经动脉肝栓塞术与钇-90放射性栓塞术治疗直径>7 cm肝细胞癌患者的疗效比较
Outcomes of Transarterial Hepatic Embolization versus Yttrium-90 Radioembolization for Treatment of Patients with Hepatocellular Carcinoma >7 cm.
作者信息
Son Sam Y, Velayati Sara, Zhao Ken, Marinelli Brett, Geevarghese Ruben, Sotirchos Vlasios S, Covey Anne, Harding James J, D'Angelica Michael I, Jarnagin William R, Wei Alice, Yarmohammadi Hooman
机构信息
Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Radiology, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
J Vasc Interv Radiol. 2025 Mar 13. doi: 10.1016/j.jvir.2025.03.006.
PURPOSE
To assess and compare the safety, effectiveness, and outcomes of transarterial hepatic embolization (TAE) and transarterial radioembolization (TARE) for the treatment of patients with unresectable hepatocellular carcinoma (HCC) >7 cm.
MATERIALS AND METHODS
Treatment-naive patients with HCC >7 cm who were treated with TAE or TARE between January 2013 and December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison. Radiological treatment response was assessed using the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Kaplan-Meier survival curves were used to estimate progression-free survival (PFS) and overall survival (OS). Log-rank tests were performed to compare survival curves.
RESULTS
A total of 125 patients with HCC >7 cm were treated with TAE (n = 103) or TARE (n = 22). After propensity score matching, 44 patients who underwent TAE and 22 patients who were treated with TARE were compared. The mean tumor sizes were 10.4 cm (SD ± 2.6) in the TAE group and 10.7 cm (SD ± 2.7) in the TARE group (P > .695). TAE and TARE exhibited comparable adverse event (AE) rates (Grade 1 AE in 22 [50%] of 44 in TAE and 6 [27%] of 22 in TARE, P = .999; 1 Grade 2 AE [4.5%] in TAE). Median OS durations were 15.2 and 23.6 months in the TAE and TARE groups, respectively (P = .252). Median local PFS (4.7 vs 21.6 months, P < .001) and PFS (3.6 vs 10.0 months, P = .002) were significantly longer after TARE. TAE and TARE had similar objective response rates (TAE, 88.6% vs TARE, 77.3%; P = .364). Systemic therapy after TAE or TARE was a significant positive prognostic factor associated with disease progression and survival (PFS hazard ratio [HR], 0.58 [P = .047]; OS HR, 0.33 [P < .001]).
CONCLUSIONS
TAE and TARE are both safe transarterial therapies for patients with HCC >7 cm. TARE is associated with a longer time to progression and longer OS.
目的
评估和比较经动脉肝栓塞术（TAE）和经动脉放射性栓塞术（TARE）治疗直径大于7cm的不可切除肝细胞癌（HCC）患者的安全性、有效性和治疗结果。
材料和方法
本回顾性研究纳入了2013年1月至2023年12月期间初治的直径大于7cm的HCC患者，这些患者接受了TAE或TARE治疗。采用最近邻2:1倾向评分匹配法进行直接比较。使用改良实体瘤疗效评价标准（mRECIST）评估放射学治疗反应。采用Kaplan-Meier生存曲线估计无进展生存期（PFS）和总生存期（OS）。进行对数秩检验以比较生存曲线。
结果
共有125例直径大于7cm的HCC患者接受了TAE（n = 103）或TARE（n = 22）治疗。倾向评分匹配后，比较了44例行TAE的患者和22例行TARE的患者。TAE组的平均肿瘤大小为10.4cm（标准差±2.6），TARE组为10.7cm（标准差±2.7）（P >.695）。TAE和TARE的不良事件（AE）发生率相当（TAE组44例中有22例[50%]发生1级AE，TARE组22例中有6例[27%]发生，P =.999；TAE组有1例2级AE[4.5%]）。TAE组和TARE组的中位OS分别为15.2个月和23.6个月（P =.252）。TARE术后的中位局部PFS（4.7个月对21.6个月，P <.001）和PFS（3.6个月对10.0个月，P =.002）显著更长。TAE和TARE的客观缓解率相似（TAE为88.6%，TARE为77.3%；P =.364）。TAE或TARE术后的全身治疗是与疾病进展和生存相关的显著阳性预后因素（PFS风险比[HR]，0.58[P =.047]；OS HR，0.33[P <.001]）。
结论
TAE和TARE对于直径大于7cm的HCC患者都是安全的经动脉治疗方法。TARE与更长的疾病进展时间和更长的OS相关。
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