伽玛刀放射外科与经导管动脉化疗栓塞治疗合并门静脉癌栓的肝细胞癌：一项倾向评分匹配研究。
Gamma knife radiosurgery versus transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score matching study.
机构信息
Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
Clinical Research Institute, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
出版信息
Hepatol Int. 2022 Aug;16(4):858-867. doi: 10.1007/s12072-022-10339-2. Epub 2022 Jun 21.
BACKGROUND
The optimal locoregional treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is unclear. This study aimed to investigate the efficacy of Gamma knife radiosurgery (GKR) versus transcatheter arterial chemoembolization (TACE) in HCC patients with PVTT.
METHODS
This retrospective study included 544 HCC patients with PVTT (GKR, 202; TACE, 342). Propensity score matching (PSM) analysis identified 171 matched pairs of patients. The primary endpoint was overall survival (OS).
RESULTS
Before PSM, the GKR group exhibited longer median OS (mOS) than the TACE group (17.2 vs. 8.0 months, p < 0.001). We followed the Cheng's classification for PVTT. In the subgroup analysis, GKR was associated with significantly longer mOS for patients with PVTT II-IV (17.5 vs. 8.7 months, p < 0.001; 17.2 vs. 7.8 months, p = 0.001; 14.5 vs. 6.5 months, p = 0.001, respectively) and comparable OS for patients with PVTT I. After PSM, the GKR group had also a longer mOS than the TACE group (15.8 vs. 10.4 months, p < 0.001). In the subgroup analysis, the GKR group demonstrated superior mOS for patients with PVTT II-IV (all p < 0.05) and comparable OS for patients with PVTT I.
CONCLUSIONS
GKR was associated better OS than TACE in HCC patients with PVTT, especially for patients with PVTT II-IV.
CLINICAL TRIALS REGISTRATION
The study was registered in the Chinese Clinical Trials Registry under the registration number ChiCTR2100051057.
背景
对于合并门静脉癌栓（PVTT）的肝细胞癌（HCC）患者，最佳的局部区域治疗方法尚不清楚。本研究旨在探讨伽玛刀放射外科（GKR）与经导管动脉化疗栓塞（TACE）治疗合并 PVTT 的 HCC 患者的疗效。
方法
这是一项回顾性研究，共纳入 544 例合并 PVTT 的 HCC 患者（GKR 组 202 例，TACE 组 342 例）。采用倾向性评分匹配（PSM）分析，共匹配出 171 对患者。主要终点为总生存期（OS）。
结果
在 PSM 之前，GKR 组的中位 OS（mOS）长于 TACE 组（17.2 个月比 8.0 个月，p<0.001）。我们按照 Cheng 的 PVTT 分类进行了亚组分析。在亚组分析中，GKR 与 PVTT II-IV 患者的 mOS 显著延长相关（17.5 个月比 8.7 个月，p<0.001；17.2 个月比 7.8 个月，p=0.001；14.5 个月比 6.5 个月，p=0.001），与 PVTT I 患者的 OS 无差异。PSM 后，GKR 组的 mOS 也长于 TACE 组（15.8 个月比 10.4 个月，p<0.001）。在亚组分析中，GKR 组在 PVTT II-IV 患者中表现出更好的 mOS（均 p<0.05），而在 PVTT I 患者中 OS 无差异。
结论
GKR 与 TACE 相比，可显著改善合并 PVTT 的 HCC 患者的 OS，尤其是对合并 PVTT II-IV 的患者。
临床试验注册
本研究在中国临床试验注册中心注册，注册号 ChiCTR2100051057。
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