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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis.
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Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis.

机译：极早期肝细胞癌的肝切除与射频消融：马尔可夫模型分析。

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摘要

No adequate randomized trials have been reported for a comparison between hepatic resection (HR) versus radiofrequency ablation (RFA) for the treatment of patients with very early stage hepatocellular carcinoma (HCC), defined as an asymptomatic solitary HCC <2 cm. For compensated cirrhotic patients with very early stage HCC, a Markov model was created to simulate a randomized trial between HR (group I) versus primary percutaneous RFA followed by HR for cases of initial local failure (group II) versus percutaneous RFA monotherapy (group III); each arm was allocated with a hypothetical cohort of 10,000 patients. The primary endpoint was overall survival. The estimates of the variables were extracted from published articles after a systematic review. In the parameter estimations, we assumed the best scenario for HR and the worst scenario for RFA. The mean expected survival was 7.577 years, 7.564 years, and 7.356 years for group I, group II, and group III, respectively. One-way sensitivity analysis demonstrated that group II was the preferred strategy if the perioperative mortality rate was greater than 1.0%, if the probability of local recurrence following an initial complete ablation was <1.9% or if the positive microscopic resection margin rate was >0.3%. The 95% confidence intervals for the difference in overall survival were -0.18-0.18 years between group I and II, 0.06-0.36 years between group I and III, and 0.13-0.30 years between group II and III, respectively. Conclusion: Primary percutaneous RFA followed by HR for cases of initial local failure was nearly identical to HR for the overall survival of compensated cirrhotic patients with very early stage HCC.
机译：尚无足够的随机试验比较肝切除（HR）与射频消融（RFA）来治疗极早期肝细胞癌（HCC）（定义为无症状孤立性HCC <2 cm）的患者。对于极早期肝癌的代偿性肝硬化患者，创建了一个马尔可夫模型以模拟HR（I组）与原发性经皮RFA继之以HR进行的局部局部衰竭（II组）与经皮RFA单药治疗（III组）之间的随机试验）;假设每个小组有10,000名患者。主要终点是总体生存率。经过系统审查后，变量的估计值是从已发表的文章中提取的。在参数估计中，我们假设HR的最佳情况和RFA的最坏情况。第一组，第二组和第三组的平均预期生存期分别为7.577年，7.564年和7.356年。单向敏感性分析表明，如果围手术期死亡率大于1.0％，初次完全消融后局部复发的可能性小于1.9％或镜检阳性切缘率大于0.3，则II组是首选策略。 ％。第一组和第二组之间的总生存期差异的95％置信区间分别为-0.18-0.18年，第一组和第三组之间的0.06-0.36年以及第二组和第三组之间的0.13-0.30年。结论：对于最初的局部衰竭病例，原发性经皮RFA继之以HR几乎与早期HCC代偿性肝硬化患者的整体生存率相同。

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