Department of Interventional Therapy, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China.
Department of Minimal Invasive Intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.
Int J Hyperthermia. 2024;41(1):2380001. doi: 10.1080/02656736.2024.2380001. Epub 2024 Jul 23.
Intra-arterial conversion therapy (ICT) is a promising option for patients with unresectable hepatocellular carcinoma (uHCC). However, the selection of sequential therapeutic modalities is still controversial. This study compared the efficacy and safety of surgical resection (SR) versus thermal ablation (TA) after patients with uHCC received ICT.
From May 2008 to November 2021, 3553 consecutive patients were reviewed and 791 patients were downstaged to receive TA or SR. Among them, 340 patients received SR, and 451 received TA after ICTs. The propensity score matching (PSM) method was applied to reduce selection bias between groups. Cumulative overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan-Meier method with the log-rank test. The occurrence of complications and adverse events (AEs) were compared using chi-square test.
After PSM 1:1 ( = 185 in both groups), the 10-year OS and PFS rates for patients who underwent SR were comparable to those of patients who underwent TA (OS: 45.2% vs. 36.1%; = 0.190; PFS: 19.3% vs. 15.9%; = 0.533). A total of 237 (29.9%) patients (203 males; mean age:57.1 ± 11.0 years) received downstaging therapy, and long-term OS and PFS remained comparable between the two groups ( = 0.718, 0.636, respectively). However, the cumulative OS and PFS rates in the downstaged cohort were significantly higher than those in the nondownstaged cohort (both s < 0.001). Additionally, there was no difference in major complications between the two groups (SR: 6.3% vs. TA: 8.6%; = 0.320).
TA might be an acceptable first-line alternative to SR after patients with uHCC receive ICT, especially patients unsuitable for SR. Better long-term survival was observed among patients in the downstaged cohort compared to those who failed to downstage.
动脉内转化治疗（ICT）是不可切除肝细胞癌（uHCC）患者的一种有前途的选择。然而，序贯治疗方式的选择仍存在争议。本研究比较了接受 ICT 治疗后行手术切除（SR）与热消融（TA）的疗效和安全性。
2008 年 5 月至 2021 年 11 月，共回顾性分析了 3553 例连续患者，其中 791 例患者降期接受 TA 或 SR。其中，340 例患者接受 SR，451 例患者接受 ICT 后 TA。采用倾向性评分匹配（PSM）法减少组间选择偏倚。采用 Kaplan-Meier 法和对数秩检验比较累积总生存率（OS）和无进展生存率（PFS）。采用卡方检验比较并发症和不良事件（AE）的发生情况。
PSM 1:1（每组均为 185 例）后，行 SR 的患者 10 年 OS 和 PFS 率与行 TA 的患者相当（OS：45.2%比 36.1%；=0.190；PFS：19.3%比 15.9%；=0.533）。共有 237 例（29.9%）患者（203 例男性；平均年龄：57.1±11.0 岁）接受降期治疗，两组间长期 OS 和 PFS 仍无差异（分别为=0.718、0.636）。然而，降期组的累积 OS 和 PFS 率明显高于未降期组（均 s<0.001）。此外，两组间主要并发症无差异（SR：6.3%比 TA：8.6%；=0.320）。
对于接受 ICT 治疗的 uHCC 患者，TA 可能是 SR 的一种可接受的一线替代方案，特别是对不适合 SR 的患者。与未能降期的患者相比，降期组患者的长期生存更好。
