超过米兰标准的 2-3 厘米 HBV 相关单发肝细胞癌的复发：切除

StephenW

超过米兰标准的 2-3 厘米 HBV 相关单发肝细胞癌的复发：切除和消融的比较
陈双刚 1 2 , 马维美 3 , 陆君沉 2 4 , 吴颖 2 4 , 韩琦 2 4 , 曹飞 2 4 , 黄涛 2 4 , 范伟君 2 4
隶属关系
隶属关系

    1
    【作者单位】： 汕头大学医学院粤北人民医院肿瘤科;
    2
    中国广州中山大学癌症中心微创介入治疗科。
    3
    中山大学附属第八医院放射科，深圳，中国。
    4
    中山大学肿瘤医学协同创新中心华南肿瘤学国家重点实验室，广州，中国。

    PMID：34733791 PMCID：PMC8558395 DOI：10.3389/fonc.2021.757149

抽象的

背景：比较超过米兰标准 (HRBM) 的早期肝细胞癌 (HCC) 复发模式和确定切除或消融后超过米兰标准 (TRBM) 的复发时间的独立危险因素可以制定最佳的一线治疗方案并为抢救性移植提供更多的机会和等待时间。

方法：回顾性分析2008年12月至2017年12月384例2～3 cm单结节HBV相关HCC患者一线切除或消融后HRBM的变化情况。 . 切除组和消融组之间的中位 TRBM 通过 Kaplan-Meier 曲线估计。分别采用Cox回归分析和二元logistic回归分析TRBM的独立危险因素和HRBM的发生。 HRBM 和复发预测总生存 (OS) 的能力通过时间相关的接收者操作特征曲线和曲线下的估计面积进行比较。

结果：在我们研究的 384 名患者中，260 名（67.7%）接受了切除（切除组），124 名（32.3%）接受了消融（消融组）。切除组的中位 TRBM 显着长于 PSM 前（中位数，不可用 vs. 101.4 个月，P < 0.001）和 PSM 后（中位数，不可用 vs. 85.7 个月，P < 0.001）。 Cox回归显示消融、高龄、CRP≥1.81mg/L、PLT≤80×109/L是TRBM的独立危险因素。二元logistic回归也显示消融、CRP≥1.81 mg/L、PLT≤80×109/L是HRBM发生的独立危险因素。两组HRBM各表型发生率无显着差异，但消融组首次复发时HRBM发生率显着高于切除组（P < 0.05）。此外，与复发相比，HRBM 是 OS 更好的预测指标（P < 0.05）。

结论：与消融相比，对于 2-3 cm 单结节 HBV 相关 HCC 患者，切除术应被视为更合适的一线选择，也是这些患者肝移植更有希望的桥梁。

关键词：消融技术；乙型肝炎病毒;肝细胞癌;超过米兰标准的复发；手术切除。

版权所有 © 2021 Chen, Ma, Shen, Wu, Qi, Cao, Huang and Fan.

StephenW

Recurrence Beyond the Milan Criteria of HBV-Related Single Hepatocellular Carcinoma of 2-3 cm: Comparison of Resection and Ablation
Shuanggang Chen  1   2 , Weimei Ma  3 , Lujun Shen  2   4 , Ying Wu  2   4 , Han Qi  2   4 , Fei Cao  2   4 , Tao Huang  2   4 , Weijun Fan  2   4
Affiliations
Affiliations

    1
    Department of Oncology, Yuebei People's Hospital, Shantou University Medical College, Shaoguan, China.
    2
    Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
    3
    Department of Radiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
    4
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China.

    PMID: 34733791 PMCID: PMC8558395 DOI: 10.3389/fonc.2021.757149

Abstract

Background: Comparison of patterns of early hepatocellular carcinoma (HCC) recurrence beyond the Milan criteria (HRBM) and identification of the independent risk factors of time to recurrence beyond the Milan criteria (TRBM) after resection or ablation can develop an optimal first-line treatment and provide more opportunities and waiting time for salvage transplantation.

Methods: The patterns of HRBM after first-line resection or ablation in 384 patients with single-nodule HBV-associated HCC of 2-3 cm were retrospectively analyzed by one-to-one propensity score matching (PSM) between December 2008 and December 2017. The median TRBM between the resection group and the ablation group was estimated by Kaplan-Meier curves. The Cox regression analysis and binary logistic regression were used for the identification of the independent risk factors of TRBM and the occurrence of HRBM, respectively. The abilities of HRBM and the recurrence to predict overall survival (OS) were compared by the time-dependent receiver operating characteristic curves and estimated area under the curve.

Results: Of 384 patients enrolled in our study, 260 (67.7%) received resection (resection group) and 124 (32.3%) underwent ablation (ablation group). The median TRBM in the resection group was significantly longer than that in the ablation group before PSM (median, not available vs. 101.4 months, P < 0.001) and after PSM (median, not available vs. 85.7 months, P < 0.001). Cox regression showed ablation, older age, CRP ≥1.81 mg/L, and PLT ≤80 × 109/L were the independent risk factors of TRBM. Binary logistic regression also showed that ablation, CRP ≥1.81 mg/L, and PLT ≤80 × 109/L were the independent risk factors of the occurrence of HRBM. The incidences of various phenotypes of HRBM were not significantly different between the two groups, but the incidence of HRBM at the first recurrence in the ablation group was significantly higher than that in the resection group (P < 0.05). Besides, compared with recurrence, HRBM was a better predictor of OS (P < 0.05).

Conclusions: Compared with ablation, resection should be considered as a more appropriate first-line option for patients with single-nodule HBV-associated HCC of 2-3 cm and a more promising bridge for liver transplantation in those patients.

Keywords: ablation techniques; hepatitis B virus; hepatocellular carcinoma; recurrence beyond the Milan criteria; surgical resection.

Copyright © 2021 Chen, Ma, Shen, Wu, Qi, Cao, Huang and Fan.

StephenW

https://www.frontiersin.org/articles/10.3389/fonc.2021.757149/pdf