手术切除与射频消融治疗乙肝相关肝细胞癌总生存率的比较

StephenW

手术切除与射频消融治疗乙肝相关肝细胞癌总生存率的比较
Moon Haeng Hur 1 , Jeong-Hoon Lee 1 , Ju Yeon Kim 1 , Ji Hoon Hong 1 , Min Kyung Park 1 , Hee Jin Cho 1 , Na Ryung Choi 1 , Jihye Kim 1 , Minseok Albert Kim 1 , Joon Yeul Nam 1 , Yun Bin Lee 1 , Eun Ju Cho 1 , Su Jong Yu 1 , Yoon Jun Kim 1 , Dong Ho Lee 2 , Jeong Min Lee 2 , Suk Kyun Hong 3 , Nam-Joon Yi 3 , Kwang-Woong Lee 3 , Kyung-Suk徐 3 , Jung-Hwan Yoon 1
隶属关系
隶属关系

    1
    首尔国立大学医学院首尔国立大学医院内科和肝脏研究所，首尔 03080，韩国。
    2
    首尔国立大学医学院首尔国立大学医院放射科，韩国首尔 03080。
    3
    首尔国立大学医学院首尔国立大学医院外科，首尔 03080，韩国。

    PMID：34885118 DOI：10.3390/癌症13236009

抽象的

与射频消融 (RFA) 相比，手术切除能否提高早期肝细胞癌 (HCC) 患者的总生存期 (OS) 仍存在争议。本研究旨在比较 RFA 后与 HCC 切除后的 OS。这项回顾性研究包括在极早期或早期阶段接受 RFA 或手术切除作为乙型肝炎病毒 (HBV) 相关 HCC 初始治疗的患者。来自首尔国立大学医院（韩国首尔）的 761 名患者（RFA，n = 194；切除，n = 567）和来自韩国原发性肝脏的 1277 名患者（RFA，n = 352；切除，n = 925）癌症登记处分别包括在医院和全国队列中。主要和次要终点分别是 OS 和无复发生存 (RFS)。在确认抗病毒治疗的历史和规定的核苷（酸）类似物的类型后，进行了额外的分析。比较医院队列中两个治疗组的并发症发生率。使用治疗加权的逆概率 (IPTW) 平衡了基线特征。在医院队列中，RFA 组的平均肿瘤大小更小（1.7 对 3.9 厘米），但肝硬化患者的比例高于切除组（85.6% 对 63.1%）（均 p < 0.01）。在 81.0（四分位距，62.3-107.1）个月的随访期间，OS（调整风险比 (aHR) = 0.870，95% 置信区间 (CI) = 0.400-1.897，p = 0.73）和 RFA 没有差异与采用 IPTW 后更短的 RFS（aHR = 1.562，95% CI = 1.099-2.219，p = 0.01）相关。在医院队列中，抗病毒治疗与更长的 OS（aHR = 0.444，95% CI = 0.251-0.786，p = 0.01）以及 RFS（aHR = 0.544，95% CI = 0.391-0.757，p < 0.01）独立相关.在全国队列中，在调整抗病毒治疗后，两个治疗组之间的 OS 没有差异（aHR = 0.981，95% CI = 0.661-1.456，p = 0.92），这是死亡率（aHR = 0.655, 95% CI = 0.451-0.952, p = 0.03) 在 IPTW 之后。在医院队列中接受替诺福韦 (n = 96) 或恩替卡韦 (n = 184) 治疗的患者中，OS (aHR = 0.522, 95% CI = 0.058-4.724, p = 0.56) 或 RFS (aHR = 1.116，95% CI = 0.738-1.688，p = 0.60）。切除组并发症的总体发生率 (26.3%) 高于 RFA 组 (13.9%) (p < 0.01)。在极早期或早期 HCC 的治疗中，RFA 可能提供与切除术相当的 OS，并发症发生率较低，尽管在调整抗病毒治疗后 RFS 比切除组略短。无论 NA 的类型如何，HBV 相关 HCC 患者的抗病毒治疗都与 OS 和 RFS 密切相关。

关键词：治愈性治疗；恩替卡韦；乙型肝炎病毒;肝癌;核苷（酸）类似物；替诺福韦。
拨款支持

    No. S0252-21-1001/韩国政府（科学和信息通信技术部）资助的国家信息技术产业振兴院补助金

StephenW

Comparison of Overall Survival between Surgical Resection and Radiofrequency Ablation for Hepatitis B-Related Hepatocellular Carcinoma
Moon Haeng Hur  1 , Jeong-Hoon Lee  1 , Ju Yeon Kim  1 , Ji Hoon Hong  1 , Min Kyung Park  1 , Hee Jin Cho  1 , Na Ryung Choi  1 , Jihye Kim  1 , Minseok Albert Kim  1 , Joon Yeul Nam  1 , Yun Bin Lee  1 , Eun Ju Cho  1 , Su Jong Yu  1 , Yoon Jun Kim  1 , Dong Ho Lee  2 , Jeong Min Lee  2 , Suk Kyun Hong  3 , Nam-Joon Yi  3 , Kwang-Woong Lee  3 , Kyung-Suk Suh  3 , Jung-Hwan Yoon  1
Affiliations
Affiliations

    1
    Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
    2
    Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
    3
    Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.

    PMID: 34885118 DOI: 10.3390/cancers13236009

Abstract

It remains controversial whether surgical resection, compared to radiofrequency ablation (RFA), improves overall survival (OS) in patients with early hepatocellular carcinoma (HCC). This study aimed to compare OS after RFA with that after resection for HCC. This retrospective study included patients who underwent RFA or surgical resection as initial treatment for hepatitis B virus (HBV)-related HCC at a very early or early stage. A total of 761 patients (RFA, n = 194; resection, n = 567) from Seoul National University Hospital (Seoul, South Korea) and 1277 patients (RFA, n = 352; resection, n = 925) from the Korean Primary Liver Cancer Registry were included in the hospital and nationwide cohorts, respectively. Primary and secondary endpoints were OS and recurrence-free survival (RFS), respectively. Additional analysis was performed when the history of the antiviral treatment and the type of prescribed nucleos(t)ide analogue were confirmed. The rate of complications was compared between the two treatment groups in the hospital cohort. Baseline characteristics were balanced, using inverse probability of treatment weighting (IPTW). In the hospital cohort, the RFA group had a smaller mean tumor size (1.7 vs. 3.9 cm) but a higher proportion of cirrhotic patients than the resection group (85.6% vs. 63.1%) (both p < 0.01). During 81.0 (interquartile range, 62.3-107.1) months of follow-up, there was no difference in OS (adjusted hazard ratio (aHR) = 0.870, 95% confidence interval (CI) = 0.400-1.897, p = 0.73) and RFA was associated with shorter RFS (aHR = 1.562, 95% CI = 1.099-2.219, p = 0.01) after employing IPTW. Antiviral treatment was independently associated with longer OS (aHR = 0.444, 95% CI = 0.251-0.786, p = 0.01) as well as RFS (aHR = 0.544, 95% CI = 0.391-0.757, p < 0.01) in the hospital cohort. In the nationwide cohort, there was no difference in OS (aHR = 0.981, 95% CI = 0.661-1.456, p = 0.92) between the two treatment groups when adjusted for antiviral treatment, which was a negative independent risk factor for mortality (aHR = 0.655, 95% CI = 0.451-0.952, p = 0.03) after IPTW. Among patients treated with tenofovir (n = 96) or entecavir (n = 184) in the hospital cohort, there was no difference in either OS (aHR = 0.522, 95% CI = 0.058-4.724, p = 0.56) or RFS (aHR = 1.116, 95% CI = 0.738-1.688, p = 0.60). The overall incidence of complications was higher in the resection group (26.3%) than in the RFA group (13.9%) (p < 0.01). RFA may provide comparable OS to resection in the treatment of very early or early HCC with a lower rate of complications, although RFS is marginally shorter than in the resection group after adjusting for antiviral treatment. Regardless of the type of NA, antiviral treatment in patients with HBV-related HCC is strongly associated with both OS and RFS.

Keywords: curative treatment; entecavir; hepatitis B virus; liver cancer; nucleos(t)ide analogue; tenofovir.
Grant support

    No. S0252-21-1001/National IT Industry Promotion Agency grant funded by the Korea government (Ministry of Science and ICT)

StephenW

https://www.mdpi.com/2072-6694/13/23/6009/pdf