- 作者：Aless ; ro Cucchetti ; Fabio Piscaglia ; Matteo Cescon ; Carla Serra ; Antonio Colecchia ; Lorenzo Maroni ; Laura Vener ; i ; Giorgio Ercolani ; Antonio Daniele Pinna
- 关键词：Hepatocellular carcinoma ; Liver function ; Monte Carlo simulation ; Radiofrequency ablation ; Survival ; Surgical therapy
- 刊名：Digestive and Liver Disease
- 出版年：March, 2014
- 年：2014
- 卷：46
- 期：3
- 页码：257-263
- 全文大小：967 K
Background
Whether to prefer hepatic resection or radiofrequency ablation as first line therapy for hepatocellular carcinoma is a matter of debate.Aims
To compare outcomes of resection and ablation, in the treatment of early hepatocellular carcinoma, through a decision-making analysis.
Methods
Data of 388 cirrhotic patients undergoing resection and of 207 undergoing radiofrequency ablation were reviewed. Two distinct regression models were devised and used to perform sensitivity and probabilistic analyses, to overcome biases of covariate distributions.
Results
Actuarial survival curves showed no difference between resection and ablation (P = 0.270) despite the fact that ablated patients were older, with worse liver function and smaller, unifocal tumours (P < 0.05), suggesting a complex, non-linear relationship between clinical, tumoral variables and treatments. Sensitivity and probabilistic analyses suggested that the superiority of resection over ablation decreased at higher Model for-End stage Liver Disease scores, and that ablation provided better results for smaller tumours and higher Model for-End stage Liver Disease scores. In patients with 2-3 tumours up to 3 cm, the two treatments produced opposite comparative results in relation to the Model for-End stage Liver Disease score.
Conclusions
The superiority, or the equivalence, of resection and ablation depends on the non-linear relationship existing between treatment, tumour number, size and degree of liver dysfunction.