From the Department of Gastroenterology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan (Y.T., H.T., Y. Morimoto, N.T., T.K., Y. Makino, H.Y.); and Department of Internal Medicine, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan (Y.T., Y. Makino).
Radiology. 2013 Dec;269(3):927-37. doi: 10.1148/radiol.13130387. Epub 2013 Oct 28.
To retrospectively compare the outcome of combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) (hereafter, TACE-RFA) with that of surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within the Milan criteria.
Institutional review board approval and informed consent were obtained. From January 2000 to December 2010, 154 patients (mean age, 69.9 years; age range, 50-89 years; 107 men, 47 women) underwent TACE-RFA, and 176 patients (mean age, 66.9 years; age range, 29-83 years; 128 men, 48 women) underwent SR. Patients with HCC who underwent TACE-RFA or SR were enrolled if they met the following inclusion criteria: no previous HCC treatment, one HCC lesion no larger than 5 cm or up to three nodules smaller than 3 cm without vascular invasion or extrahepatic metastasis, and Child-Pugh class A or B disease. Cumulative overall survival (OS) and disease-free survival (DFS) rates were compared after adjustment with propensity score matching.
After this adjustment, OS rates were comparable between the groups (P = .393), but DFS was superior in the SR group (P < .048). Among patients with very early stage HCC (lesions <2 cm in diameter), OS and DFS rates in the SR group were significantly higher than those in the TACE-RFA group (P < .001 and P = .008, respectively). However, adjustment with propensity score matching yielded comparable OS and DFS rates between the two groups (P = .348 and P = .614, respectively).
TACE-RFA may be a viable alternative treatment for early-stage HCC when SR is not feasible.
回顾性比较米兰标准范围内肝细胞癌（HCC）患者接受经导管动脉化疗栓塞（TACE）联合射频消融（RFA）（以下简称 TACE-RFA）与手术切除（SR）的治疗效果。
本研究获得了机构审查委员会批准和患者知情同意。2000 年 1 月至 2010 年 12 月，共 154 例患者（平均年龄 69.9 岁；年龄范围 50-89 岁；107 例男性，47 例女性）接受了 TACE-RFA，176 例患者（平均年龄 66.9 岁；年龄范围 29-83 岁；128 例男性，48 例女性）接受了 SR。符合以下纳入标准的 HCC 患者接受 TACE-RFA 或 SR：无 HCC 治疗史、单个 HCC 病灶直径不超过 5cm 或 3 个结节直径均小于 3cm 且无血管侵犯或肝外转移、Child-Pugh 分级为 A 或 B。通过倾向性评分匹配调整后比较累积总生存（OS）和无病生存（DFS）率。
调整后，两组 OS 率无显著差异（P =.393），但 SR 组 DFS 显著优于 TACE-RFA 组（P <.048）。在非常早期 HCC（病灶直径<2cm）患者中，SR 组的 OS 和 DFS 率显著高于 TACE-RFA 组（P <.001 和 P =.008）。然而，通过倾向性评分匹配调整后，两组 OS 和 DFS 率无显著差异（P =.348 和 P =.614）。
当 SR 不可行时，TACE-RFA 可能是早期 HCC 的可行替代治疗方法。
