Kim Jong Woo, Kim Jin Hyoung, Sung Kyu-Bo, Ko Heung-Kyu, Shin Ji Hoon, Kim Pyo Nyun, Choi Hyun-Kyung, Ko Gi-Young, Yoon Hyun-Ki, Chun Seng-Yong, Gwon Dong Il
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Gastroenterol. 2014 Aug;109(8):1234-40. doi: 10.1038/ajg.2014.152. Epub 2014 Jun 17.
To compare the effectiveness of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for treating small (≤2 cm) hepatocellular carcinomas (HCCs).
This retrospective study consisted of 287 patients (mean age, 57.1 years; age range, 29-84 years; 221 men, 66 women; 73.5% with HBV; 100% with liver cirrhosis) with Barcelona Clinic Liver Cancer very early-stage HCC (≤2 cm single HCC) who were initially treated with TACE (n=122) or RFA (n=165). The primary study end point was overall patient survival. Secondary study end points were time to progression and tumor response.
The RFA and TACE groups were well balanced in terms of baseline variables. The two groups did not differ significantly in overall survival (P=0.079) or major complication (P>0.999) rates. The respective cumulative survival rates at 1, 3, 5, and 8 years were 97.6, 86.7, 74.5, and 60.0% for RFA and 93.4, 75.4, 63.1, and 51.1% for TACE. Their objective tumor regression (complete or partial response) rates were 100% (165/165) and 95.9% (117/122), respectively (P=0.013). The median times to progression for RFA and TACE were 27.0±3.8 (95% confidence intervals (CIs): 19.6-34.4) and 18.0±2.9 (95% CIs: 12.2-23.8) months, respectively. RFA yielded a significantly longer time to progression (P=0.034).
TACE may be a viable alternative treatment for ≤2 cm HCCs when RFA is not feasible.
比较经动脉化疗栓塞术（TACE）和射频消融术（RFA）治疗小肝癌（直径≤2cm）的疗效。
这项回顾性研究纳入了287例巴塞罗那临床肝癌极早期肝癌（单个肝癌直径≤2cm）患者（平均年龄57.1岁；年龄范围29 - 84岁；男性221例，女性66例；73.5%为乙肝患者；100%有肝硬化），这些患者最初接受了TACE治疗（n = 122）或RFA治疗（n = 165）。主要研究终点是患者总生存期。次要研究终点是疾病进展时间和肿瘤反应。
RFA组和TACE组在基线变量方面均衡良好。两组在总生存期（P = 0.079）或主要并发症发生率（P > 0.999）方面无显著差异。RFA组1年、3年、5年和8年的累积生存率分别为97.6%、86.7%、74.5%和60.0%，TACE组分别为93.4%、75.4%、63.1%和51.1%。它们的客观肿瘤退缩（完全或部分缓解）率分别为100%（165/165）和95.9%（117/122）（P = 0.013）。RFA组和TACE组的疾病进展中位时间分别为27.0±3.8（95%置信区间（CI）：19.6 - 34.4）个月和18.0±2.9（95%CI：12.2 - 23.8）个月。RFA组的疾病进展时间显著更长（P = 0.034）。
当RFA不可行时，TACE可能是治疗直径≤2cm肝癌的一种可行替代治疗方法。
