探讨手术切除和局部热消融治疗小肝癌患者预后差异。

回顾性分析2004年至2016年美国Surveillance，Epidemiology, and End Results（SEER）数据库中手术切除或局部热消融治疗（微波或射频消融）的4 565例肝癌患者临床资料。患者肿瘤直径≤5 cm且未发生局部和远处转移。根据治疗方式的不同分为手术切除组（2 061例）和局部治疗组（2 504例）。根据人种的不同将患者分为亚洲人群和非亚洲人群进行分析。采用逆处理概率加权（IPTW）校正的Kaplan-Meier和Cox比例风险回归模型对两组进行生存分析，结局指标采用总体生存率（OS）和肿瘤特异性生存率（CSS）。

IPTW校正后，手术切除组中位总体生存期、肿瘤特异性生存期分别为62、97个月，局部治疗组相应为40、65个月，手术切除组OS和CSS优于局部治疗组（χ²=155.14，78.41；P<0.05）。Cox多因素回归分析显示，局部治疗组的死亡风险均明显高于手术切除组（HR=1.523，P<0.05）。在肿瘤直径≤1 cm患者中，局部治疗组和手术切除组死亡风险差异无统计学意义（HR=0.687，P>0.05），而在肿瘤直径1～2 cm、2～3 cm、3～4 cm、4～5 cm患者中，局部治疗组死亡风险均明显高于手术切除组（HR=1.523，1.279，1.849，1.922；P<0.05）。

对于小肝癌患者，手术切除治疗预后优于局部热消融，死亡风险则低于热消融，而对于肿瘤直径≤1 cm患者两种治疗方式死亡风险无明显差异。

To compare the clinical prognosis between surgical resection and local thermal ablation for patients with small liver cancer.

Clinical data of 4 565 patients with liver cancer who underwent surgical resection or local thermal ablation (microwave or radiofrequency ablation) in Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2016 were retrospectively analyzed. The tumor diameter was ≤5 cm and no local or distant metastases was observed in these patients. All patients were divided into the surgical resection group (n=2 061) and local treatment group (n=2 504). All patients were classified into the Asian and non-Asian population according to different races. Survival analysis between two groups was performed by Kaplan-Meier method and Cox's proportional hazards regression model adjusted by inverse probability of treatment weighting (IPTW). The overall survival (OS) and cancer-specific survival (CSS) were considered as the outcome parameters.

After IPTW adjustment, the median OS and CSS in surgical resection group were 62 and 97 months, and were 40 and65 months in local treatment group, the OS and CSS in surgical resection group were significantly better than those in local treatment group (χ²=155.14, 78.41; P<0.05). Cox's multivariate regression analysis showed that the death risk in local treatment group was significantly higher than that in surgical resection group (HR=1.523, P<0.05). For patients with tumor diameter≤1 cm, the death risk did not significantly differ between the local treatment and surgical resection groups (HR=0.687, P>0.05). However, for patients with tumor diameter of 1-2 cm, 2-3 cm, 3-4 cm and 4-5 cm, the death risk in local treatment group was significantly higher than those in surgical resection group (HR=1.523, 1.279, 1.849, 1.922; P<0.05).

For patients with small liver cancer, the prognosis in patients undergoing surgical resection is better and the death risk is lower, compared with those undergoing local thermal ablation. The death risk does not significantly differ in patients with tumor diameter≤1 cm between two therapies.