Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria

作     者：Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Letizia Laera Francesca Ratti Maximiliano Gelli Ferdinando Anelli Alexis Laurent Giulio Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño AntonioRampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo 

作者机构：Departement of Emergency and Trasplantation of OrgansGeneral Surgery Unit“M.Rubino”Policlinico di BariBari 70124Italy Interventional Radiology Unit"F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Emergency and Organ TransplantationGeneral Surgery Unit“M.Rubino”University of BariCeglie Messapica 70124Italy Department of Oncology"F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of SurgeryUniv Vita Salute San RaffaeleMilan 20132Italy Department of Visceral and Oncological SurgeryGustave Roussy Cancer Campus Grand ParisVillejuif 94800France Unit of Oncologic and Pancreatic SurgeryHospital University Reina SofíaCordoba 14004Spain Department of Digestive and Hepatobiliary SurgeryHenri Mondor University HospitalCreteil 94000France Department of SurgeryUniversity of Geneva HospitalsGeneva 44041Switzerland Hepato-Pancreato-Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModena 41124Italy Institut de Recherche Contre les Cancers de l'Appareil DigestifStrasbourg 67000France Department of SurgeryKeio University School of MedicineShinjuku-ku 160-8582Japan Hepato-Biliary and Pancreatic Surgical UnitNouvel Hôpital CivilStrasbourg cedex 67091France Department of HepatobiliaryPancreatic and Digestive SurgeryUniversity Hospital Robert Debréof ReimsReims 51100France Hepatobiliary and Pancreatic Surgery UnitGeneral Surgery DepartementTroyes HospitalTroyes Zip or Postal CodeFrance University of Champagne-ArdenneReims 51100France Unit of Minimally Invasive and Robotic Digestive Surgery"F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of General and Digestive SurgeryReina Sofia University HospitalCordoba 14004Spain Interventional Radiology UnitNiguarda HospitalMilan 20132Italy 20132Italy RenèAdam Hepatobiliary CenterHopital Paul BrousseVillejuif 94800France Unit of Hepato-Pancreatic-Biliary SurgeryUniv Vita Salute San RaffaeleMilan 20132Italy Unit of Hepato-Pancreatic-Biliary Surgery"F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第18期

页      面：2205-2218页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Hepatocellular carcinoma Milan criteria Radiofrequency ablation Surgical resection Elderly patients Propensity score matching 

摘      要：BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan *** To evaluate short-and long-term outcome in elderly patients(70 years)with HCC in Milan criteria,which underwent liver resection(LR)or *** The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European *** analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox *** After PSM,we compared 136 patients in the LR group with 136 patients in the RFA *** survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(10)[odds ratio(OR)=1.89],increased value of international normalized ratio(1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence *** Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(70 years)with HCC in Milan criteria.