经导管动脉化疗栓塞耐药后分步消融为巨大不可切除肝细胞癌患者行微波消融的获益。
Benefits of step-by-step debulking microwave ablation for huge unresectable hepatocellular carcinoma patients after transcatheter arterial chemoembolization refractoriness.
机构信息
Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
出版信息
Int J Hyperthermia. 2022;39(1):935-945. doi: 10.1080/02656736.2022.2093413.
OBJECTIVES
To compare the safety and efficacy of step-by-step debulking Microwave Ablation (MWA) with Transarterial Chemoembolization (TACE) monotherapy for huge (≥10 cm in diameter) unresectable hepatocellular carcinoma (HCC) after TACE refractoriness.
METHODS
This is a multi-center retrospective study carried out on 599 patients with huge unresectable HCC who received TACE as first-line therapy at five hospitals from January 2009 to December 2018. A total of 103 patients with TACE refractoriness were divided into two cohorts: monthly step-by-step debulking MWA ( = 52) or continued TACE ( = 51). Overall survival (OS) and progression-free survival (PFS) after refractory TACE were evaluated. Residual liver and tumor volume were recorded for the MWA group.
RESULTS
Median follow-up period was 24.3 months and median OS and PFS were significantly longer in the MWA group than in the TACE group (OS 21.0 vs. 11.7 months, PFS 6.1 vs. 3.0 months, both < 0.001). The one-, two-, and three-year OS rates in the MWA and TACE groups were 73.1%, 46.6%, and 37.2% versus 43.1%, 15.5%, and 2.9%, respectively. Furthermore, the 0.5-, 1-, and 2-year PFS rates in the MWA and TACE groups were 51.9%, 36.5%, and 25.0% versus 27.5%, 11.8%, and 0, respectively. Multivariate analyses confirmed that switching to debulking MWA treatment was an independent favorable prognostic factor for PFS and OS. In the MWA group, the average additions of residual liver volume/total liver volume were 7.7% ± 6.7%, 7.2% ± 10.2%, and 10.1% ± 8.8% after the first, second, and third MWA procedure.
CONCLUSION
Step-by-step debulking MWA can significantly improve long-term OS and PFS in patients with huge unresectable HCCs compared with repeated TACE after TACE refractoriness. Key PointThe debulking MWA therapy provides significantly longer OS and PFS than continued TACE for patients with huge unresectable HCCs after TACE-refractory, especially with complete tumor ablation.The most common complications were fever (48.1%) and pain (46.2%) in the MWA group. Two major complications (abdominal infection) were recorded in the MWA group, which recovered after symptomatic treatment.During the course of repeated MWAs, liver hyperplasia appeared mainly after the second MWA procedure and the average maximum increased RLV/TLV rate was 16.3%±12.7%.
目的
比较经皮分步消瘤微波消融（MWA）与经动脉化疗栓塞（TACE）单药治疗 TACE 耐药后巨大（直径≥10cm）不可切除肝细胞癌（HCC）的安全性和疗效。
方法
这是一项多中心回顾性研究，纳入了 2009 年 1 月至 2018 年 12 月在五家医院接受 TACE 作为一线治疗的 599 例巨大不可切除 HCC 患者。103 例 TACE 耐药患者分为两组：每月分步消瘤 MWA（ = 52）或继续 TACE（ = 51）。评估 TACE 耐药后的总生存期（OS）和无进展生存期（PFS）。记录 MWA 组的残余肝和肿瘤体积。
结果
中位随访时间为 24.3 个月，MWA 组的 OS 和 PFS 明显长于 TACE 组（OS 21.0 与 11.7 个月，PFS 6.1 与 3.0 个月，均<0.001）。MWA 和 TACE 组的 1、2、3 年 OS 率分别为 73.1%、46.6%和 37.2%与 43.1%、15.5%和 2.9%。此外，MWA 和 TACE 组的 0.5、1、2 年 PFS 率分别为 51.9%、36.5%和 25.0%与 27.5%、11.8%和 0。多变量分析证实，转为消瘤 MWA 治疗是 PFS 和 OS 的独立有利预后因素。在 MWA 组中，第一次、第二次和第三次 MWA 术后残余肝体积/总肝体积的平均增加值分别为 7.7%±6.7%、7.2%±10.2%和 10.1%±8.8%。
结论
与 TACE 耐药后重复 TACE 相比，经皮分步消瘤 MWA 可显著提高巨大不可切除 HCC 患者的长期 OS 和 PFS。关键发现：对于 TACE 耐药后的巨大不可切除 HCC 患者，消瘤 MWA 治疗提供的 OS 和 PFS 明显长于继续 TACE，特别是完全肿瘤消融的患者。MWA 组最常见的并发症是发热（48.1%）和疼痛（46.2%）。MWA 组记录了 2 例主要并发症（腹部感染），经对症治疗后恢复。在重复 MWA 过程中，主要在第二次 MWA 后出现肝增生，平均最大增加 RLV/TLV 率为 16.3%±12.7%。
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