Front Oncol:肝硬化严重程度对肝细胞癌患者进行手术(LR)和微波消融(PMCT)治疗的影响

2021-10-09 yd2015 MedSci原创

研究表明,对于单发结节≤3cm,肝功能Child-Pugh A的HCC,LR治疗的OS和DFS优于PMCT。但是对于合并严重肝硬化患者,PMCT可能更优。

肝细胞癌(HCC)是世界上最常见的恶性肿瘤之一,其发病率近年来一直在上升。值得注意的是,早期肝癌患者的最佳治疗手段仍存在争议,尤其是那些伴有不同程度肝硬化的患者。许多指南推荐肝切除术(LR)和肝移植(LT)是早期HCC患者的标准治疗方法。对于伴有严重肝硬化的HCC患者,根据米兰标准,肝移植被广泛接受为金标准,因为它可以消除肿瘤和肝硬化。但是因为供体问题临床上受限。近年来,微波消融(PMCT)常用于小肝癌的治疗。但是,对于伴有不同程度肝硬化的HCC患者,LR 和PMCT的疗效以及安全性尚不清楚。因此,来自华中科技大学同济医院的团队联合国内其他医院开展了回顾性研究,主要比较LR和PMCT治疗单发、小肝细胞癌合并不同程度肝硬化的疗效。相关结果发表在Frontiers in Oncology杂志上。

该研究回顾性分析230例单发HCC病变≤3cm,肝功能Child-Pugh A的患者。在这些患者中,122例患者接受LR, 108例接受PMCT。比较两种治疗策略的短期和长期疗效。肝硬化程度通过临床评分系统(CSS)进行评估。亚组分析是基于CSS评估两种治疗策略的疗效。

                                         CSS评分

所有患者肝功能均为Child-Pugh A级,两组基线特征无统计学差异。大约88.3%的患者是男性,他们中的大多数患有乙型病毒性肝炎。两组患者肝硬化的比例相似(89.3 vs. 92.6%, p= 0.393)。肿瘤大小相似(中位数:2.9 cm vs.2.8cm,p=0.250)。

Kaplan-Meier曲线分析显示,LR组的OS和无病生存期(DFS)优于PMCT组。LR组的1年、3年和5年DFS率分别为95.4%、74.5%和51.7%,而PMCT组分别为83.4%、51.2%和31.5% (p = 0.004)。LR组1年、3年和5年的OS率分别为97.2%、91.6%和65.2%,而PMCT组分别为90.1%、72.4%和42% (p=0.006)。

                                      DFS和OS

多因素分析中,血清胆红素(HR=2.114, 95% CI: 1.076-4.155, p<0.05),肝硬化(HR=3.022, 95% CI:1.132-8.064, p<0.05)和CSS (HR=4.570, 95% CI: 1.499-13.934, p <0.01)为DFS的独立危险因素。多因素分析显示,OS的独立预后因素包括血清胆红素(HR=1.047, 95% CI: 1.005-1.091, p<0.05)、肝硬化(HR=3.746, 95% CI: 1.221-11.495, P<0.05)和CSS (HR=10.119,95% CI: 1.706-60.026, p<0.05)。

              DFS和OS的预后因素

进一步对基于CSS评估肝硬化程度亚组进行分析,当CSS评分≥4时,LR和PMCT治疗的5年DFS率分别为22.8%和16.2% (p=0.818)。LR组和PMCT组的5年OS率分别为41.4%和25.8% (p=0.3)。因此,两组间DFS和OS率均无显著差异。

                  CSS≥4患者的OS和DFS

在治疗后的最初90天内,两组患者均无死亡。肝出血(10/122 vs. 0/108)和疼痛(58/122 vs. 13/108)在LR组显著高于PMCT组(p<0.05)。LR组的胸腔积液(9/122 vs. 1/108)和腹水(15/122 vs. 5/108)明显更常见(p<0.05)。未发生肝脓肿、腹腔出血、肝梗死、胆道腹膜炎等严重并发症。LR组的主要并发症明显多于PMCT组(18.8% vs. 4.6%,p<0.001)。在CSS≥4的患者中, LR组和PMCT组的主要并发症发生率分别为28.4%和5.9%(p = 0.001)。LR组的住院时间明显长于PMCT组,以及总住院费用明显高于PMCT组。

综上,研究表明,对于单发结节≤3cm,肝功能Child-Pugh A的HCC,LR治疗的OS和DFS优于PMCT。但是对于合并严重肝硬化患者,PMCT可能更优。

原始出处:

Li J, Tao H-s, Li J, Wang W-q, Sheng W-w, Huang Z-y and Zhang E-l (2021) Effect of Severity of Liver Cirrhosis on Surgical Outcomes of Hepatocellular Carcinoma After Liver Resection and Microwave Coagulation. Front. Oncol. 11:745615. doi: 10.3389/fonc.2021.745615

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    2022-01-02 minlingfeng
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    2022-04-28 xjy02
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    2021-10-09 ms7000002142400254

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