经动脉化疗栓塞联合微波消融与单纯微波消融治疗巴塞罗那临床肝癌分期B期肝细胞癌的倾向评分匹配研究。
Transarterial chemoembolization combined with microwave ablation versus microwave ablation only for Barcelona clinic liver cancer Stage B hepatocellular carcinoma: A propensity score matching study.
作者信息
Li Xin, Chen Baohua, An Chao, Cheng Zhigang, Han Zhiyu, Liu Fangyi, Yu Jie, Liang Ping
机构信息
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
Department of Hepatobiliary Surgery, The 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Yingtan, China.
出版信息
J Cancer Res Ther. 2020 Sep;16(5):1027-1037. doi: 10.4103/jcrt.JCRT_380_19.
PURPOSE
We aimed to compare the outcomes of microwave ablation (MWA) alone with those of transarterial chemoembolization combined with MWA (TACE-MWA) for Barcelona clinic liver cancer (BCLC) Stage B hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with the two treatments.
MATERIALS AND METHODS
This retrospective study was conducted in 150 BCLC Stage B HCC patients from April 2006 to November 2017. Of these, 88 patients were treated with MWA alone while 62 with TACE-MWA. Propensity score matching (PSM) was conducted to adjust for imbalances in clinical parameters. Procedure-related complications, local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) were analyzed.
RESULTS
Before PSM, the maximal tumor diameters were 6.0 ± 1.0 cm and 6.7 ± 1.3 cm in the TACE-MWA and MWA groups, respectively, with a significant difference (P = 0.002); a significant difference was also detected in α-fetoprotein level (P = 0.013). After PSM, no difference was found in the two parameters (P = 0.067, 0.470). Before and after PSM, no difference was detected in the procedure-related complications (P = 0.803 vs. 1.000, P = 1.000 vs. 1.000), RFS (P = 0.786 vs. 0.689), and OS (P = 0.684 vs. 0.929). Tumor size and α-fetoprotein level were independent influencing factors for OS before and after PSM (P = 0.009, 0.023), while tumor size (D > 7) was an independent risk factor for poor OS (P = 0.011). Tumor number was an independent risk factor for RFS before and after PSM (P = 0.007 vs. P = 0.008). A significant difference was detected in LTP between the two groups with single tumor before and after PSM (P = 0.059 vs. P = 0.006).
CONCLUSIONS
The MWA alone group had RFS and OS comparable to that of the TACE-MWA group. TACE-MWA was effective in controlling LTP in patients with a single tumor.
目的
我们旨在比较单纯微波消融（MWA）与经动脉化疗栓塞联合微波消融（TACE-MWA）治疗巴塞罗那临床肝癌（BCLC）B期肝细胞癌（HCC）的疗效，并确定与这两种治疗方法相关的预后因素。
材料与方法
本回顾性研究纳入了2006年4月至2017年11月期间的150例BCLC B期HCC患者。其中，88例患者接受单纯MWA治疗，62例接受TACE-MWA治疗。采用倾向评分匹配（PSM）来调整临床参数的不平衡。分析了与手术相关的并发症、局部肿瘤进展（LTP）、无复发生存期（RFS）和总生存期（OS）。
结果
在PSM之前，TACE-MWA组和MWA组的最大肿瘤直径分别为6.0±1.0 cm和6.7±1.3 cm，差异有统计学意义（P = 0.002）；甲胎蛋白水平也有显著差异（P = 0.013）。PSM之后，这两个参数无差异（P = 0.067，0.470）。在PSM前后，与手术相关的并发症（P = 0.803对1.000，P = 1.000对1.000）、RFS（P = 0.786对0.689）和OS（P = 0.684对0.929）均无差异。肿瘤大小和甲胎蛋白水平在PSM前后均是OS的独立影响因素（P = 0.009，0.023），而肿瘤大小（D>7）是OS不良的独立危险因素（P = 0.011）。肿瘤数量在PSM前后均是RFS的独立危险因素（P = 0.007对P = 0.008）。两组单发病灶患者在PSM前后的LTP有显著差异（P = 0.059对P = 0.006）。
结论
单纯MWA组的RFS和OS与TACE-MWA组相当。TACE-MWA在控制单发病灶患者的LTP方面有效。
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