The risk factors for long-term survival outcome in solitary hepatocellular carcinoma up to 2 cm: Propensity score matching analysis in a population cohort with a high rate of HBV infection

INTERNATIONAL JOURNAL OF SURGERY

卷:72

Article

Wang, Guoliang^1,2  Zhang, Wei^1,3  Tan, Yifei¹  Jiang, Li¹  Yang, Jian¹  Yang, Jiayin¹  Yan, Lunan¹ 

[1] Sichuan Univ, West China Hosp, Liver Transplantat Ctr, Dept Liver Surg, Chengdu, Sichuan, Peoples R China

[2] Gui Zhou Prov Peoples Hosp, Dept Hepatobiliary Surg, Guiyang, Guizhou, Peoples R China

[3] Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Breast Tumor Ctr, Guangzhou, Guangdong, Peoples R China

关键词: Liver resection;    Hepatocellular carcinoma;    Radiofrequency ablation;    Propensity score matching;   

DOI  :  10.1016/j.ijsu.2019.10.006

来源: Elsevier

【 摘 要 】

Background: The American Joint Committee on Cancer staging recently classified solitary hepatocellular carcinoma (HCC) <= 2 cm with or without vascular invasion as stage T1 a. We aimed to discuss the risk factors of these stage T1 a patients. Methods: Patients diagnosed with solitary HCC <= 2 cm from September 2008 to June 2015 were included in our study. Due to the small number of patients undergoing a non-curable approach and liver transplantation, patients undergoing liver resection (LR) and radiofrequency ablation (RFA) were included. In the comparison between LR and RFA, 1:1 propensity score matching (PSM) was used. The overall survival (OS) and disease-free survival (DFS) were predicted, and the Cox proportional hazard model was used to find the prognostic factors, described as hazard ratio (HR) and 95% confidence interval (CI). Results: In total, 273 HCC patients were involved in our study, of whom 192 patients underwent LR and 81 patients underwent RFA. The proportion of Child-Pugh A patients was higher in the LR group (91.7%) versus the RFA group (76.5%) (P = 0.001), and the tumour size was slightly larger in the LR group, with a median size of 1.9 cm versus 1.7 cm in the RFA group (P = 0.001). No difference was found in OS between LR and RFA. However, RFA was the only risk factor for recurrence (HR 1.578, 95% CI 1.006-2.467, P = 0.047). A total of 80 pairs were compared after PSM, and there was no significant difference in OS or DFS between LR and RFA after PSM (P = 0.5434 or P = 0.1642, respectively). Child-Pugh stage B was the only risk factor for OS in the multivariate analysis after PSM (HR 2.289, 95% CI 1.089-4.812, P = 0.029). Conclusion: RFA was comparable with LR in treating solitary HCC up to 2 cm but with a higher risk for recurrence due to the imbalanced pre-operative covariates. When the pre-operative factors were consistent, liver function was the only prognostic factor for long-term OS.

【 授权许可】

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