PDF(Pubmed)
Abstract：
BACKGROUND: There is currently a lack of convincing evidence for microwave ablation (MWA) and laparoscopic liver resection (LLR) for patients ≥60 years old with 3-5 cm hepatocellular carcinoma.
METHODS: Patients were divided into three cohorts based on restricted cubic spline analysis: 60-64, 65-72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost.
RESULTS: Among 672 patients, the median age was 66 (IQR 62-71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4-52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P =0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P =0.007). The 60-64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P =0.370), MWA was associated with a higher recurrence rate (HR 1.94, P =0.004). A total of 146 patients were matched in the 65-72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P =0.900), DFS (HR 1.56, P =0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P =0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P =0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding ( P =0.032) and hypoproteinemia ( P =0.024).
CONCLUSIONS: MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3-5 cm hepatocellular carcinoma in capable elderly\'s.
METHODS: Patients were divided into three cohorts based on restricted cubic spline analysis: 60-64, 65-72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost.
RESULTS: Among 672 patients, the median age was 66 (IQR 62-71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4-52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P =0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P =0.007). The 60-64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P =0.370), MWA was associated with a higher recurrence rate (HR 1.94, P =0.004). A total of 146 patients were matched in the 65-72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P =0.900), DFS (HR 1.56, P =0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P =0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P =0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding ( P =0.032) and hypoproteinemia ( P =0.024).
CONCLUSIONS: MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3-5 cm hepatocellular carcinoma in capable elderly\'s.
摘要：
背景：对于年龄≥60岁的3-5cm肝细胞癌（HCC）患者，目前缺乏令人信服的证据进行微波消融（MWA）和腹腔镜肝切除术（LLR）。
方法：根据限制性三次样条（RCS）分析将患者分为三个队列：60-64岁、65-72岁和≥73岁。进行倾向评分匹配(PSM)以1:1比例平衡基线变量。评估总生存期（OS）和无病生存期（DFS），接下来是并发症的比较，住院和费用。
结果：在672名患者中，中位年龄为66岁(IQR62~71岁).PSM之后,选择两组各210例患者。在36.0(20.4-52.4)个月的随访期内，1-,MWA组的3年和5年OS率为97.6%，80.9%,65.3%和95.5%，78.7%,LLR组为60.4%(HR0.98,P=0.900)。相应的DFS率为78.6%，49.6%,以及37.5%和82.8%，67.8%,52.9%(HR1.52,P=0.007)。60-64岁的队列涉及176名患者，MWA和LLR组之间的OS没有显着差异（HR1.25，P=0.370），MWA与较高的复发率相关(HR1.94,P=0.004)。在65-72岁的队列中，共有146例患者进行了匹配，两组间OS和DFS无显著差异(OS(HR1.04,P=0.900),DFS(HR1.56,P=0.110)。在PSM后年龄≥73岁的76例患者中，MWA为患者提供了较好的OS(HR0.27,P=0.015),两组间DFS差异无统计学意义(HR1.41,P=0.380)。一起来看,对于65岁以上的患者，MWA的复发率与LLR相当.安全性分析表明，LLR与术后出血（P=0.032）和低蛋白血症（P=0.024）有关。
结论：在65岁及以上的患者中，MWA与LLR相当。MWA可能是年龄最大的老年人或负担不起LLR的病人的替代方案，而LLR仍然是有能力的老年人早期3-5cmHCC的首选治疗方法。
方法：根据限制性三次样条（RCS）分析将患者分为三个队列：60-64岁、65-72岁和≥73岁。进行倾向评分匹配(PSM)以1:1比例平衡基线变量。评估总生存期（OS）和无病生存期（DFS），接下来是并发症的比较，住院和费用。
结果：在672名患者中，中位年龄为66岁(IQR62~71岁).PSM之后,选择两组各210例患者。在36.0(20.4-52.4)个月的随访期内，1-,MWA组的3年和5年OS率为97.6%，80.9%,65.3%和95.5%，78.7%,LLR组为60.4%(HR0.98,P=0.900)。相应的DFS率为78.6%，49.6%,以及37.5%和82.8%，67.8%,52.9%(HR1.52,P=0.007)。60-64岁的队列涉及176名患者，MWA和LLR组之间的OS没有显着差异（HR1.25，P=0.370），MWA与较高的复发率相关(HR1.94,P=0.004)。在65-72岁的队列中，共有146例患者进行了匹配，两组间OS和DFS无显著差异(OS(HR1.04,P=0.900),DFS(HR1.56,P=0.110)。在PSM后年龄≥73岁的76例患者中，MWA为患者提供了较好的OS(HR0.27,P=0.015),两组间DFS差异无统计学意义(HR1.41,P=0.380)。一起来看,对于65岁以上的患者，MWA的复发率与LLR相当.安全性分析表明，LLR与术后出血（P=0.032）和低蛋白血症（P=0.024）有关。
结论：在65岁及以上的患者中，MWA与LLR相当。MWA可能是年龄最大的老年人或负担不起LLR的病人的替代方案，而LLR仍然是有能力的老年人早期3-5cmHCC的首选治疗方法。
