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[其他] 立体定向放疗与肝切除术治疗肝细胞癌(≤5 cm):倾向评分 [复制链接]

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发表于 2020-10-16 19:43 |只看该作者 |倒序浏览 |打印
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.

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才高八斗

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发表于 2020-10-16 19:43 |只看该作者
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。

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发表于 2020-10-26 09:08 |只看该作者
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?
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