Wang Xiao-Hui, Duan Wen-Bin, Liang Wei, Li Hui, Xie Xiao-Yan, Li Shao-Qiang, Chen Min-Shan, Liang Ping, Mao Xian-Hai, Zhou Qun-Fang
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha, Hunan province, 410005, China.
Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
EClinicalMedicine. 2023 Jan 20;56:101816. doi: 10.1016/j.eclinm.2022.101816. eCollection 2023 Feb.
The evidence of radiofrequency ablation (RFA) following transarterial chemoembolisation (TACE) combined with sorafenib for intermediate-stage recurrent hepatocellular carcinoma (RHCC) is limited. Patient responses to this treatment vary because of the heterogeneous nature of RHCC, making it important to identify patients who are most likely to benefit from this combination therapy. The aim of this study was to evaluate the efficacy of RFA following TACE and sorafenib for the intermediate-stage RHCC.
This retrospective, multicentre, cohort study included 363 patients with intermediate-stage RHCC underwent TACE combined with sorafenib (TACE-sorafenib group) or RFA following TACE and sorafenib (TACE-sorafenib + RFA group) between January 01, 2009 to December 31, 2015 from four institutions in China. Overall survival (OS), progression-free survival (PFS) and efficacy of patients were compared between the two groups by propensity score-matching (PSM).
The 1-, 3-, and 5-year OS rates were 97.7%, 83.7%, 54.7% in TACE-sorafenib + RFA group, and 93.3%, 57.0%, 32.7% in TACE-sorafenib group. The 1-, 2-, and 3-year PFS rates were 85.3%, 58.0%, 26.9% in TACE-sorafenib + RFA group, and 55.3%, 30.7%, 15.3% in TACE-sorafenib group. Compared with the TACE-sorafenib group, the TACE-sorafenib + RFA group had significantly longer OS (HR, 0.54; 95%CI, 0.40-0.73; < 0.001) and PFS (HR, 0.52; 95% CI, 0.41-0.66; < 0.001). Subgroup analysis was conducted to precisely screen out the beneficial population from RFA treatment.
Our findings suggest that addition of RFA following TACE and sorafenib combination was superior to TACE combined with sorafenib for intermediate-stage RHCC, resulting in longer OS and PFS. Patients who had good response to TACE and achieved downstaging successfully could not benefit from the RFA therapy.
This research was funded by National Natural Science Foundation of China (No. 81627803), Chen Xiao-Ping Science and Technology Development Fund (CXPJJH1200009-06).
对于中期复发性肝细胞癌（RHCC），经动脉化疗栓塞术（TACE）联合索拉非尼后再行射频消融术（RFA）的证据有限。由于RHCC的异质性，患者对这种治疗的反应各不相同，因此确定最有可能从这种联合治疗中获益的患者非常重要。本研究的目的是评估TACE联合索拉非尼后行RFA治疗中期RHCC的疗效。
这项回顾性、多中心队列研究纳入了2009年1月1日至2015年12月31日期间来自中国四个机构的363例中期RHCC患者，这些患者接受了TACE联合索拉非尼治疗（TACE-索拉非尼组）或TACE联合索拉非尼后行RFA治疗（TACE-索拉非尼+RFA组）。通过倾向评分匹配（PSM）比较两组患者的总生存期（OS）、无进展生存期（PFS）和疗效。
TACE-索拉非尼+RFA组的1年、3年和5年OS率分别为97.7%、83.7%、54.7%，TACE-索拉非尼组分别为93.3%、57.0%、32.7%。TACE-索拉非尼+RFA组的1年、2年和3年PFS率分别为85.3%、58.0%、26.9%，TACE-索拉非尼组分别为55.3%、30.7%、15.3%。与TACE-索拉非尼组相比，TACE-索拉非尼+RFA组的OS（HR，0.54；95%CI，0.40-0.73；P<0.001）和PFS（HR，0.52；95%CI，0.41-0.66；P<0.001）显著更长。进行亚组分析以精确筛选出从RFA治疗中获益的人群。
我们的研究结果表明，对于中期RHCC，TACE联合索拉非尼后加用RFA优于TACE联合索拉非尼，可延长OS和PFS。对TACE反应良好并成功降期的患者无法从RFA治疗中获益。
本研究由中国国家自然科学基金（编号81627803）、陈孝平科技发展基金（CXPJJH1200009-06）资助。
