| Part 1 Analysis of independent risk factors of radiofrequency ablation in hepatocellular carcinomaObjective:The factors affecting the treatment of hepatocellular carcinoma are generally considered to be divided into the tumor itself and the surrounding environment of the tumor,which could be reflected in the results of tumor diameter,number,blood routine,blood biochemistry,and imaging.This study hopes to find out factors that independently affect radiofrequency ablation therapy by analyzing factors such as tumor characteristics,blood routine,biochemistry,and imaging parameters.At the same time,radiofrequency ablation outcome prediction models were established and quantitatively analyzed for different patient’s hepatocellular carcinoma.Methods:Retrospectively collected and analyzed 527 patients who had undergone radiofrequency ablation for liver cancer from January 2012 to October 2016 at the Second Affiliated Hospital of Zhejiang University,and 594 patients had liver resection.At the end,105 patients were included in the radiofrequency ablation(RFA)and 119 patients were undergone surgical resection(SR).The clinical baseline data,blood biochemistry,and blood routine information for these patients were recorded.The number of tumors,diameters of tumors,and recurrences were recorded during preoperative and postoperative MRI images.At the same time,the apparent diffusion coefficient(ADC)of each patient was calculated using MRI imaging.Through statistical analysis of clinical baseline data of patients in radiofrequency group,univariate logistic regression was used to find out statistically significant factors.These factors were then included in multivariate logistic regression to establish hepatocellular carcinoma outcome prediction model.In order to further verify the independent risk factors of radiofrequency ablation,the clinical baseline data of the patients in the surgical resection group were compared with the radiofrequency ablation group to analyze the differences between patients.Further univariate and multivariate logistic regression analysis were used to compare patients in the surgical resection group with those in the radiofrequency ablation group.The differences between outcomes in the hepatectomy group and the radiofrequency group were compared and independent risk factors for radiofrequency ablation treatment were explored.Results:Finally,40 patients in the RFA group showed incomplete response within 1 year.Statistical analysis revealed that the independent risk factors for incomplete ablation were tumor diameter>3cm(OR=3.084;95%CI 2.434-8.910,P=0.009);multiple tumor numbers(OR=4.556;95%CI 2.604-9.822,P = 0.004)and the ADC<125*10-5 s/mm2(OR=3.084;95%CI 2.434-7.582,P=0.043).Based on this,a prediction model is established.When the model score is higher than 2 points,the RFA group is in high risk of incomplete ablation with the highest Youden index.Therefore,the model formula is:1*ADC(<125*10-5s/mm2 for 1)+3*tumor number(multiple for 1)+ 3*tumor diameter(>3 cm for 1).The sensitivity of the model was 65.9%,the specificity was 68.7%,the positive likelihood ratio was 2.11(95%CI 1.12-3.96),and the negative likelihood ratio was 0.50(95%CI 0.25-0.91).The clinical data of patients in the SR group were compared with those in the RFA group.There was no significant difference in AFP(P=0.483),ALT(P=0.543),tumor number(P=0.255),and ADC value(P=0.105).Under multivariate logistic regression,it was found that the independent risk factors like ADC and tumor diameter in the RFA group were not independent risk factors for tumor recurrence in the SR group.The independent risk factor for SR was ALT>20 U/L(OR=5.117;95%CI 1.909-13.717,P<0.001),AFP≥20ug/L(OR=2.397;95%CI 1.381-4.160,P=0.002)and multiple tumors(OR=2.270;95%CI 0.758-6.799,P=0.043).The multivariate logistic regression analysis of the SR group using ROC curve was AUC=0.769(95%CI 0.676-0.862,P<0.001).Conclusion:ADC values<125*10-5s/mm2 and tumor diameter>3cm are independent risk factors for the treatment of patients with radiofrequency.The number of tumors is a risk factor for both radiofrequency and surgical resection.Therefore,the effect for radiofrequency treatment is more on the whole of liver cancer,and it is not related to the choice of radiofrequency ablation or surgical resection.AFP ≥ 20ug/L and ALT>20U/L were independent risk factors in patients undergoing hepatectomy.Therefore,patients with ADC<125*10-5s/mm2 or tumor diameter>3cm should be cautiously selected for radiofrequency ablation.For patients with multiple tumors,radiofrequency or surgical resection should be selected depending on the condition of the patient.If the patient’s AFP value or ALT value is high,consider using radiofrequency ablation instead of surgical resection for preferred treatment.Part 2 A prognostic meta analysis about radiofrequency ablation versus surgical resection in hepatocellular carcinomaObjective:This study hopes to analyze the prognostic effect of surgical resection and radiofrequency ablation treatment for liver cancer in recent years,and further explores advantages and disadvantages of radiofrequency ablation and hepatectomy for liver cancer,and hopes it works for future treatment options.Methods:The studies were searched by computer on Pubmed,web of science,China Knowledge Network and Google Scholar.To find out all the Study on the prognosis of liver cancer treated with surgical resection or radiofrequency ablation,and the research language is limited to Chinese or English in the past 10 years.By studying the difference of the overall survival rate and disease-free survival rate in the literature between 1,3,and 5 years,we analyzed and compared the differences in the treatment of radiofrequency ablation and hepatectomy in the details of the prognosis.The statistical method was performed using the Revman software downloaded from the Cochrane Collaboration for meta-analysis.Results:Finally,13 articles were included in 1,235 search articles and 1341 RFA patients and 1324 SR patients were included.In the end,it was found that from the perspective of overall survival,there was no statistically significant difference between the 1-year and 3-year survival rates of RFA and SR.1-year overall survival 0.81[95%CI 0.48,1.36,Z-test P=0.43]and 3-year overall survival 0.80[95%CI 0.59,1.07,Z-test P=0.13].However,there was a difference in overall 5-year survival rate,OR 0.71[95%CI 0.50,0.99,Z test P=0.05].In terms of disease-free survival rate,SR patients on the 1,3,and 5 years of disease-free survival rate was significantly better than RFA patients.1-year disease-free survival OR 0.79[95%CI 0.63,0.98,Z-test P=0.04],3-year disease-free survival OR 0.67[95%CI 0.56,0.80,Z-test P<0.001],5-year disease-free survival rate was OR 0.66[95%CI 0.38,1.14,Z test P<0.001].For further subgroup analyses,subgroup analysis was performed on 3-year overall survival and 3-year disease-free survival,whether by region(Asia or other),by year of publication(before or after 2012),or type of study(by RCT).The differences in RFA and SR at the end of the rate are consistent with the overall situation.Regionally,Asia(OR 0.79[95%CI 0.49,1.26,Z test P=0.32])and other regions(OR 0.87[95%CI 0.54,1.44,Z test P=0.40]).According to published years,before 2012 subgroups(OR 0.55[95%CI 0.20,1.46,Z test P=0.23])and after 2012 subgroup(OR 0.89[95%CI 0.70,1.15,Z test P= 0.39]).According to the study type,RCT(OR 0.59[95%CI 0.40,0.88,Z-test P=0.009])and NRCT(OR 0.69[95%CI 0.56,0.84,Z-test P=0.0002]).Conclusion:In terms of overall survival rate,RFA and SR have only marginal differences in 5-year overall survival rate,and there is no significant difference in 1-year and 3-year overall survival rates.In terms of disease-free survival,RFA is not as good as SR in both the short-term 1-year survival rate and the 3-year and 5-year disease-free survival rates in the mid-to-long term,indicating that SR is still required for higher quality of survival.Preferred. |
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