一项为期5年的随访研究，比较肝切除（HR）和CK-SBRT在天真的小肝细胞癌（sHCC）合并肝炎病毒相关性肝硬化的患者中的疗效。
材料和方法

这项回顾性队列研究包括2011年11月至2015年12月接受HR（n = 195）或CK-SBRT（n = 122）治疗的317例初治的sHCC患者（246例男性和71例女性），患有HB或C病毒性肝硬化。使用Kaplan–Meier方法计算总生存（OS）率和无进展生存（PFS）率。
结果

在倾向得分匹配分析之后，从每组中选择104位患者进行进一步分析。 HR组的1年，2年，3年和5年OS率分别为96.2％，89.4％，85.5％和70.7％，CK-SBRT组为93.3％，89.4％，83.7％和71.0％ ， 分别。 HR组的1年，2年，3年和5年PFS率分别为78.8％，64.3％，56.4％和47.3％，而CK-SBRT组为84.5％，67.8％，58.9％和49.0％ ， 分别。两组的OS和PFS率无显着差异（OS，p = 0.673； PFS，p = 0.350）。没有因HR或CK-SBRT的毒性或并发症而导致死亡。
结论

对于sHCC天真性肝炎相关性肝硬化患者，CK-SBRT可能是HR的有效替代方法，尤其是在CP评分较高且PLT计数较低的患者中。在肝癌治疗的生存评估中应考虑PLT计数。

yorklee

这个数据似乎颠覆了以往的临床印象，射波刀的OS和PFS都优于（至少不劣于）肝切除术？