Su Ting-Shi, Liang Ping, Zhou Ying, Huang Yong, Cheng Tao, Qu Song, Chen Long, Xiang Bang-De, Zhao Chang, Huang De-Jia, Liang Shi-Xiong, Li Le-Qun
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, China.
Front Oncol. 2020 Mar 24;10:347. doi: 10.3389/fonc.2020.00347. eCollection 2020.
It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively ( = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively ( = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively ( = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively ( = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03-2.47; = 0.04; HR = 1.61; 95% CI: 1.13-2.29; = 0.009). SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.
立体定向体部放射治疗（SBRT）与经动脉化疗栓塞术（TACE）哪种方法更适合治疗无法手术的早期肝细胞癌（HCC）尚不清楚。本研究旨在回顾性比较SBRT与TACE治疗无法手术的巴塞罗那临床肝癌（BCLC）-A期HCC患者的疗效。在这项多机构回顾性研究中，共纳入326例无法手术的BCLC-A期HCC患者。其中，167例患者最初接受SBRT，159例最初接受TACE。在单变量分析和倾向评分匹配分析中评估总生存期（OS）、局部控制（LC）、肝内控制（IC）和无进展生存期（PFS）。SBRT组的中位肿瘤大小小于TACE组（3.4 cm对7.2 cm，<0.001）。在选择95对患者进行倾向评分匹配后，SBRT在LC、IC和PFS方面优于TACE，但OS相当。SBRT组1年、3年和5年的累积OS率分别为85.7%、65.1%和62.8%，TACE组分别为83.6%、61.0%和50.4%（P = 0.29）。SBRT组1年、3年和5年的累积PFS分别为63.4%、35.9%和27.5%，TACE组分别为53.5%、27.4%和14.2%（P = 0.049）。SBRT组1年、3年和5年的累积LC分别为86.8%、62.5%和56.9%，TACE组分别为69.3%、53.3%和36.6%（P = 0.0047）。SBRT组1年、3年和5年的累积IC分别为77.3%、45.9%和42.4%，TACE组分别为57.3%、34.1%和17.7%（P = 0.003）。多变量分析显示，治疗方法（SBRT与TACE）是与局部和肝内控制相关的显著协变量（HR = 1.59；95%CI：1.03 - 2.47；P = 0.04；HR = 1.61；95%CI：1.13 - 2.29；P = 0.009）。对于无法手术的BCLC-A期HCC，SBRT是TACE的一种替代方法，具有更好的局部和肝内控制。建议进行对照临床试验以充分评估这种新方案的实际效果。
