Abstract：
BACKGROUND: This study aimed to compare the effectiveness of liver resection (LR) and microwave ablation (MWA) in hepatocellular carcinoma (HCC) patients with early recurrence and varying stages of cirrhosis.
METHODS: This study analyzed patients with HCC who underwent hepatectomy and experienced early tumor recurrence (≤3 cm) between December 2002 and December 2020 at the Tongji Hospital. Treatment effectiveness was assessed using a propensity score matching (PSM) analysis.
RESULTS: This study included 295 patients (106, LR; 189, MWA), 86 patients in each of the 2 groups were chosen for further comparison, after PSM. After PSM, both LR and MWA demonstrated similar recurrence-free survival (RFS) and overall survival (OS) rates (p = 0.060 and p = 0.118, respectively). However, the LR group had more treatment-related complications. In patients with moderate or severe cirrhosis, no significant differences in RFS or OS rates were found between the LR and MWA groups (p = 0.779 and p = 0.772, respectively). In patients without cirrhosis or with mild cirrhosis, LR showed better RFS and OS rates than MWA (p = 0.024 and p = 0.047, respectively). Multivariate analysis after PSM identified moderate or severe cirrhosis and recurrence intervals ≤12 months as independent predictors of poor RFS and OS in patients with early recurrence of HCC.
CONCLUSIONS: LR is more effective than MWA for early recurrence of HCC in patients without cirrhosis or with mild cirrhosis, showing improved RFS and OS rates. In patients with moderate or severe cirrhosis, the OS and RFS were statistically equal between the two therapies. However, MWA may be preferred owing to its low complication rate.
METHODS: This study analyzed patients with HCC who underwent hepatectomy and experienced early tumor recurrence (≤3 cm) between December 2002 and December 2020 at the Tongji Hospital. Treatment effectiveness was assessed using a propensity score matching (PSM) analysis.
RESULTS: This study included 295 patients (106, LR; 189, MWA), 86 patients in each of the 2 groups were chosen for further comparison, after PSM. After PSM, both LR and MWA demonstrated similar recurrence-free survival (RFS) and overall survival (OS) rates (p = 0.060 and p = 0.118, respectively). However, the LR group had more treatment-related complications. In patients with moderate or severe cirrhosis, no significant differences in RFS or OS rates were found between the LR and MWA groups (p = 0.779 and p = 0.772, respectively). In patients without cirrhosis or with mild cirrhosis, LR showed better RFS and OS rates than MWA (p = 0.024 and p = 0.047, respectively). Multivariate analysis after PSM identified moderate or severe cirrhosis and recurrence intervals ≤12 months as independent predictors of poor RFS and OS in patients with early recurrence of HCC.
CONCLUSIONS: LR is more effective than MWA for early recurrence of HCC in patients without cirrhosis or with mild cirrhosis, showing improved RFS and OS rates. In patients with moderate or severe cirrhosis, the OS and RFS were statistically equal between the two therapies. However, MWA may be preferred owing to its low complication rate.
摘要：
背景：本研究旨在比较肝切除术（LR）和微波消融（MWA）对早期复发和不同阶段肝硬化的肝细胞癌（HCC）患者的有效性。
方法：本研究分析了2002年12月至2020年12月在同济医院接受肝切除术并经历早期肿瘤复发（≤3cm）的HCC患者。使用倾向评分匹配(PSM)分析评估治疗有效性。
结果：这项研究包括295例患者（106，LR；189，MWA），选择两组各86例患者作进一步比较,在PSM之后。PSM之后,LR和MWA的无复发生存率(RFS)和总生存率(OS)相似(分别为p=0.060和p=0.118).然而,LR组治疗相关并发症较多.在中度或重度肝硬化患者中，LR组和MWA组的RFS或OS率无显著差异(分别为p=0.779和p=0.772).在没有肝硬化或轻度肝硬化的患者中，LR显示比MWA更好的RFS和OS率（分别为p=0.024和p=0.047）。多因素分析后PSM确定中度或重度肝硬化和复发间隔≤12个月作为肝癌早期复发患者RFS和OS差的独立预测因子。
结论：LR比MWA对无肝硬化或轻度肝硬化患者的早期HCC复发更有效。显示改进的RFS和OS速率。在中度或重度肝硬化患者中，两种疗法的OS和RFS在统计学上相等.然而,由于并发症发生率低，MWA可能是首选。
方法：本研究分析了2002年12月至2020年12月在同济医院接受肝切除术并经历早期肿瘤复发（≤3cm）的HCC患者。使用倾向评分匹配(PSM)分析评估治疗有效性。
结果：这项研究包括295例患者（106，LR；189，MWA），选择两组各86例患者作进一步比较,在PSM之后。PSM之后,LR和MWA的无复发生存率(RFS)和总生存率(OS)相似(分别为p=0.060和p=0.118).然而,LR组治疗相关并发症较多.在中度或重度肝硬化患者中，LR组和MWA组的RFS或OS率无显著差异(分别为p=0.779和p=0.772).在没有肝硬化或轻度肝硬化的患者中，LR显示比MWA更好的RFS和OS率（分别为p=0.024和p=0.047）。多因素分析后PSM确定中度或重度肝硬化和复发间隔≤12个月作为肝癌早期复发患者RFS和OS差的独立预测因子。
结论：LR比MWA对无肝硬化或轻度肝硬化患者的早期HCC复发更有效。显示改进的RFS和OS速率。在中度或重度肝硬化患者中，两种疗法的OS和RFS在统计学上相等.然而,由于并发症发生率低，MWA可能是首选。
