Wong Tiffany Cl, Chiang Chi-Leung, Lee Ann-Shing, Lee Victor Hf, Yeung Cynthia Sy, Ho Connie Hm, Cheung Tan-To, Ng Kelvin Kc, Chok Siu-Ho, Chan Albert Cy, Dai Wing-Chiu, Wong Frank Cs, Luk Mai-Yee, Leung To-Wai, Lo Chung-Mau
Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong.
Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong.
Surg Oncol. 2019 Mar;28:228-235. doi: 10.1016/j.suronc.2019.01.006. Epub 2019 Jan 29.
This study compared outcomes of nonresectable hepatocellular carcinoma (HCC) who had transarterial chemoembolization (TACE) vs. stereotactic body radiation therapy (SBRT) after TACE (TACE + SBRT).
This was a retrospective study of 2 centers in Hong Kong. There were 49 patients who had TACE + SBRT and 202 patients who had TACE alone. Propensity score matching was used to adjust for differences in patients' demographics and tumor characteristics between the 2 groups. The primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS) and treatment-related toxicity.
After matching, 49 patients were in the TACE + SBRT group and 98 patients in the TACE group with similar baseline characteristics. The 1-&3-year OS were better in TACE + SBRT group (67.2 vs. 43.9% and 36.5 vs. 13.3%, p = 0.003). The 1-&3-year PFS was also better in TACE + SBRT group (32.5 vs. 21.4% and 15.1 vs. 5.1%, p = 0.012). Radiological disease control was better in the TACE + SBRT group (98 vs. 56.7%). Risk of severe toxicity was uncommon in both treatment arms. TACE + SBRT was an independent good prognostic factor for OS and PFS in multivariate analysis, whereas AFP>200 ng/ml, large tumor and multiple tumors predicted worse OS.
TACE + SBRT is safe and results in better survivals in nonresectable HCC patients.
本研究比较了不可切除肝细胞癌（HCC）患者接受经动脉化疗栓塞术（TACE）与TACE后立体定向体部放疗（SBRT，即TACE+SBRT）的疗效。
这是一项对香港2个中心进行的回顾性研究。有49例患者接受了TACE+SBRT，202例患者仅接受了TACE。采用倾向评分匹配法来调整两组患者在人口统计学和肿瘤特征方面的差异。主要结局是总生存期（OS），次要结局是无进展生存期（PFS）和治疗相关毒性。
匹配后，TACE+SBRT组有49例患者，TACE组有98例患者，两组基线特征相似。TACE+SBRT组的1年和3年总生存率更高（分别为67.2%对43.9%，36.5%对13.3%，p=0.003）。TACE+SBRT组的1年和3年无进展生存率也更高（分别为32.5%对21.4%，15.1%对5.1%，p=0.012）。TACE+SBRT组的放射学疾病控制更好（98%对56.7%）。两个治疗组中严重毒性风险均不常见。在多变量分析中，TACE+SBRT是OS和PFS的独立良好预后因素，而甲胎蛋白>200 ng/ml、肿瘤体积大及肿瘤多发预示着更差的总生存期。
TACE+SBRT对不可切除的HCC患者是安全的，且能带来更好的生存结局。
