Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Cancer Med. 2021 Jun;10(11):3715-3725. doi: 10.1002/cam4.3923. Epub 2021 May 7.
Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC), but it is difficult to use against tumors in some locations and often leads to incomplete ablation as a result of the heat-sink effect. This study was conducted to evaluate the efficacy of cryoablation compared with that of RFA in the treatment of single HCC.
This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2015, patients aged 40 to 79 diagnosed with HCC were included in the study. A propensity score matching (PSM) model was used to reduce selection biases.
Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) in the RFA group were slightly longer than those in the cryoablation group (p > 0.05). In the subgroup analysis, the mOS and mCSS of patients with tumor sizes <3, 3-5, and >5 cm who received RFA treatment were longer than those of patients given cryoablation treatment, but there was no significant difference (p > 0.05). Similar results were presented in patients at American Joint Committee on Cancer (AJCC) stages I and II. After PSM, the mOS and mCSS were slightly better in the RFA group than the cryoablation group but without significant differences. Univariate and multivariate analysis showed that cryoablation treatment was not an unfavorable factor for OS and CSS before or after PSM (p > 0.05). In the multivariable competing risk model, non-cancer-specific death was taken as a competing factor and cryoablation was also not unfavorable for the survival of patients before and after PSM (p > 0.05).
Cryoablation is non-inferior to RFA therapy for single HCC patients without lymph node invasion or distant metastasis.
射频消融（RFA）是治疗单发肝细胞癌（HCC）的有效方法，但对于某些部位的肿瘤，由于热沉效应，其疗效往往不理想，且常导致消融不完全。本研究旨在评估冷冻消融与 RFA 治疗单发 HCC 的疗效。
本研究基于监测、流行病学和最终结果（SEER）数据库进行回顾性研究。纳入 2004 年至 2015 年间年龄在 40 至 79 岁之间诊断为 HCC 的患者。采用倾向评分匹配（PSM）模型来减少选择偏倚。
在 PSM 之前，RFA 组的中位总生存期（mOS）和中位癌症特异性生存期（mCSS）略长于冷冻消融组（p>0.05）。在亚组分析中，接受 RFA 治疗的肿瘤大小<3、3-5 和>5 cm 的患者的 mOS 和 mCSS 长于接受冷冻消融治疗的患者，但差异无统计学意义（p>0.05）。在 AJCC 分期 I 和 II 的患者中也得到了相似的结果。PSM 后，RFA 组的 mOS 和 mCSS 略优于冷冻消融组，但差异无统计学意义。单因素和多因素分析表明，PSM 前后冷冻消融治疗均不是 OS 和 CSS 的不利因素（p>0.05）。在多变量竞争风险模型中，非癌症特异性死亡被视为竞争因素，PSM 前后冷冻消融对患者的生存也没有不利影响（p>0.05）。
对于无淋巴结侵犯或远处转移的单发 HCC 患者，冷冻消融与 RFA 治疗疗效相当。
