Long-term Survival Analysis of Stereotactic Ablative Radiotherapy Versus Liver Resection for Small Hepatocellular Carcinoma
Menée à partir de données portant sur 117 patients atteints d'un carcinome hépatocellulaire de petite taille (inférieure ou égale à 5 cm) avec 1 ou 2 nodules et un score de Child-Pugh de classe A, cette étude évalue, du point de vue de la survie sans progression et de la survie globale à 1, 3 et 5 ans, l'efficacité d'une radiothérapie ablative stéréotaxique par rapport à une résection hépatique
Purpose : To compare the efficacy of stereotactic ablative radiotherapy (SABR) versus liver resection for small hepatocellular carcinoma (HCC) ≤5 cm with Child–Pugh A cirrhosis. Materials and Methods : This retrospective study included 117 patients with small HCCs with 1 or 2 nodules. Eighty-two patients received SABR (SABR group) and 35 patients underwent liver resection (resection group). Overall survival (OS) and progression-free survival (PFS) were analyzed. One-to-one matched pairs between the 2 groups were performed using propensity score matching to reduce the effect of potential confounding effect of treatment and selection bias. Results : There was no between-group difference in OS and PFS. Before propensity score matching, the 1-, 3-, and 5-year OS was 96.3%, 81.8%, and 70.0% in the SABR group and 93.9%, 83.1%, and 64.4% in the resection group, respectively (P=0.558). The 1-, 3- and 5-year PFS was 81.4%, 50.2%, and 40.7% in the SABR group and 68.0%, 58.3%, and 40.3% in the resection group, respectively (P=0.932). After propensity score matching, 33 paired patients were selected from the SABR and resection groups. The 1-, 3-, and 5-year OS was 100%, 91.8%, and 74.3% in the SABR group and 96.7%, 89.3%, and 69.2% in the resection group, respectively (P=0.405). The 1-, 3-, and 5-year PFS was 84.4%, 59.2%, and 43.9% in the SABR group and 69.0%, 62.4%, and 35.9% in the resection group, respectively (P=0.945). There was a similarity of hepatotoxicity between the two groups. The SABR group showed fewer complications, such as hepatic hemorrhage, hepatic pain, and weight loss. Acute nausea was significantly more frequent in the SABR group than in the resection group. Conclusion : For patients with small primary HCC with 1 or 2 nodules and Child–Pugh A cirrhosis, SABR has local effects that are similar to liver resection. SABR has an advantage over resection in being less invasive.