经导管动脉化疗栓塞联合仑伐替尼序贯微波消融治疗超过 7 项标准的大肝癌：一项回顾性队列研究。

Transarterial Chemoembolization Combined with Lenvatinib Plus Sequential Microwave Ablation for Large Hepatocellular Carcinoma Beyond Up-to-Seven Criteria: A Retrospective Cohort Study.

机构信息

Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.).

出版信息

Acad Radiol. 2024 Jul;31(7):2795-2806. doi: 10.1016/j.acra.2024.01.015. Epub 2024 Jan 29.

DOI:10.1016/j.acra.2024.01.015

PMID:38290885

Abstract

RATIONALE AND OBJECTIVES

The aim of this study was to investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with Lenvatinib plus sequential microwave ablation (MWA) for the treatment of patients with large hepatocellular carcinoma (HCC) beyond up-to-seven criteria.

MATERIALS AND METHODS

This retrospective cohort study assessed the medical records of patients with large HCC who underwent TACE combined with Lenvatinib plus sequential MWA (TLM) or TACE plus sequential MWA (TM). Lenvatinib was administered to patients within 3-5 days after TACE and sequential MWA was performed once they met the criteria for curative ablation after TACE or the combination therapy. The progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared between two groups.

RESULTS

Of the 81 patients who underwent TLM or TM, 64 who met the eligibility criteria were included in this study. Among them, 28 patients underwent TLM and 36 underwent TM. The inverse probability weighting method (IPTW) was used to balance differences between two groups. The TLM group had longer PFS than the TM group (median, before IPTW: 18.53 vs. 5.62 months, p < 0.001; median, after IPTW: 28.27 vs. 5.30 months, p < 0.001). Univariate and multivariate analyses revealed that TLM and the maximum tumor diameter were independent prognostic factors for PFS. The overall incidence rate of minor complications related to TACE or MWA was lower in the TLM group (32.1% vs. 66.7%, p = 0.006).

CONCLUSION

TACE combined with Lenvatinib plus sequential MWA can prolong the progression-free survival of patients with large HCC beyond up-to-seven criteria.

摘要

背景与目的

本研究旨在探讨经动脉化疗栓塞术（TACE）联合仑伐替尼序贯微波消融（MWA）治疗超出 up-to-seven 标准的大肝癌患者的疗效和安全性。

材料与方法

本回顾性队列研究评估了接受 TACE 联合仑伐替尼序贯 MWA（TLM）或 TACE 联合序贯 MWA（TM）治疗的大肝癌患者的病历。TACE 后 3-5 天内给予患者仑伐替尼，TACE 后符合根治性消融标准或联合治疗后，行序贯 MWA。比较两组患者的无进展生存期（PFS）、总生存期（OS）和治疗相关并发症。

结果

在接受 TLM 或 TM 的 81 例患者中，符合纳入标准的 64 例患者纳入本研究。其中，28 例患者接受 TLM，36 例患者接受 TM。采用逆概率加权法（IPTW）平衡两组间差异。TLM 组的 PFS 长于 TM 组（未经 IPTW 校正的中位 PFS：18.53 个月比 5.62 个月，p<0.001；经 IPTW 校正的中位 PFS：28.27 个月比 5.30 个月，p<0.001）。单因素和多因素分析显示，TLM 和最大肿瘤直径是 PFS 的独立预后因素。TLM 组 TACE 或 MWA 相关轻微并发症的总发生率较低（32.1%比 66.7%，p=0.006）。