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Abstract：
UNASSIGNED: The rate of contraindications to percutaneous ablation (PA) for inoperable early hepatocellular carcinoma (HCC) and subsequent outcomes is not well described. We investigated the prevalence and outcomes of inoperable early HCC patients with contraindications to PA, resulting in treatment stage migration (TSM).
UNASSIGNED: Barcelona Clinic Liver Cancer (BCLC) 0/A patients diagnosed between September 2013 and September 2019 across five hospitals were identified. Primary endpoint was proportion of BCLC 0/A HCCs with contraindications to PA. Secondary endpoints included overall survival (OS), local tumor control (LTC), and recurrence-free survival (RFS). The causal effects of PA versus TSM were assessed using a potential outcome means (POM) framework in which the average treatment effects (ATEs) of PA were estimated after accounting for potential selection bias and confounding.
UNASSIGNED: Two hundred twenty patients with inoperable BCLC 0/A HCC were identified. One hundred twenty-two patients (55.5%) had contraindications to PA and received TSM therapy, 98 patients (44.5%) received PA. The main contraindication to PA was difficult tumor location (51%). Patients who received TSM therapy had lower median OS (2.4 vs 5.3 years), LTC (1.0 vs 4.8 years), and RFS (0.8 vs 2.9 years); P < 0.001, respectively, compared with PA. The ATE for PA versus TSM yielded an additional 1.11 years (P = 0.019), 2.45 years (P < 0.001), and 1.64 years (P < 0.001) for OS, LTC, and RFS, respectively. Three-year LTC after PA was suboptimal (65%).
UNASSIGNED: Our study highlights high rates of contraindication to PA in early HCCs, resulting in TSM and poorer outcomes. The LTC rate for PA appears suboptimal despite being considered as curative therapy. Both findings support the exploration of improved treatment options for early HCCs.
UNASSIGNED: Barcelona Clinic Liver Cancer (BCLC) 0/A patients diagnosed between September 2013 and September 2019 across five hospitals were identified. Primary endpoint was proportion of BCLC 0/A HCCs with contraindications to PA. Secondary endpoints included overall survival (OS), local tumor control (LTC), and recurrence-free survival (RFS). The causal effects of PA versus TSM were assessed using a potential outcome means (POM) framework in which the average treatment effects (ATEs) of PA were estimated after accounting for potential selection bias and confounding.
UNASSIGNED: Two hundred twenty patients with inoperable BCLC 0/A HCC were identified. One hundred twenty-two patients (55.5%) had contraindications to PA and received TSM therapy, 98 patients (44.5%) received PA. The main contraindication to PA was difficult tumor location (51%). Patients who received TSM therapy had lower median OS (2.4 vs 5.3 years), LTC (1.0 vs 4.8 years), and RFS (0.8 vs 2.9 years); P < 0.001, respectively, compared with PA. The ATE for PA versus TSM yielded an additional 1.11 years (P = 0.019), 2.45 years (P < 0.001), and 1.64 years (P < 0.001) for OS, LTC, and RFS, respectively. Three-year LTC after PA was suboptimal (65%).
UNASSIGNED: Our study highlights high rates of contraindication to PA in early HCCs, resulting in TSM and poorer outcomes. The LTC rate for PA appears suboptimal despite being considered as curative therapy. Both findings support the exploration of improved treatment options for early HCCs.
摘要：
未经证实：无法手术的早期肝细胞癌（HCC）的经皮消融（PA）禁忌症的发生率和随后的结局没有得到很好的描述。我们调查了有PA禁忌症的不能手术的早期HCC患者的患病率和结果，导致处理阶段迁移(TSM)。
UNASSIGNED：巴塞罗那诊所肝癌（BCLC）0/2013年9月至2019年9月在五家医院诊断的患者被确定。主要终点是有PA禁忌症的BCLC0/AHCC的比例。次要终点包括总生存期（OS），局部肿瘤控制（LTC），和无复发生存率（RFS）。使用潜在结果均值（POM）框架评估了PA与TSM的因果效应，其中在考虑了潜在的选择偏差和混杂因素后，估计了PA的平均治疗效应（ATE）。
未经批准：确认了220例无法手术的BCLC0/AHCC患者。122名患者（55.5％）有PA禁忌症并接受TSM治疗，98例患者（44.5%）接受PA治疗。PA的主要禁忌症是肿瘤定位困难(51%)。接受TSM治疗的患者的中位OS较低（2.4年vs5.3年），LTC（1.0比4.8年），和RFS（0.8年vs2.9年）；分别为P<0.001，与PA相比。PA与TSM的ATE额外产生了1.11年(P=0.019)，2.45年（P<0.001），OS为1.64年(P<0.001)，LTC,和RFS,分别。PA后三年LTC次优(65%)。
未经评估：我们的研究强调了早期HCC中PA禁忌症的高发生率，导致TSM和较差的结果。尽管被认为是治愈性治疗，但PA的LTC率似乎并不理想。这两个发现都支持探索早期HCC的改进治疗方案。
UNASSIGNED：巴塞罗那诊所肝癌（BCLC）0/2013年9月至2019年9月在五家医院诊断的患者被确定。主要终点是有PA禁忌症的BCLC0/AHCC的比例。次要终点包括总生存期（OS），局部肿瘤控制（LTC），和无复发生存率（RFS）。使用潜在结果均值（POM）框架评估了PA与TSM的因果效应，其中在考虑了潜在的选择偏差和混杂因素后，估计了PA的平均治疗效应（ATE）。
未经批准：确认了220例无法手术的BCLC0/AHCC患者。122名患者（55.5％）有PA禁忌症并接受TSM治疗，98例患者（44.5%）接受PA治疗。PA的主要禁忌症是肿瘤定位困难(51%)。接受TSM治疗的患者的中位OS较低（2.4年vs5.3年），LTC（1.0比4.8年），和RFS（0.8年vs2.9年）；分别为P<0.001，与PA相比。PA与TSM的ATE额外产生了1.11年(P=0.019)，2.45年（P<0.001），OS为1.64年(P<0.001)，LTC,和RFS,分别。PA后三年LTC次优(65%)。
未经评估：我们的研究强调了早期HCC中PA禁忌症的高发生率，导致TSM和较差的结果。尽管被认为是治愈性治疗，但PA的LTC率似乎并不理想。这两个发现都支持探索早期HCC的改进治疗方案。
