Yan Liangliang, Ren Yanqiao, Qian Kun, Kan Xuefeng, Zhang Hongsen, Chen Lei, Liang Bin, Zheng Chuansheng
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
BMC Gastroenterol. 2021 Apr 20;21(1):182. doi: 10.1186/s12876-021-01765-x.
Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatment methods for unresectable hepatocellular carcinoma (HCC). However, there is still a lack of clinical research on whether early sequential RFA, compared with late combination therapy, can improve the long-term efficacy of initial TACE treatment.
This retrospective study investigated a cohort of patients who underwent combination therapy using TACE and RFA (TACE followed by RFA) from January 2010 to January 2020 at our medical centre. A total of 96 patients underwent TACE combined with early RFA (usually during the first hospitalization), which was called TACE + eRFA. Thirty-four patients received 1-2 palliative TACE treatments first and then underwent TACE treatment combined with late RFA (TACE + lRFA). All patients continued to receive palliative TACE treatments after intrahepatic lesion progression until reaching intolerance. The overall survival (OS) rate, time to tumour progression (TTP), tumour response rate and major complication rates were compared between the two groups.
There were significant differences in the median OS (46 months vs 33 months; P = 0.013), median TTP (28 months vs 14 months; P < 0.00), objective response rate (ORR) (89.6% vs 61.8%, P = 0.000) and disease control rate (DCR) (94.8% vs 73.5% P = 0.002) between the two groups. Multivariable analysis revealed that the Barcelona Clinic Liver Cancer stage was an independent risk factor for OS. Meanwhile, multivariable analysis revealed that TACE + eRFA was associated with an enhanced TTP.
Early sequential RFA treatment in patients with early-intermediate HCC can improve local tumour control and clinical outcomes while reducing the frequency of TACE treatment. In clinical practice, in HCC patients initially treated with TACE, it is recommended to combine RFA as soon as possible to obtain long-term survival.
经动脉化疗栓塞术（TACE）和射频消融术（RFA）是不可切除肝细胞癌（HCC）的有效治疗方法。然而，与晚期联合治疗相比，早期序贯RFA是否能提高初始TACE治疗的长期疗效，目前仍缺乏临床研究。
这项回顾性研究调查了2010年1月至2020年1月在我们医疗中心接受TACE和RFA联合治疗（TACE后行RFA）的一组患者。共有96例患者接受了TACE联合早期RFA（通常在首次住院期间），称为TACE + eRFA。34例患者先接受1 - 2次姑息性TACE治疗，然后接受TACE联合晚期RFA治疗（TACE + lRFA）。所有患者在肝内病变进展后继续接受姑息性TACE治疗，直至出现不耐受。比较两组的总生存率（OS）、肿瘤进展时间（TTP）、肿瘤反应率和主要并发症发生率。
两组患者的中位OS（46个月 vs 33个月；P = 0.013）、中位TTP（28个月 vs 14个月；P < 0.00）、客观缓解率（ORR）（89.6% vs 61.8%，P = 0.000）和疾病控制率（DCR）（94.8% vs 73.5%，P = 0.002）存在显著差异。多变量分析显示，巴塞罗那临床肝癌分期是OS的独立危险因素。同时，多变量分析显示TACE + eRFA与延长的TTP相关。
早期 - 中期HCC患者早期序贯RFA治疗可改善局部肿瘤控制和临床结局，同时减少TACE治疗的频率。在临床实践中，对于初始接受TACE治疗的HCC患者，建议尽早联合RFA以获得长期生存。
