Supplementary Material for: Comparative study of laparoscopic hepatectomy, open hepatectomy, and percutaneous radiofrequency ablation for small hepatocellular carcinoma: an ancillary study of the SURF trial

Background: Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) is increasing. To evaluate the efficacy of LH for small HCC (≤3 tumors within ≤3 cm), we compared short- and long-term outcomes between LH, open hepatectomy (OH), and radiofrequency ablation (RFA) as an ancillary study of the prospective multicenter study “Efficacy of SUrgery vs. Radio Frequency ablation on primary hepatocellular carcinoma” (SURF trial). Methods: The study population comprised patients enrolled in the SURF trial. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Secondary endpoints were short-term outcomes and the relation between tumor conditions and prognosis for each treatment. RFS and OS were adjusted by inverse probability of treatment-weighted analysis. Results: Of 398 patients included in the study, 38 underwent LH (LH group), 139 underwent OH (OH group), and 221 underwent RFA (RFA group). RFS and OS did not differ significantly between groups. Five-year RFS and OS rates in the LH, OH, and RFA groups were 50%, 41.6%, and 41.8% (p=0.89) and 85.2%, 80.1%, and 80.1% (p=0.83), respectively. Postoperative complication rates (Clavien-Dindo classification ≥III) in the LH, OH, and RFA groups were 22.5%, 23.2%, and 4.2%, respectively (p2 cm (OR=3.13; 95% CI=1.72–5.69), proximity to major vessels (OR=2.08; 95% CI=1.01–4.30), and good liver function (OR=0.46; 95% CI=0.22–0.93). There was no significant difference in prognosis between tumor conditions and each treatment. Conclusions: Survival rates after LH for early HCC were not significantly different from those of OH and RFA. However, LH is a feasible and effective treatment for early HCC with a wide variety of tumor conditions.

背景：针对肝细胞癌（hepatocellular carcinoma, HCC）的腹腔镜肝切除术（laparoscopic hepatectomy, LH）临床应用愈发广泛。本研究作为前瞻性多中心研究「手术与射频消融治疗原发性肝细胞癌疗效评估」（SURF trial）的附属分析，旨在评估LH治疗小肝细胞癌（≤3个肿瘤且单个肿瘤最大径≤3cm）的疗效，对比LH、开腹肝切除术（open hepatectomy, OH）与射频消融术（radiofrequency ablation, RFA）的短期与长期临床结局。
方法：本研究的研究人群来自SURF试验的入组患者。主要研究终点为无复发生存期（recurrence-free survival, RFS）与总生存期（overall survival, OS）；次要研究终点包括短期临床结局，以及不同治疗方式下肿瘤特征与预后的相关性。本研究通过治疗加权逆概率分析对RFS与OS进行校正。
结果：本研究共纳入398例患者，其中38例接受LH治疗（LH组）、139例接受OH治疗（OH组）、221例接受RFA治疗（RFA组）。各组间无复发生存期（RFS）与总生存期（OS）均无显著统计学差异。LH组、OH组与RFA组的5年RFS率分别为50%、41.6%与41.8%（p=0.89），5年OS率分别为85.2%、80.1%与80.1%（p=0.83）。LH组、OH组与RFA组的术后并发症发生率（克莱恩-丁多分级Clavien-Dindo classification ≥Ⅲ级）分别为22.5%、23.2%与4.2%（原文此处p值存在缺失）。此外，肿瘤最大径＞2cm（优势比（odds ratio, OR）=3.13；95%置信区间（confidence interval, CI）=1.72~5.69）、肿瘤紧邻大血管（OR=2.08；95%CI=1.01~4.30）以及肝功能良好（OR=0.46；95%CI=0.22~0.93）与肿瘤复发显著相关。不同治疗方式下，肿瘤特征与预后均无显著统计学差异。
结论：早期肝细胞癌患者接受LH治疗后的生存率与OH及RFA治疗无显著差异。但对于存在多种肿瘤特征的早期肝细胞癌患者，LH是一种可行且有效的治疗方案。