Department of Oncology, 3201 Hospital of Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi, China.
Department of Imaging, 3201 Hospital of Xi'an Jiaotong University Health Science Center, Hanzhong, Shaanxi, China.
J Cancer Res Ther. 2023 Aug;19(4):924-932. doi: 10.4103/jcrt.jcrt_2296_22.
To examine post-operative progression and risk impact of insufficient radiofrequency ablation (RFA) following transarterial chemoembolization (TACE) for the prognosis of large hepatocellular carcinoma (HCC).
From January 2014 to January 2021 were analyzed. A total of 343 patients with large HCC (diameter >5 cm) who received TACE combined with RFA were enrolled and were divided into two groups: complete ablation (CA, n = 172) and insufficient ablation (IA, n = 171). Overall survival (OS) and progression-free survival (PFS) were determined by the Kaplan-Meier curve and compared with the log-rank test. To find parameters influencing OS and PFS, clinicopathological variables underwent univariate and multivariate analysis.
The cumulative 1-, 3-, and 5-year OS and PFS rates of the CA group were significantly higher than that of the IA group (P < 0.001). 25 (41%) patients in local tumor progression (LTP), 36 (59%) in intrahepatic distant recurrence (IDR), and 0 (0%) in extrahepatic distant recurrence (EDR) in the CA group. 51 (32.1%) patients in LTP, 96 (60.4%) patients in IDR, and 12 (7.5%) cases in EDR in the IA group. The recurrence patterns of the two groups were statistically significant difference (P = 0.039). In multivariate analysis, inadequate ablation and conjunction with TKIs were both significant risk factors for OS and PFS. Apart from these, older age and >7 cm of tumor size were indicators of poor OS and multiple tumors were indicators of poor PFS.
Insufficient ablation causes a poor survival outcome of TACE combined with RFA for large HCC, particularly, which can promote IDR.
探讨经肝动脉化疗栓塞术（TACE）联合射频消融术（RFA）治疗大肝癌（HCC）后射频消融不足对预后的影响。
分析了 2014 年 1 月至 2021 年 1 月期间收治的 343 例接受 TACE 联合 RFA 治疗的大 HCC（直径>5cm）患者，将其分为完全消融（CA）组（n=172）和消融不足（IA）组（n=171）。采用 Kaplan-Meier 曲线法和对数秩检验法比较两组患者的总生存期（OS）和无进展生存期（PFS）。采用单因素和多因素分析确定影响 OS 和 PFS 的参数。
CA 组患者的 1、3、5 年 OS 和 PFS 累积率明显高于 IA 组（P<0.001）。CA 组中 25 例（41%）患者出现局部肿瘤进展（LTP），36 例（59%）患者出现肝内远处复发（IDR），0 例（0%）患者出现肝外远处转移（EDR）；IA 组中 51 例（32.1%）患者出现 LTP，96 例（60.4%）患者出现 IDR，12 例（7.5%）患者出现 EDR。两组患者的复发模式差异有统计学意义（P=0.039）。多因素分析显示，消融不足和联合 TKI 治疗是 OS 和 PFS 的独立危险因素。此外，年龄较大和肿瘤直径>7cm 是 OS 不良的指标，多发肿瘤是 PFS 不良的指标。
对于大 HCC 患者，TACE 联合 RFA 治疗后消融不足会导致生存结果较差，尤其是会促进 IDR 的发生。
