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A multicenter case controlled study on laparoscopic hepatectomy versus microwave ablation as first-line therapy for 3-5 cm hepatocellular carcinoma in patients aged 60 and older

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机构： [1]Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039 [2]Department of Gynecology, Jinan Zhangqiu District People's Hospital, Jinan, China, 250200 [3]Abdominal ultrasound department, the first hospital of Jilin university, Changchun, China, 130012 [4]Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China, 350001 [5]Department of Hepatobiliary Surgery, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039 [6]Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xian, China, 710032 [7]Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, China, 530021 [8]Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, China [9]Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,100021 [10]Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China [11]Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510630 [12]Department of Surgery, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, NO.N1, Shangcheng Road, Yiwu，P.R.China [13]Department of General Surgery, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China, 530021 [14]Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, 610041 [15]Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China, 250013 [16]Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China, 100000

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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 (HCC).Patients were divided into three cohorts based on restricted cubic spline (RCS) 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.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-, 3- and 5-year OS rates in the MWA group were 97.6%, 80.9%, 65.3% and 95.5%, 78.7%, 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).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 fist option of treatments for early-stage 3-5 cm HCC in capable elderlys.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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大类 | 2 区医学

小类 | 2 区外科

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Q1 SURGERY

影响因子： 12.5 最新[2023版] 8.9 最新五年平均 12.5 出版当年[2023版] 0 出版当年五年平均 12.5 出版前一年[2023版]

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第一作者机构： [1]Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039

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通讯机构： [1]Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039 [*1]Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, China, 100039. 28 Fuxing Road, Beijing, 100853, China

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