| ObjectiveSeveral treatments have been developed for patients with primary hepatocellular carcinoma(HCC),including transcatheter arterial chemoembolization(TACE),radiofrequency ablation(RFA),TACE+RFA,su rgical resection(SR),and so on.In China,there have not been a definite conclusion about the optimum management method for primary HCC nodules less than or equal to 7cm among these four treatments.This research was projected to ascertain the optimum management method for Chinese primary HCC patients whose nodules were less than or equal to 7cm.It is a retrospective study.MethodsThe inclusion criteria:①age between 17 and 85;②Child-Pugh class A or B;③no former management for HCC;④one to three HCC nodules with the diameter of each nodule less than or equal to 7cm,the sum of all the nodules(1-3 nodules)in every patient were less than 10cm;⑤no extrahepatic metastasis and no vascular invasion.The exclusion criteria:①a platelet count of less than 30 × 10^9/L;②the one who was performed in emergency situation for an intraperitoneal hemorrhage from a ruptured HCC.We classified patients into three categories according to the diameter of their maximal HCC nodule.The preferable treatment method was determined by comparing overall survival(OS)and recurrence-free survival(RFS)rates.We collected and recorded the following data:①General information:Gender,Age,MELD score,Child-Pugh grade,Etiology,Child-Pugh score;②Laboratory results:Albumin(ALB),Total bilirubin(TBil),Prothrombin time(PT),Platelet(PLT),Hemoglobin(Hb),Creatinine(Cr),Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Alkaline phosphatase(AKP),Gamma-glutamyl transpeptidase(GGT),Alpha fetoprotein(AFP),Hepatitis B surface antigen(HBsAg);③Imaging examination:Size of the biggest nodule,Cirrhosis,Portal hypertension,Tumor number,Lobe involvement.Data processing:All statistical analysis were conducted by employing SPSS version 21.0 statistical software.Fisher exact test and Pearson chi-square test were applied to analyze the categorical variables among different treatment methods respectively from each group.One-way analysis of variance was used to analyze the continuous variables among different treatment methods respectively from each group.Patients whose cause of death had nothing to do with HCC would be recorded.OS and RFS rates were estimated using the Kaplan-Meier method,and discrepancies among different treatment methods were analyzed applying the log-rank test.Baseline predictors probably affecting OS and RFS rates were evaluated using Cox proportional hazards regression model.All predictors in the univariate analysis were absorbed into the multivariate analysis to assess whether they could be considered as independent predictors or not.A P value of less than 0.05 was deemed to denote a significant difference.Results386 patients were included between March 1 2007 and May 31 2016 in our hospital.Of patients with maximal nodule size(0<x≤3 cm),58 underwent radiofrequency ablation(RFA),30 underwent transcatheter arterial ablation(TACE)+RFA,and 70 underwent surgical resection(SR);OS and RFS rates were comparable between SR and RFA(P=0.096 and P=0.066,respectively),while there was a tendency for SR to be more advantageous.There were significant differences in OS and RFS rates between TACE+RFA and RFA(P=0.011 and P=0.007,respectively).For the 3 cm<x≤5 cm group,34 patients underwent TACE,24 underwent RFA,24 underwent TACE+RFA,and 70 underwent SR.SR and RFA showed advantages over TACE and TACE+RFA,and OS and RFS rates were similar between SR and RFA(P=0.256 and P=0.429,respectively),and between TACE and TACE+RFA(P=0.229 and P=0.500,respectively).For the 5 cm<x≤7 cm group,23 underwent TACE,14 underwent TACE+RFA,and 39 underwent SR.There was a tendency for SR to have an advantage over TACE+RFA;OS rates of SR were similar to those of TACE+RFA(P=0.276),and RFS rates of TACE+RFA were worse than those of SR(P=0.010).TACE showed significantly different OS and RFS rates compared with SR(P=0.007 and P=0.018,respectively).ConclusionsFor patients in the 0<x≤3 cm group,SR showed similar effects to RFA,and SR tended to be more advantageous;for the 3 cm<x≤5 cm group,SR yielded similar effects to RFA;and for the 5 cm<x≤7 cm group,SR tended to show greater advantage. |
