巴塞罗那诊所肝癌 0-A 期肝细胞癌经皮消融术、开腹或腹腔镜肝切除术的比较：同期广义倾向得分分析
IF 4.2
3区 医学
Q2 ONCOLOGY
引用次数: 0
摘要
目的：肝切除术和消融术仍是巴塞罗那临床肝癌（BCLC）0-A期肝细胞癌（HCC）最常见的治疗方案，但目前缺乏证据表明哪种疗法最合适。本研究旨在对这些患者接受经皮消融术（PA）、开腹肝切除术（OLR）或腹腔镜肝切除术（LLR）的短期和长期疗效进行多臂比较：这是一项回顾性观察队列研究。对多个治疗组进行了一系列广义倾向评分法，同时比较这三种治疗方案的临床结果，以平衡潜在的混杂因素。研究采用回归标准化方法计算全因死亡率和组间差异复发的风险：在纳入的 1778 例患者中，分别有 1237 例、307 例和 234 例接受了 OLR、LLR 和 PA 治疗。经过重叠加权（最佳调整策略）后，微创组（LLR 和 PA 组）患者术后并发症少，术后住院时间短（P 均为 0.001）。与 OLR 组和 PA 组相比，LLR 组的 5 年无复发生存率（RFS）和 5 年总生存率（OS）明显更高（RFS：55.6% vs 48.0% vs 30.2%，P < 0.001；OS：89.1% vs 79.7%，P < 0.001）：89.1% vs 79.7% vs 84.0%，P = 0.020）。多变量 Cox 分析和回归标准化显示，与 OLR 和 PA 相比，LLR 是提高 RFS 的独立因素。在亚组分析中，BCLC A期HCC患者的长期预后与整个人群一致：关键词：肝细胞癌；腹腔镜肝切除术；广义倾向评分分析；重叠加权；临床结果本文章由计算机程序翻译，如有差异，请以英文原文为准。
Comparisons of Percutaneous Ablation, Open or Laparoscopic Liver Resection for Barcelona Clinic Liver Cancer Stage 0-A Hepatocellular Carcinoma: A Concurrent Generalized Propensity Score Analysis
Purpose: Liver resection and ablation remain the most common therapeutic options for Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC), but there is a lack of evidence to show which is the most suitable therapy. This study aimed to make concurrent multi-arm comparisons of the short-term and long-term outcomes of percutaneous ablation (PA), open (OLR) or laparoscopic liver resection (LLR) for these patients.
Patients and Methods: This was a retrospective observational cohort study. A series of generalized propensity score methods for multiple treatment groups were performed to concurrently compare the clinical outcomes of these three treatment options to balance potential confounders. Regression standardization was used to account for hazard of all-cause mortality and recurrence of intergroup differences.
Results: Of the 1778 patients included, 1237, 307 and 234 underwent OLR, LLR and PA, respectively. After overlap weighting, which was the optimal adjustment strategy, patients in the minimally invasive group (LLR and PA groups) had few postoperative complications and short postoperative hospital stays (both P < 0.001). The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate were significantly higher in the LLR group when compared with the OLR and PA groups (RFS: 55.6% vs 48.0% vs 30.2%, P < 0.001; OS: 89.1% vs 79.7% vs 84.0%, P = 0.020). Multivariable Cox analysis and regression standardization showed that LLR was an independent factor for better RFS when compared with OLR and PA. In subgroup analysis, the long-term outcomes of patients with BCLC stage A HCC were consistent with the whole population.
Conclusion: In the observational study using various covariate adjustment analysis with excellent balance, LLR is not only minimally invasive, but also provides better RFS and equivalent OS for patients with BCLC stage 0-A HCC when compared with OLR and PA.
Keywords: hepatocellular carcinoma, laparoscopic liver resection, generalized propensity score analysis, overlap weighting, clinical outcome
Patients and Methods: This was a retrospective observational cohort study. A series of generalized propensity score methods for multiple treatment groups were performed to concurrently compare the clinical outcomes of these three treatment options to balance potential confounders. Regression standardization was used to account for hazard of all-cause mortality and recurrence of intergroup differences.
Results: Of the 1778 patients included, 1237, 307 and 234 underwent OLR, LLR and PA, respectively. After overlap weighting, which was the optimal adjustment strategy, patients in the minimally invasive group (LLR and PA groups) had few postoperative complications and short postoperative hospital stays (both P < 0.001). The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate were significantly higher in the LLR group when compared with the OLR and PA groups (RFS: 55.6% vs 48.0% vs 30.2%, P < 0.001; OS: 89.1% vs 79.7% vs 84.0%, P = 0.020). Multivariable Cox analysis and regression standardization showed that LLR was an independent factor for better RFS when compared with OLR and PA. In subgroup analysis, the long-term outcomes of patients with BCLC stage A HCC were consistent with the whole population.
Conclusion: In the observational study using various covariate adjustment analysis with excellent balance, LLR is not only minimally invasive, but also provides better RFS and equivalent OS for patients with BCLC stage 0-A HCC when compared with OLR and PA.
Keywords: hepatocellular carcinoma, laparoscopic liver resection, generalized propensity score analysis, overlap weighting, clinical outcome
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