Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, University of Rennes 1, Rennes, France.
Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.
Ann Surg. 2023 Nov 1;278(5):756-762. doi: 10.1097/SLA.0000000000006061. Epub 2023 Aug 4.
The aim of this study was to evaluate the efficacy of yttrium-90 transarterial radioembolization (TARE) to convert to resection initially unresectable, single, large (≥5 cm) hepatocellular carcinoma (HCC).
TARE can downsize cholangiocarcinoma to resection but its role in HCC resectability remains debatable.
All consecutive patients with a single large HCC treated between 2015 and 2020 in a single tertiary center were reviewed. When indicated, patients were either readily resected (upfront surgery) or underwent TARE. TARE patients were converted to resection (TARE surgery) or not (TARE-only). To further assess the effect of TARE on the long-term and short-term outcomes, a propensity score matching analysis was performed.
Among 216 patients, 144 (66.7%) underwent upfront surgery. Among 72 TARE patients, 20 (27.7%) were converted to resection. TARE-surgery patients received a higher mean yttrium-90 dose that the 52 remaining TARE-only patients (211.89±107.98 vs 128.7±36.52 Gy, P <0.001). Postoperative outcomes between upfront-surgery and TARE-surgery patients were similar. In the unmatched population, overall survival at 1, 3, and 5 years was similar between upfront-surgery and TARE-surgery patients (83.0%, 60.0%, 47% vs 94.0%, 86.0%, 55.0%, P =0.43) and compared favorably with TARE-only patients (61.0%, 16.0% and 9.0%, P <0.0001). After propensity score matching, TARE-surgery patients had significantly better overall survival than upfront-surgery patients ( P =0.021), while disease-free survival was similar ( P =0.29).
TARE may be a useful downstaging treatment for unresectable localized single large HCC providing comparable short-term and long-term outcomes with readily resectable tumors.
本研究旨在评估钇-90 经动脉放射栓塞术（TARE）将不可切除的单个大（≥5cm）肝细胞癌（HCC）转化为可切除的效果。
TARE 可使胆管细胞癌降期达到可切除，但在 HCC 可切除性方面的作用仍存在争议。
回顾性分析 2015 年至 2020 年期间在一家三级中心接受治疗的所有连续的单个大 HCC 患者。当有指征时，患者可直接行切除术（ upfront surgery）或 TARE。TARE 患者可转为行切除术（TARE 手术）或不行（仅 TARE）。为进一步评估 TARE 对长期和短期结果的影响，进行了倾向评分匹配分析。
在 216 例患者中，144 例（66.7%）行 upfront surgery。在 72 例 TARE 患者中，20 例（27.7%）转为行 TARE 手术。与其余 52 例仅行 TARE 的患者相比，TARE 手术患者接受的平均钇-90 剂量更高（211.89±107.98 与 128.7±36.52Gy，P<0.001）。 upfront-surgery 和 TARE-surgery 患者的术后结果相似。在未匹配的人群中， upfront-surgery 和 TARE-surgery 患者的总体生存率在 1、3 和 5 年时相似（83.0%、60.0%、47% vs 94.0%、86.0%、55.0%，P=0.43），且明显优于仅行 TARE 的患者（61.0%、16.0%和 9.0%，P<0.0001）。在倾向评分匹配后，TARE 手术患者的总体生存率明显优于 upfront-surgery 患者（P=0.021），而无病生存率相似（P=0.29）。
TARE 可能是一种有用的不可切除局部单发大 HCC 降级治疗方法，可提供与可直接切除肿瘤相似的短期和长期结果。
