射频消融与手术切除治疗肝细胞癌小结节和大结节的 Meta 分析

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.06.009

Rino A. Gani, Maria Teressa, Refael A. Budiman, Kemal F. Kalista, Cosmas Rinaldi A. Lesmana

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引用次数: 0

摘要

尽管有研究表明，在早期 HCC 中，RFA 和手术切除的疗效相当，但对于肿瘤较大的患者，其获益证据仍不明确。本研究旨在评估 RFA 与手术切除对 HCC 患者的疗效和安全性，考虑到结节的大小，以 3 厘米为分界线。研究人员对多个数据库进行了全面检索。系统回顾和荟萃分析遵循了 PRISMA 指南。与 RFA 相比，手术切除显示出更佳的 OS（HR = 1.18，95% CI：1.11-1.27，p = 0.008）和 RFS（HR = 1.17，95% CI：1.11-1.25，p < 0.00001）。对于小于3厘米或大于5厘米的结节，手术切除组的OS和RFS明显高于RFA组，而对于3-5厘米的结节则无明显差异。然而，手术切除后发生的不良事件明显增多（OR = 0.43，95% CI：0.33-0.56，P < 0.00001）。对于小于3厘米或大于5厘米的肝脏肿瘤，手术切除的OS和RFS均优于RFA。对于 3-5 厘米的肝脏肿瘤，RFA 和手术切除的结果相似。对于不适合手术的患者来说，RFA的疗效相当，不良反应较少，因此可能成为这些3-5厘米肿瘤的首选。

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Meta analysis of radiofrequency ablation versus surgical resection in small and large nodule of hepatocellular carcinoma

Introduction

Although studies have indicated comparable outcomes between RFA and surgical resection in early HCC, there is still unclear evidence of benefit in larger tumor sizes. This study aimed to assess the efficacy and safety of RFA versus surgical resection in HCC patients, considering nodule size with a cutoff at 3 cm.

Methods

A comprehensive search of multiple databases was conducted. The systematic review and meta-analysis followed the PRISMA guidelines.

Result

Surgical resection showed superior OS (HR = 1.18, 95% CI: 1.11–1.27, p = 0.008) and RFS (HR = 1.17, 95% CI: 1.11–1.25, p < 0.00001), compared to RFA. For nodules less than 3 cm or larger than 5 cm, the OS and RFS in the surgical resection group were significantly higher than those in the RFA group, while no significant differences were observed for nodules sized 3–5 cm. However, significantly more adverse events occurred following surgical resection (OR = 0.43, 95% CI: 0.33–0.56, P < 0.00001).

Conclusion

Surgical resection has better OS and RFS compared to RFA for liver tumors less than 3 cm or larger than 5 cm. For liver tumors sized 3–5 cm, RFA and surgical resection yield similar findings. RFA may become a preferable option in these 3–5 cm tumors due to its comparable efficacy and fewer adverse events for patients unsuitable for surgery.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).