Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, 30322, USA.
Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Cardiovasc Intervent Radiol. 2021 Mar;44(3):401-413. doi: 10.1007/s00270-020-02712-1. Epub 2020 Nov 23.
To evaluate the efficacy and safety of Y90 radiation segmentectomy (RS) vs. percutaneous microwave ablation (MWA) in patients with solitary HCC ≤ 4 cm.
From 2014 to 2017, 68 consecutive treatment naïve patients were included (34 per treatment arm). Chi-square and t-test were used to evaluate differences in baseline demographics between groups. Objective response was evaluated using mRECIST and toxicity using CTCAE. Overall survival (OS) and progression free survival (PFS) in the targeted tumor and the remainder of liver from initial treatment was calculated using Kaplan-Meier estimation. Propensity score matching was then performed with n = 24 patients matched in each group. Similar outcome analysis was then pre-formed.
In the overall study population, both groups had similar baseline characteristics with the exception of larger lesions in the RS group. There was no difference in toxicity, objective tumor response, OS and non-target liver PFS between the MWA and RS group (p's > 0.05). In the matched cohort, the objective tumor response was 82.6% in MWA vs. 90.9%% in RS (p = 0.548). The mean OS in the MWA group (44.3 months) vs RS (59.0 months; p = 0.203). The targeted tumor mean PFS for the MWA groups was 38.6 months vs. 57.8 months in RS group (p = 0.005). There was no difference overall PFS and toxicity between the 2 matched groups.
Our data suggest Y90 RS achieves similar tumor response and OS with a similar safety compared to MWA in the management of HCC lesions ≤ 4 cm. Additionally, targeted tumor PFS appears to be prolonged in the RS group with similar non-target liver PFS between RS and MWA group.
评估 Y90 放射切除术（RS）与经皮微波消融（MWA）治疗直径≤4cm 单发 HCC 的疗效和安全性。
2014 年至 2017 年，纳入 68 例初治患者（每组 34 例）。采用卡方检验和 t 检验比较两组患者的基线人口统计学差异。采用 mRECIST 评估客观反应，采用 CTCAE 评估毒性。采用 Kaplan-Meier 估计计算初始治疗后靶肿瘤和剩余肝的总生存（OS）和无进展生存（PFS）。然后采用倾向评分匹配（n=24 例）对每组进行匹配，并进行类似的结果分析。
在总体研究人群中，两组患者的基线特征相似，除 RS 组的肿瘤较大外。两组间的毒性、肿瘤客观反应、OS 和非靶肝 PFS 无差异（p>0.05）。在匹配队列中，MWA 组的客观肿瘤反应为 82.6%，RS 组为 90.9%（p=0.548）。MWA 组的平均 OS 为 44.3 个月，RS 组为 59.0 个月（p=0.203）。MWA 组的靶肿瘤平均 PFS 为 38.6 个月，RS 组为 57.8 个月（p=0.005）。两组之间的总 PFS 和毒性无差异。
我们的数据表明，Y90 RS 在治疗直径≤4cm 的 HCC 病变时，与 MWA 相比，肿瘤反应和 OS 相似，安全性相似。此外，RS 组的靶肿瘤 PFS 似乎延长，而 RS 组和 MWA 组的非靶肝 PFS 相似。
