直径不大于5cm孤立性肝癌:射频消融与手术治疗的比较

Comparison of survival outcomes between radiofrequency ablation and surgery for solitary hepatocellular carcinoma≤5cm(multicenter prognostic analysis)

目的分析射频消融(RFA)和手术切除(SR)两种治疗方式对直径≤5 cm孤立性肝细胞癌预后的影响,比较其优劣性。方法回顾性分析2015年1月至2018年12月中山大学附属中山医院、华中科技大学附属同济医院、孝感市中心医院收治的直径≤5 cm的孤立性肝细胞癌、并接受以上其中一种治疗方式的病人资料,共606例。患者分为A组(直径≤2 cm)、B组(2 cm<直径≤3 cm)、C组(3 cm<直径≤5 cm)3个亚组,其中A组:77例;B组:239例;C组:290例。调查RFA和SR两种治疗方式在各亚组和总体人群中对预后影响,并进一步分析影响RFA疗效的主要原因。结果在肝细胞癌患者总体人群中,行SR组患者的生存预后优于RFA组,差异具有统计学差异(P<0.05)。肿瘤直径≤2 cm时,SR与RFA临床疗效相当,生存预后和无复发生存无统计学差异(P>0.05)。2 cm<直径≤3 cm时,SR的生存预后和无复发生存均优于RFA;直径为>3 cm且≤5 cm的肝细胞癌患者,SR的生存预后和无复发生存优于RFA,差异存在统计学差异(P<0.05)。结论对于肿瘤直径≤2 cm患者,RFA可达到与SR一样的临床疗效;对于2 cm<肿瘤直径≤5 cm肝细胞癌患者,应优先考虑SR。

Objective To compare the effects of radiofrequency ablation(RFA)and surgical resec⁃tion(SR)on the prognosis of solitary hepatocellular carcinoma with tumor diameter≤5 cm.Method Theclinicopathological data of patients with solitary hepatocellular carcinoma with a diameter of≤5 cm who were admitted to Zhongshan Hospital Affiliated to Sun Yat⁃sen University,Tongji Hospital Affiliated to Huazhong University of Science and Technology,and Xiaogan Central Hospital from January 2015 to December 2018 and who received the above two treatments were collected.A total of 606 cases were included in this study.According to tumor diameter,the patients were divided into three subgroups:Group A(diameter≤2 cm),Group B(2 cm<diameter≤3 cm),Group C(3 cm<diameter≤5 cm),among which Group A:77 patients;Group B:239 patients;Group C:290 patients.The effects of RFA and SR on the prognosis in each subgroup and the total population were compared and analyzed,and the main reasons affecting the efficacy of RFA were further explored.Results In the overall population of patients,the survival prognosis of patients in the SR group was better than that in the RFA group,and the difference was statistically significant(P<0.05).When the tumor diameter was less than or equal to 2 cm,the clinical efficacy of SR and RFA were comparable,and there was no significant difference in overall survival(OS)and recurrence⁃free survival(RFS)(P>0.05).When 2 cm<diameter≤3 cm,SR had better OS and RFS than RFA;for patients with HCC whose tumor diameter was>3cm and≤5 cm,SR had better long⁃term prognosis and RFS than RFA,the difference was statistically significant(P<0.05).Conclusion For patients with tumor diameter≤2 cm,RFA can achieve the same clinical efficacy as SR;for patients with of 2 cm<tumor diameter≤5 cm,SR should be given priority.