对于直径 >3-<5 厘米的肝细胞癌，采用常规经动脉化疗栓塞（cTACE）联合微波消融（MWA）的联合治疗。

Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm.

机构信息

Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Diagnostic Radiology Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.

出版信息

Int J Hyperthermia. 2021;38(1):248-256. doi: 10.1080/02656736.2021.1887941.

DOI:10.1080/02656736.2021.1887941

PMID:33615957

Abstract

PURPOSE

To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm.

METHODS

This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit.

RESULTS

Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA ( = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) ( = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) ( = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 ( < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively.

CONCLUSIONS

Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.

摘要

目的

比较联合经动脉化疗栓塞（cTACE）+微波消融（MWA）与单独 TACE 或 MWA 治疗直径 3-5cm 肝癌的安全性和疗效。

方法

本随机对照试验（NCT04721470）筛选了 278 例直径 3-5cm 的 HCC 患者。患者被随机分为三组：90 例行 TACE（组 1）；95 例行 MWA（组 2）；93 例行联合治疗（组 3）。患者接受增强 CT 或 MRI 随访。根据实体瘤反应评价标准的改良版评价和比较治疗反应和不良反应。在基线和每次随访时测量血清甲胎蛋白（AFP）浓度。

结果

最终分析包括 265 例患者（男性 154 例，女性 111 例；平均年龄 54.5±11.8 岁；范围 38-76 岁）。联合治疗组完全缓解率为 86.5%，明显高于单独 TACE 组的 54.8%和单独 MWA 组的 56.5%（=0.0002）。联合治疗组 12 个月后的复发率（22.47%）明显低于单独 TACE 组（60.7%）和单独 MWA 组（51.1%）（=0.0001）。联合治疗组的总生存率（治疗后 3 年）明显高于单独 TACE 组（54.7%）和单独 MWA 组（54.3%）（=0.02）。联合治疗组的无进展生存率明显高于单独 TACE 组和单独 MWA 组（均<0.001）。联合治疗组 AFP 浓度下降的患者分别为 75%、63%和 48%，单独 TACE 组分别为 63%、55%和 38%，单独 MWA 组分别为 48%、36%和 24%。