Microwave ablation versus laparoscopic resection as first‐line therapy for solitary 3–5‐cm HCC

医学 肝细胞癌 倾向得分匹配 微波消融 内科学 回顾性队列研究 队列 胃肠病学 总体生存率 烧蚀 外科 核医学
作者
Zhen Wang,Miao Liu,Dezhi Zhang,Songsong Wu,Zhixian Hong,Guangbin He,Hong Yang,Bang‐De Xiang,Xiao Li,Tianan Jiang,Kai Li,Zhe Tang,Fei Huang,Man Lu,Jian Chen,Yucheng Lin,Xiao Lü,Yuquan Wu,Xiao‐wu Zhang,Yefan Zhang
出处
期刊:Hepatology [Lippincott Williams & Wilkins]
卷期号:76 (1): 66-77 被引量:83
标识
DOI:10.1002/hep.32323
摘要

Abstract Background and Aims The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3–5‐cm HCC over time. Approach and Results From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the two groups in 2008–2019 ( n = 335 in each group) and 2014–2019 ( n = 257 in each group) cohorts, respectively. For cohort 2008–2019, during a median follow‐up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (HR: 0.88, 95% CI 0.65–1.19, p = 0.420), and MWA was inferior to LLR regarding disease‐free survival (DFS) (HR 1.36, 95% CI 1.05–1.75, p = 0.017). For cohort 2014–2019, there was comparable OS (HR 0.85, 95% CI 0.56–1.30, p = 0.460) and approached statistical significance for DFS (HR 1.33, 95% CI 0.98–1.82, p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1–4.0‐cm HCCs (HR 0.88, 95% CI 0.53–1.47, p = 0.630) and 4.1–5.0‐cm HCCs (HR 0.77, 95% CI 0.37–1.60, p = 0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both p > 0.05), shorter hospitalization, and lower cost to LLR (all p < 0.001). Conclusions MWA might be a first‐line alternative to LLR for solitary 3–5‐cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.
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