Lee Bo-Ching, Liu Kao-Lang, Wu Chih-Horng, Huang Kai-Wen, Ho Cheng-Maw, Hu Rey-Heng, Ho Ming-Chih, Wu Yao-Ming, Lee Po-Huang, Liang Po-Chin
Department of Medical Imaging, National Taiwan University Hospital, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan.
Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan.
Cardiovasc Intervent Radiol. 2018 Nov;41(11):1699-1707. doi: 10.1007/s00270-018-1978-0. Epub 2018 Jun 26.
Hepatocellular carcinoma (HCC) in the caudate lobe is technically challenging for both radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). However, each of these modalities has its strengths. This retrospective study compares the effectiveness of RFA and TACE in patients with caudate HCC within the Milan criteria.
This study was approved by institutional review board. Between November 2005 and August 2016, we retrospectively reviewed 74 patients with a single HCC ≤ 5 cm or up to three HCCs ≤ 3 cm without vascular invasion or extrahepatic metastasis who were treated with RFA (n = 43) or TACE (n = 31). The overall survival (OS) and local progression rates were compared after propensity score analysis.
The mean follow-up period was 2.8 ± 1.9 years. The 1-, 2-, and 3-year survival rates were 97.1, 94.0, and 80.7% for the RFA group and 89.0, 80.8, and 62.0% for the TACE group, respectively. The clinical variables of the RFA and the TACE groups were well balanced by propensity score adjustment, and the RFA group showed better OS (P = .039) and local progression rates (P = .004) than the TACE group.
RFA appears to outperform TACE for patients with caudate HCC within the Milan criteria and should be the favored treatment option when surgical resection is not feasible.
对于射频消融（RFA）和经动脉化疗栓塞术（TACE）而言，尾状叶肝细胞癌（HCC）在技术上具有挑战性。然而，这些治疗方式各有优势。本回顾性研究比较了RFA和TACE对符合米兰标准的尾状叶HCC患者的疗效。
本研究经机构审查委员会批准。2005年11月至2016年8月期间，我们回顾性分析了74例单个HCC≤5 cm或最多3个HCC≤3 cm且无血管侵犯或肝外转移的患者，其中43例接受RFA治疗，31例接受TACE治疗。在进行倾向评分分析后，比较总生存期（OS）和局部进展率。
平均随访期为2.8±1.9年。RFA组1年、2年和3年生存率分别为97.1%、94.0%和80.7%，TACE组分别为89.0%、80.8%和62.0%。通过倾向评分调整，RFA组和TACE组的临床变量得到了良好平衡，且RFA组的OS（P = 0.039）和局部进展率（P = 0.004）均优于TACE组。
对于符合米兰标准的尾状叶HCC患者，RFA似乎优于TACE，在无法进行手术切除时应作为首选治疗方案。
