From the Department of Internal Medicine and Liver Research Institute (H.J.Y., J.H.L., D.H.L., S.J.Y., Y.J.K., J.H.Y., H.S.L.), Department of Radiology (H.C.K., J.M.L., J.W.C.), and Department of Surgery (N.J.Y., K.W.L., K.S.S.), Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-744, Korea.
Radiology. 2014 Jun;271(3):909-18. doi: 10.1148/radiol.13131760. Epub 2014 Feb 8.
To compare the effectiveness of transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and hepatic resection (HR) in patients with small single-nodule hepatocellular carcinoma by using inverse probability weighting to control selection bias.
This retrospective cohort study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The study included 197 consecutive patients (146 men and 51 women; mean age ± standard deviation, 57.4 years ± 9.7) with single-nodule hepatocellular carcinomas measuring 3 cm or smaller and no vascular invasion who were treated initially with HR (n = 52), RFA (n = 79), or TACE (n = 66) from January 2005 to December 2006 at a single tertiary hospital. The primary endpoint was overall survival.
The baseline liver status of the groups differed significantly and was most favorable for the HR group, followed by the RFA group, and then the TACE group. The 5-year overall survival rates were 93.6% in the HR group, 86.6% in the RFA group, and 74.2% in the TACE group (P = .023). However, after inverse probability weighting, weighted survival rates among the three groups were similar (5-year overall survival: 85.6% with HR, 87.6% with RFA, and 80.7% with TACE; P = .834). In multivariate Cox regression analysis, TACE showed a hazard ratio of 0.978 (95% confidence interval: 0.407, 2.347; P = .960) compared with HR and of 1.335 (95% confidence interval: 0.619, 2.879; P = .461) compared with RFA.
TACE is an effective treatment that allows achievement of long-term survival rates comparable to those with HR and RFA in patients with small single-nodule hepatocellular carcinoma.
通过使用逆概率加权来控制选择偏差，比较经动脉化疗栓塞术（TACE）、射频消融术（RFA）和肝切除术（HR）在小单发肝细胞癌患者中的疗效。
本回顾性队列研究获得了机构审查委员会的批准，并豁免了获得知情同意的要求。该研究纳入了 197 例连续患者（146 名男性和 51 名女性；平均年龄±标准差，57.4 岁±9.7 岁），他们患有直径 3cm 或以下且无血管侵犯的单发肝细胞癌，最初分别接受 HR（n=52）、RFA（n=79）或 TACE（n=66）治疗，治疗时间为 2005 年 1 月至 2006 年 12 月，在一家三级医院进行。主要终点为总生存率。
三组患者的基线肝脏状况差异显著，HR 组的肝脏状况最佳，其次是 RFA 组，然后是 TACE 组。HR 组的 5 年总生存率为 93.6%，RFA 组为 86.6%，TACE 组为 74.2%（P=0.023）。然而，经过逆概率加权后，三组的加权生存率相似（HR 组的 5 年总生存率为 85.6%，RFA 组为 87.6%，TACE 组为 80.7%；P=0.834）。多变量 Cox 回归分析显示，与 HR 相比，TACE 的风险比为 0.978（95%置信区间：0.407，2.347；P=0.960），与 RFA 相比，TACE 的风险比为 1.335（95%置信区间：0.619，2.879；P=0.461）。
TACE 是一种有效的治疗方法，可使小单发肝细胞癌患者获得与 HR 和 RFA 相当的长期生存率。
