Berger Nicholas G, Tanious Michael N, Hammad Abdulrahman Y, Miura John T, Mogal Harveshp, Clarke Callisia N, Christians Kathleen K, Tsai Susan, Gamblin T Clark
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Oncol. 2017 Sep;116(3):307-312. doi: 10.1002/jso.24661. Epub 2017 May 2.
Hepatocellular carcinoma (HCC) patients are often not candidates for resection. This study hypothesized that external beam radiation (XRT) could be equally effective compared to ablation therapy (AT) for selected HCC patients.
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify HCC patients (2004-2012) undergoing XRT or AT for solitary HCC lesions. Propensity score modeling was utilized to adjust for baseline characteristics.
Propensity matching identified 784 patients: 157 (20%) XRT and 627 (80%) AT. Median OS for XRT and AT was 22, and 32 months (P < 0.001), respectively. AT demonstrated improved OS for tumors 3-5 cm (30 vs 16 m, P < 0.001) and >5 cm (25 vs 9 m, P < 0.001). Similar survival was found in patients with tumor size <3 cm (37 vs 47 m P = 0.508). Following multivariate analyses, XRT was associated with an increased hazard ratio (HR = 1.64, P < 0.001). Elevated AFP at diagnosis (HR = 1.54, P = 0.001) and tumor size >3 were identified as negative predictors of survival.
Similar survival for solitary HCC lesions <3 cm exists between XRT and AT. However, AT demonstrates improved survival rates compared to XRT for lesions >3 cm. This 3 cm reference point may serve as a valuable metric to guide treatment decisions and future investigations.
肝细胞癌（HCC）患者通常不适合进行手术切除。本研究假设，对于部分HCC患者，外照射放疗（XRT）与消融治疗（AT）的效果相当。
利用监测、流行病学与最终结果（SEER）数据库，确定2004年至2012年间因孤立性HCC病灶接受XRT或AT治疗的患者。采用倾向评分模型对基线特征进行调整。
倾向匹配后纳入784例患者：157例（20%）接受XRT治疗，627例（80%）接受AT治疗。XRT组和AT组的中位总生存期分别为22个月和32个月（P < 0.001）。对于直径3 - 5 cm的肿瘤，AT组的总生存期更长（30个月对16个月，P < 0.001）；对于直径>5 cm的肿瘤，同样如此（25个月对9个月，P < 0.001）。肿瘤直径<3 cm的患者中，两组生存期相似（37个月对47个月，P = 0.508）。多因素分析显示，XRT与更高的风险比相关（风险比=1.64，P < 0.001）。诊断时甲胎蛋白升高（风险比=1.54，P = 0.001）和肿瘤直径>3 cm被确定为生存的负性预测因素。
XRT与AT治疗直径<3 cm的孤立性HCC病灶的生存期相似。然而，对于直径>3 cm的病灶，AT组的生存率高于XRT组。这个3 cm的参考点可能是指导治疗决策和未来研究的重要指标。
