An Chao, Wu Songsong, Zuo Mengxuan, Li Wang, Li Kai, Wu Peihong
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, P.R. China.
Ther Adv Med Oncol. 2025 Jan 1;17:17588359241306648. doi: 10.1177/17588359241306648. eCollection 2025.
Transarterial chemoembolization (TACE) is an effective and safe downstaging therapy for hepatocellular carcinoma (HCC). However, the selection of sequential therapeutic modalities is still controversial.
This study compared the effectiveness and safety of surgical resection (SR) and thermal ablation (TA) after patients with HCC underwent TACE downstaging therapy.
A retrospective, multi-institutional study.
From June 2008 to October 2022, a total of 4782 consecutive patients with HCC beyond the initial Milan criteria underwent TACE at 12 hospitals. Among them, 609 patients who received successful downstaging therapy were retrospectively reviewed. Among them, 209 patients underwent an SR, and 390 patients received TA after TACE. 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.
After PSM 1:1 ( = 185 in both groups), the cumulative 1-, 3-, 5-, and 10-year OS rates were 98.8%, 89.3%, 82.9%, and 64.4%, respectively, in the SR group and 99.5%, 88.4%, 75.3%, and 53.9%, respectively, in the TA group; these two groups were not significantly different (HR: 1.22; 95% CI: 0.78-1.89; = 0.381). The cumulative 1-, 3-, 5-, and 10-year PFS rates were 88.5%, 69.2%, 58.8%, and 32.2%, respectively, in the SR group and 90.6%, 71.4%, 53.1%, and 32.0%, respectively, in the TA group, revealing no significant difference between the two groups (HR: 0.97; 95% CI: 0.71-1.32; = 0.855).
For HCC patients beyond the Milan criteria who received TACE downstaging therapy, TA might be acceptable as an alternative to SR in the first-line sequential treatment scheme.
经动脉化疗栓塞术（TACE）是一种治疗肝细胞癌（HCC）安全有效的降期治疗方法。然而，后续治疗方式的选择仍存在争议。
本研究比较了肝细胞癌患者接受TACE降期治疗后手术切除（SR）和热消融（TA）的有效性和安全性。
一项回顾性、多机构研究。
2008年6月至2022年10月，共有4782例初诊时超出米兰标准的连续性肝细胞癌患者在12家医院接受了TACE治疗。其中，对609例接受成功降期治疗的患者进行回顾性分析。其中，209例患者接受了手术切除，390例患者在TACE后接受了热消融。采用倾向评分匹配（PSM）方法以减少组间选择偏倚。采用Kaplan-Meier法和对数秩检验比较累积总生存期（OS）和无进展生存期（PFS）。
在1:1的PSM（两组均为185例）后，SR组的1年、3年、5年和10年累积总生存率分别为98.8%、89.3%、82.9%和64.4%，TA组分别为99.5%、88.4%、75.3%和53.9%；两组之间无显著差异（HR：1.22；95%CI：0.78 - 1.89；P = 0.381）。SR组的1年、3年、5年和10年累积无进展生存率分别为88.5%、69.2%、58.8%和32.2%，TA组分别为90.6%、71.4%、53.1%和32.0%，两组之间无显著差异（HR：0.97；95%CI：0.71 - 1.32；P = 0.855）。
对于接受TACE降期治疗的超出米兰标准的肝细胞癌患者，在一线序贯治疗方案中，热消融可作为手术切除的替代方案。
