[1]刘嘉龙,黄登,曹利,等.腹腔镜肝切除术和射频消融术治疗复发性肝癌的前瞻性随机对照研究(中期随访分析)[J].第三军医大学学报,2019,41(05):467-472.
 LIU Jialong,HUANG Deng,CAO Li,et al.Laparoscopic hepatectomy versus radiofrequency ablation in treatment of recurrent hepatocellular carcinoma: a prospective randomized control study based on interim follow-up analysis[J].J Third Mil Med Univ,2019,41(05):467-472.
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腹腔镜肝切除术和射频消融术治疗复发性肝癌的前瞻性随机对照研究(中期随访分析)
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第05期
页码:
467-472
栏目:
临床医学
出版日期:
2019-03-15

文章信息/Info

Title:
Laparoscopic hepatectomy versus radiofrequency ablation in treatment of recurrent hepatocellular carcinoma: a prospective randomized control study based on interim follow-up analysis
作者:
陆军军医大学(第三军医大学)第一附属医院全军肝胆外科研究所
Author(s):
 

Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
腹腔镜肝切除术肝细胞癌射频消融复发生存率
Keywords:
 
分类号:
R181.32; R730.5; R735.7
文献标志码:
A
摘要:

目的 比较腹腔镜肝切除术(laparoscopic hepatectomy,LH)与射频消融术(radiofrequency ablation,RFA)治疗复发性肝癌的围术期及术后生存结果,为复发性肝癌患者治疗方式选择提供高级别循证医学证据。方法 2016年9月至2017年9月共入组80例复发性肝癌患者,通过随机数字表法随机分至LH组和RFA组。应用前瞻性随机对照研究,分析两组患者围术期指标及总体生存期和无瘤生存期,通过COX比例风险模型分析影响患者术后再次复发的危险因素。结果 中期随访结果显示,LH组与RFA组患者的平均生存期差异无统计学意义[(19.3±6.8)月vs (18.6±6.2)月, P=0.293]。LH组患者1、2年总体生存率为:92.3%和89.7%,RFA组为:85.4%、80.5%。LH无瘤生存期与RFA比较差异有统计学意义[(16.4±8.5)月vs(8.3±7.2)月,P=0.000]。两组1、2年无瘤生存率分别为LH:69.2%、51.3%,RFA:26.8%、22.0%。COX比例风险模型分析显示手术方式及患者术前甲胎蛋白(alpha fetoprotein,AFP)水平是影响患者再次复发的危险因素。结论 中期随访结果显示,对选择性复发肝癌患者,腹腔镜肝切除术后2年无瘤生存率高于射频消融术。

Abstract:
Objective To compare the perioperative and postoperative survival outcomes of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (RHCC) in order to provide high-level evidence-based medical evidence for the treatment.  Methods From September 2016 to September 2017, a total of 80 RHCC patients were prospectively enrolled and randomly assigned to the LH and RFA groups. A prospective randomized controlled study was used to analyze perioperative factors, overall survival and disease-free survival of patients between the 2 groups, and COX proportional risk model was used to analyze the risk factors for postoperative recurrence.  Results According to this interim follow-up analysis, there was no significant difference in the overall survival time between the LH group and the RFA group (19.3±6.8 vs 18.6±6.2 months, P=0.293). The 1- and 2-year overall survival rates were 92.3% and 89.7% in the LH group and 85.4% and 80.5% in the RFA group. There was statistical significant difference in disease-free survival time between the LH group and the RFA group (16.4±8.5 vs 8.3±7.2 months, P=0.000). The 1-year and 2-year disease-free survival rates were 69.2% and 51.3% in LH group, and 26.8% and 22.0% in RFA group. COX proportional risk model analysis showed that the surgical procedures and preoperative alpha fetoprotein (AFP) level were the risk factors for re-recurrence.  Conclusion Our interim follow-up analysis shows that, in selective RHCC patients, LH has a better 2-year disease-free survival rate than RFA.
 

参考文献/References:

[1]JEMAL A, BRAY F, CENTER M M, et al. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2): 69-90. DOI:10.3322/caac.20107. 
[2]CHOI D, LIM H K, RHIM H, et al. Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors[J]. Ann Surg Oncol, 2007, 14(8): 2319-2329. DOI:10.1245/s10434-006-9220-8. 
[3]CHAN A C, POON R T, CHOK K S, et al.Feasibility of laparoscopic re-resection for patients with recurrent hepatocellular carcinoma[J].World J Surg,2014 ,38(5):1141- 1146.DOI:10.1007/s00268-013-2380-3.
[4]BUELL J F, CHERQUI D, GELLER D A, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008[J]. Ann Surg, 2009, 250(5): 825-830. 
[5]GOH B K, TEO J Y, CHAN C Y, et al. Review of 103 cases of laparoscopic repeat liver resection for recurrent hepatocellular carcinoma[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(11): 876-881. DOI:10.1089/lap.2016.0281. 
[6]LIANG H H, CHEN M S, PENG Z W, et al. Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: a retrospective study[J]. Ann Surg Oncol, 2008, 15(12): 3484-3493. DOI:10.1245/s10434-008-0076-y. 
[7]LU M D, YIN X Y, XIE X Y, et al. Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy[J]. Br J Surg, 2005, 92(11): 1393-1398. DOI:10.1002/bjs.5102. 
[8]MAZZAFERRO V, REGALIA E, DOCI R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J]. N Engl J Med, 1996, 334(11): 693-699. DOI:10.1056/NEJM19960314334 1104. 
[9]ERRIDGE S, PUCHER P H, MARKAR S R, et al. Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma[J]. Br J Surg, 2017, 104(11): 1433-1442. DOI:10.1002/bjs.10597. 
[10]BRUIX J, SHERMAN M,American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update[J]. Hepatology, 2011, 53(3): 1020-1022. DOI:10. 1002/hep.24199. 
[11]BELLI G, CIOFFI L, FANTINI C, et al. Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results[J]. Surg Endosc, 2009, 23(8): 1807-1811. DOI:10.1007/s00464-009-0344-3. 
[12]BELLI G, FANTINI C, D’AGOSTINO A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results[J]. Surg Endosc, 2007, 21(11): 2004-2011. DOI:10.1007/ s00464-007-9503-6. 
[13]HU M, ZHAO G, XU D, et al. Laparoscopic repeat resection of recurrent hepatocellular carcinoma[J]. World J Surg, 2011, 35(3): 648-655. DOI:10.1007/s00268-010-0919-0. 
[14]FENG K, YAN J, LI X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma[J]. J Hepatol, 2012, 57(4): 794-802. DOI:10.1016/j.jhep.2012.05.007. 
[15]GAVRIILIDIS P, ASKARI A, AZOULAY D. Survival following redo hepatectomy vs radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and metaanalysis[J]. HPB (Oxford), 2017, 19(1): 3-9. DOI:10.1016/j.hpb.2016.10.003. 
[16]WANG K, LIU G, LI J, et al. Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: a prospective cohort study[J]. Eur J Surg Oncol, 2015, 41(2): 236-242. DOI:10.1016/j.ejso.2014.11.002. 
[17]CHEN X, CHEN Y, LI Q, et al. Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis[J]. J Surg Res, 2015, 195(1): 166-174. DOI:10.1016/j.jss.2015.01.042. 
[18]THOMASSET S C, DENNISON A R, GARCEA G. Ablation for recurrent hepatocellular carcinoma: a systematic review of clinical efficacy and prognostic factors[J]. World J Surg, 2015, 39(5): 1150-1160. DOI:10.1007/s00268-015-2956-1. 
[19]ARII S, MONDEN K, NIWANO M, et al. Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis, intrahepatic metastasis, and extrahepatic recurrence[J]. J Hepatobil Pancreat Surg, 1998, 5(1): 86-92. DOI:10.1007/pl00009956. 
[20]ZHANG X, LI C, WEN T, et al. Appropriate treatment strategies for intrahepatic recurrence after curative resection of hepatocellular carcinoma initially within the Milan criteria: according to the recurrence pattern[J]. Eur J Gastroenterol Hepatol, 2015, 27(8): 933-940. DOI:10.1097/MEG.0000000000000383. 
 

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更新日期/Last Update: 2019-03-05