Comparison of resection, ablation, and stereotactic body radiation therapy in treating solitary hepatocellular carcinoma ≤5 cm: a retrospective, multicenter, cohort study

作者：Yizhen Fu, Zhoutian Yang, Shiliang Liu, Renguo Guan, Xiaohui Wang, Jinbin Chen, Juncheng Wang, Yangxun Pan, Mengzhong Liu, Minshan Chen, Mian Xi, Yaojun Zhang · 发表于：International Journal of Surgery · 年份：2024 · DOI：10.1097/js9.0000000000001977 · 被引用次数：13 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Cholangiocarcinoma and Gallbladder Cancer Studies、Management of metastatic bone disease

BACKGROUND: Few studies have focused on the efficacy of stereotactic body radiation therapy (SBRT) in treating early hepatocellular carcinoma (HCC) for curative intention. This study aims to determine the best option among resection, ablation, and SBRT in dealing with single HCC no more than 5 cm. MATERIALS AND METHODS: This multicenter retrospective cohort study included 985 patients from 3 hospitals: 495, 335, and 155 in the resection, ablation, and SBRT groups, respectively, between January 2014 and December 2021. Subgroup analysis and propensity score matching (PSM) were performed. RESULTS: The SBRT group had unfavorable clinical features including larger tumor size, poorer liver function, and more relapsed tumors. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 84.3%, 66.8%, and 56.2% with resection, 73.3%, 49.8%, and 37.2% with ablation and 73.2%, 56.4%, and 53.6% with SBRT, respectively ( P <0.001). The 3-year overall survival (OS) rates were 89.0%, 89.2%, and 88.8% in the resection, ablation, and SBRT group, respectively ( P =0.590). The three modalities resulted in similar RFS and OS after adjusting for clinical factors. Resection provided ideal local tumor control, successively followed by SBRT and ablation. SBRT led to comparable RFS time compared to resection for tumors <3 cm (HR=0.75, P =0.205), relapsed tumors (HR=0.83, P =0.420), and patients with poor liver function (HR=0.70, P =0.330). In addition, SBRT was superior to ablation regard...