4 周时序常规经导管动脉化疗栓塞（cTACE）联合微波消融与单纯 cTACE 治疗单个中等大小肝细胞癌的疗效比较：倾向评分匹配研究
Single medium-sized hepatocellular carcinoma treated with sequential conventional transarterial chemoembolization (cTACE) and microwave ablation at 4 weeks versus cTACE alone: a propensity score.
机构信息
Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical Colleague, 287 Changhuai Road, Bengshan District, Bengbu, 233004, China.
出版信息
World J Surg Oncol. 2022 Jun 10;20(1):192. doi: 10.1186/s12957-022-02643-w.
BACKGROUND
Microwave ablation (MWA) is a potentially curative treatment for unresectable patients with hepatocellular carcinoma (HCC) ≤ 3 cm, while its therapeutic efficacy decreases significantly for HCC > 3cm. Previous studies have demonstrated that conventional transarterial chemoembolization (cTACE) combined with MWA (cTACE-MWA) may improve local tumor control rate and reduce the recurrence rate for HCC > 3cm. However, there have been few study designs to analyze the clinical efficacy of cTACE-MWA for medium-sized HCC (3-5cm). Therefore, this study aims to compare the clinical efficacy and safety of cTACE-MWA with cTACE alone for a single medium-sized HCC of 3-5 cm in diameter.
METHODS
We retrospectively investigate the data of 90 patients with a single medium-sized HCC who were referred to our hospital and underwent cTACE-MWA or cTACE alone from December 2017 to March 2020. Then, patients were identified with propensity score-matched (1:1). The local tumor response to treatment and time to progression (TTP) were compared using mRECIST criteria between the cTACE-MWA group and the cTACE group.
RESULTS
A total of 42 patients were included after matching (cTACE-MWA: 21; cTACE: 21). Comparing with cTACE, cTACE-MWA demonstrate significantly better local tumor control (ORR: 95.2% vs 61.9%, p = 0.02; DCR: 95.2% vs 66.7%, p = 0.045) and TTP (median 19.8 months vs 6.8 months, p < 0.001). The 1- and 2-year cumulative probabilities of OS were 100% and 95% in the cTACE-MWA group, which were significantly higher than those in the cTACE group (95% and 76%) (p = 0.032). Multivariate Cox regression analysis illustrates that cTACE-MWA was associated with better TTP (hazard ratio, 0.28; 95% CI: 0.1, 0.76; p = 0.012), but tumor size was associated with worse TTP (hazard ratio, 1.71; 95% CI: 1.01, 2.89; p = 0.045).
CONCLUSIONS
cTACE followed by MWA improved TTP and OS in patients with a single medium-sized HCC, and no major complication was observed in this study.
背景
微波消融（MWA）是一种潜在的可治愈的治疗方法，适用于不可切除的≤3cm 肝细胞癌（HCC）患者，而对于>3cm 的 HCC，其治疗效果显著降低。先前的研究表明，常规经动脉化疗栓塞（cTACE）联合 MWA（cTACE-MWA）可能提高局部肿瘤控制率并降低 HCC>3cm 的复发率。然而，很少有研究设计来分析 cTACE-MWA 治疗直径为 3-5cm 的中大型 HCC 的临床疗效。因此，本研究旨在比较 cTACE-MWA 与单独 cTACE 治疗单个直径为 3-5cm 的中大型 HCC 的临床疗效和安全性。
方法
我们回顾性研究了 2017 年 12 月至 2020 年 3 月期间我院收治的 90 例单个中大型 HCC 患者的资料，这些患者接受了 cTACE-MWA 或单独 cTACE 治疗。然后，使用倾向评分匹配（1：1）对患者进行识别。使用 mRECIST 标准比较 cTACE-MWA 组和 cTACE 组的局部肿瘤治疗反应和无进展生存期（TTP）。
结果
匹配后共有 42 例患者纳入研究（cTACE-MWA：21 例；cTACE：21 例）。与 cTACE 相比，cTACE-MWA 显示出更好的局部肿瘤控制（ORR：95.2%比 61.9%，p=0.02；DCR：95.2%比 66.7%，p=0.045）和 TTP（中位 19.8 个月比 6.8 个月，p<0.001）。cTACE-MWA 组的 1 年和 2 年累积生存率分别为 100%和 95%，明显高于 cTACE 组（95%和 76%）（p=0.032）。多变量 Cox 回归分析表明，cTACE-MWA 与更好的 TTP 相关（风险比，0.28；95%CI：0.1，0.76；p=0.012），但肿瘤大小与更差的 TTP 相关（风险比，1.71；95%CI：1.01，2.89；p=0.045）。
结论
cTACE 后行 MWA 可提高单个中大型 HCC 患者的 TTP 和 OS，本研究未观察到主要并发症。
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