From the Gastroenterological Center (H.F., K.N., S. Moriya, Y.S., T.I., A.N., M.K., M.M., K.T.), Department of Gastroenterology (S. Maeda), Department of Biostatistics and Epidemiology (K.S., S. Morita), and Clinical Research Coordinating Center (K.S., S. Morita, K.T.), Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
Radiology. 2014 Aug;272(2):598-604. doi: 10.1148/radiol.14131640. Epub 2014 Apr 2.
To retrospectively compare radiofrequency ablation (RFA) combined with the multikinase inhibitor sorafenib (hereafter, sorafenib-RFA) and RFA alone in the treatment of hepatocellular carcinoma (HCC).
Institutional review board approval and informed consent were obtained. Between January 2007 and December 2011, 16 patients (mean age, 72.8 years; age range 52-84 years; 10 men, six women) with HCC tumors less than 3 cm in diameter were included in the sorafenib-RFA group, and 136 patients (mean age, 72.1 years; age range, 51-86 years; 92 men, 44 women) with HCC tumors less than 3 cm in diameter were included in the RFA alone (control) group. Mean diameters of the greatest long-axis dimensions of HCC were 22.8 mm ± 4.6 (standard deviation) in the sorafenib-RFA group and 18.1 mm ± 4.4 in the control group. RFA was performed immediately after the 7-day administration of sorafenib. Propensity score matching analysis was used to adjust for potential biases.
Fifteen of the 16 patients in the sorafenib-RFA group and 30 of the 136 patients in the control group were selected during propensity score matching. No significant differences between the sorafenib-RFA group (n = 15) and the control group (n = 30) were observed with regard to age, sex, etiology, Child-Pugh class, tumor size, puncture number, needle size, location at the liver margin, or location adjacent to a main vessel. The respective mean diameters of the greatest long- and short-axis dimensions of the RFA-induced ablated area were 46.3 mm ± 10.3 and 33.0 mm ± 6.9 in the sorafenib-RFA group and 32.9 mm ± 7.6 and 25.6 mm ± 5.7 in the control group; both of these dimensions were significantly larger in the sorafenib-RFA group (both P < .001).
Sorafenib-RFA may be superior to standard RFA alone in the treatment of HCC tumors smaller than 3 cm in diameter.
回顾性比较射频消融（RFA）联合多激酶抑制剂索拉非尼（以下简称索拉非尼-RFA）与单纯 RFA 治疗肝细胞癌（HCC）的效果。
本研究获得了机构审查委员会的批准和患者知情同意。2007 年 1 月至 2011 年 12 月，16 例 HCC 肿瘤直径小于 3cm 的患者纳入索拉非尼-RFA 组（平均年龄 72.8 岁，年龄范围 5284 岁，男性 10 例，女性 6 例），136 例 HCC 肿瘤直径小于 3cm 的患者纳入单纯 RFA（对照组）组（平均年龄 72.1 岁，年龄范围 5186 岁，男性 92 例，女性 44 例）。索拉非尼-RFA 组 HCC 最大长轴直径的平均直径为 22.8mm±4.6（标准差），对照组为 18.1mm±4.4。在给予索拉非尼 7 天后立即进行 RFA。采用倾向性评分匹配分析来调整潜在偏倚。
16 例索拉非尼-RFA 组患者中有 15 例，136 例对照组患者中有 30 例进行了倾向性评分匹配。在年龄、性别、病因、Child-Pugh 分级、肿瘤大小、穿刺次数、针的大小、肝边缘位置或毗邻主要血管位置等方面，索拉非尼-RFA 组（n=15）与对照组（n=30）之间无显著差异。在索拉非尼-RFA 组，RFA 诱导的消融区域最大长轴和短轴的平均直径分别为 46.3mm±10.3 和 33.0mm±6.9；对照组分别为 32.9mm±7.6 和 25.6mm±5.7；两组的这两个维度均显著大于对照组（均 P<0.001）。
对于直径小于 3cm 的 HCC 肿瘤，索拉非尼-RFA 可能优于单纯 RFA。
