基于倾向评分匹配的腹腔镜与开腹肝切除治疗早期肝细胞癌的安全性及疗效比较

Comparison of safety and efficacy of laparoscopic and open hepatectomy for early hepatocellular carcinoma using propensity score matching

目的:在匹配良好的情况下比较腹腔镜肝切除和开腹肝切除治疗BCLC-A期肝细胞癌(HCC)的安全性及疗效。方法:回顾性分析2012年1月-2016年12月期间在湖南省人民医院肝脏外科313例BCLC-A期HCC行首次肝脏切除术患者的临床资料,其中102例行腹腔镜肝切除(腔镜组),211例行开腹肝切除(开腹组)。使用包括肿瘤特征和患者基本情况、切除方式等基线资料对病例进行1:1的倾向评分匹配(PSM),比较匹配后两组的相关临床指标。结果:两组患者匹配后平衡良好(ROC曲线下面积为0.584),匹配后每组患者86例。腔镜组与开腹组比较,肿瘤分化等级、微血管侵犯、切缘阳性方面无统计学差异(均P>0.05),但前者的术中出血量(100 mL vs. 200 mL)、术中需要输血患者比例(4.7%vs.16.3%)、手术时间(160 min vs. 200 min)、术后住院时间(9 d vs. 12 d)、并发症发生率(5.8%vs. 16.3%)均较后者明显减少(均P<0.05),两者总体生存率与无瘤生存率均无统计学差异(P=0.863、P=0.789)。结论:对于BCLC-A期HCC,腹腔镜肝切除术和开腹肝切除术的疗效相似,但前者有更好的围手术期安全性。

Objective: To compare the safety and efficacy of laparoscopic and open liver resection for BCLC-A hepatocellular carcinoma(HCC) between well-matched patient groups. Methods: The clinical data of 313 patients with BCLC-A HCC undergoing primary hepatectomy from January 2012 to December 2016 in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital were retrospectively analyzed. Among them, 102 cases underwent laparoscopic hepatectomy(laparoscopic group)and 211 cases underwent open hepatectomy(laparotomy group). The 1:1 propensity score matching(PSM) was performed using the baseline variables that included tumor characteristics, general conditions and resection types of the patients. Then, the relevant clinical variables were compared between the two groups.Results: The baseline variables were well balanced between the two groups after PSM(the area under ROC curve was 0.584), with 86 matched patients in each group. In laparoscopic group compared with laparotomy group, no significant differences were noted regarding the histological grade, microvascular invasion and positive margin(all P>0.05), but the intraoperative blood loss(100 mL vs. 200 mL), proportion of cases requiring intraoperative blood transfusion(4.7% vs.16.3%), operative time(160 min vs. 200 min), postoperative hospital stay(9 d vs. 12 d) and incidence of complications(5.8% vs. 16.3%) were significantly reduced(all P<0.05);the overall survival rate and tumor-free survival rate had no significant differences between them(P=0.863, P=0.789).Conclusion: For BCLC-A HCC, laparoscopic hepatectomy has efficacy similar to that of open hepatectomy, but the former has better perioperative safety.