Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea.
J Vasc Interv Radiol. 2019 Oct;30(10):1533-1543. doi: 10.1016/j.jvir.2019.06.006. Epub 2019 Aug 27.
To compare survival outcomes of patients with single medium-sized hepatocellular carcinomas (HCCs) who underwent treatment with transarterial chemoembolization, radiofrequency (RF) ablation, or a combination of the 2 therapies.
Between 2000 and 2016, 538 patients underwent combined chemoembolization and RF ablation (n = 109), chemoembolization alone (n = 314), or RF ablation alone (n = 115) as first-line treatment for a single medium-sized (3.1-5.0 cm) HCC. Baseline demographic data (age, sex, etiology, Eastern Cooperative Oncology Group performance status, presence of liver cirrhosis, and serum bilirubin, albumin, and α-fetoprotein levels) were similar among groups except for Child-Pugh class, albumin level, and tumor size. Propensity-score analysis with inverse probability weighting (IPW) was used to reduce any bias in treatment selection and other potential confounding factors.
Median follow-up time was 46.2 months. Before IPW, overall survival (OS) durations were significantly different among the 3 groups (median, 85 months for combined therapy, 56.5 months for chemoembolization alone, and 52.1 months for RF ablation alone; P = .01). The 10-year OS rates were 40.1%, 25.5%, and 19.5% for the combined, chemoembolization-only, and RF ablation-only groups, respectively. After IPW, OS remained superior in the combined chemoembolization/RF ablation group compared with the monotherapy groups (10-y OS, 41.8% with combined therapy, 28.4% with chemoembolization alone, and 11.9% with RF ablation alone; P = .022).
Chemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs.
比较经动脉化疗栓塞术、射频消融术或联合两种治疗方案治疗单发中等大小肝细胞癌（HCC）患者的生存结果。
2000 年至 2016 年间，538 例单发中等大小（3.1-5.0cm）HCC 患者行联合化疗栓塞和射频消融（n=109）、单纯化疗栓塞（n=314）或单纯射频消融（n=115）作为一线治疗。除了 Child-Pugh 分级、白蛋白水平和肿瘤大小外，各组之间的基线人口统计学数据（年龄、性别、病因、东部合作肿瘤组表现状态、肝硬化存在情况以及血清胆红素、白蛋白和甲胎蛋白水平）相似。采用逆概率加权（Inverse Probability Weighting，IPW）进行倾向评分分析，以减少治疗选择和其他潜在混杂因素的偏倚。
中位随访时间为 46.2 个月。在 IPW 之前，三组的总生存（Overall Survival，OS）时间差异有统计学意义（中位数，联合治疗组为 85 个月，单纯化疗栓塞组为 56.5 个月，单纯射频消融组为 52.1 个月；P=0.01）。联合、单纯化疗栓塞和单纯射频消融组的 10 年 OS 率分别为 40.1%、25.5%和 19.5%。在 IPW 之后，联合化疗栓塞/射频消融组的 OS 仍优于单药治疗组（10 年 OS，联合治疗组为 41.8%，单纯化疗栓塞组为 28.4%，单纯射频消融组为 11.9%；P=0.022）。
化疗栓塞联合射频消融可能比单纯化疗栓塞或射频消融治疗提供更好的生存结果，可作为不可切除单发中等大小 HCC 的可行替代治疗方法。
