ObjectiveTo explore transcatheter arterial chemoembolization (TACE) influences on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma (HCC).MethodsThe clinicopathologic data of BCLC stage 0–A HCC patients underwent the radical resection in the Affiliated Hospital of Southwest Medical University from January 2006 to June 2018 were retrospectively analyzed. These patients were divided into a preoperative TACE treatment group (PTT group, n=365) and a directly surgical resection group (DSR group, n=365). The Kplan-Meier method was used to compare the overall survival (OS) and disease free survival (DFS) between the two groups. The Cox proportional hazard model was used to analyze whether the preoperative TACE was an independent factor affecting the prognosis of patient with BCLC stage 0–A HCC.ResultsA total of 465 patients with BCLC stage 0–A HCC were enrolled, including 365 patients in the DSR group and 100 patients in the PTT group. The baseline data of the two groups were similar（P>0.050）. In the cohort, the 1-, 3-, 5-, 10-year OS rates and DFS rates were 95.3%, 83.5%, 74.3%, 56.8% and 88.0%, 63.8%, 51.1%, 36.4%, respectively in the DSR group, which were 92.7%, 72.9%, 52.3%, 35.3% and 78.1%, 54.2%, 40.4%, 31.2%, respectively in the PTT group. The Kplan-Meier survival analysis showed that the OS and DFS in the DSR group were significantly better than those in the PTT group (P=0.009, P=0.033). The multivariate Cox proportional hazard model analysis showed that the preoperative TACE was the independent risk factor for the poor prognosis in the patients with BCLC stage 0–A HCC [ HR=1.389, 95% CI (1.158, 2.199), P=0.021].ConclusionsFor patients with BCLC stage 0–A HCC, preoperative TACE doesn’t improve patient’s prognosis and might reduce survival rate. If there is no special reason, direct surgery should be performed.
ObjectiveTo compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma.MethodsFrom January 2012 to December 2018, 291 patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes.Results Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS.ConclusionThere is no statistical difference in OS between the two groups, but the RATS group gets better DFS.