Wang Yujue, Pan Jinhua, Zhao Qiyu, Dong Gang, Ren Zhigang, Zhang Wu, Aji Tuerganaili, Ji Jiansong, Jiang Tian-An, Xu Min
Department of Ultrasound, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (Y.W.).
Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (J.P., Q.Z., T.J., M.X.).
Acad Radiol. 2025 Aug;32(8):4544-4554. doi: 10.1016/j.acra.2025.03.013. Epub 2025 Mar 30.
The therapeutic efficacy of irreversible electroporation (IRE) for treating subcapsular hepatocellular carcinoma (HCC) remains under-explored. The current study aimed to compare IRE and radiofrequency ablation (RFA) outcomes in an HCC patient group.
In this retrospective cohort study, we analyzed 213 patients with subcapsular HCC who met the Milan criteria and underwent either IRE (n = 80) or RFA (n = 133). We assessed local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications rates, using inverse probability of treatment weighting (IPTW).
After a median follow-up of 22 months, patients in the IRE group showed significantly lower LTP rates (1-year: 6.2% [95% CI: 2.1-14.0%], 2-year: 8.8% [95% CI: 3.6-17.2%] vs. RFA 18.0% [95% CI: 11.9-25.6%], 21.1% [95% CI: 14.5-29.0%]; P = 0.008) and higher RFS rates (1-year: 75.0% [95% CI: 64.1-84.0%], 2-year: 67.5% [95% CI: 56.1-77.6%] vs. RFA 60.9% [95% CI: 52.1-69.2%], 51.9% [95% CI: 43.1-60.6%]; P = 0.003). However, 2-year OS remained comparable across groups (IRE 100% [95.5-100%] vs. RFA 99.1% [95.9-100%]; P = 0.990). IPTW-adjusted analyses confirmed these findings. We determined that treatment modality was an independent influencing factor for LTP (RFA vs. IRE HR [95% CI]: 2.46 [1.05, 5.74], P = 0.037) and RFS (RFA vs. IRE HR [95% CI]: 1.62 [1.01, 2.61], P = 0.046). However, the complication rate (6.3% vs. 9.8%) and median hospital stay (3 vs. 3 days) were similar across groups (both P > 0.05).
For patients with subcapsular HCC meeting the Milan criteria, IRE demonstrated significantly improved LTP and RFS compared to RFA. These results may suggest that IRE is a viable therapeutic alternative for this tumor subtype.
不可逆电穿孔（IRE）治疗包膜下肝细胞癌（HCC）的疗效仍有待深入研究。本研究旨在比较IRE与射频消融（RFA）在HCC患者群体中的治疗效果。
在这项回顾性队列研究中，我们分析了213例符合米兰标准且接受IRE（n = 80）或RFA（n = 133）治疗的包膜下HCC患者。我们使用治疗权重逆概率（IPTW）评估局部肿瘤进展（LTP）、无复发生存期（RFS）、总生存期（OS）和并发症发生率。
中位随访22个月后，IRE组患者的LTP发生率显著更低（1年：6.2% [95% CI：2.1 - 14.0%]，2年：8.8% [95% CI：3.6 - 17.2%]，而RFA组分别为18.0% [95% CI：11.9 - 25.6%]，21.1% [95% CI：14.5 - 29.0%]；P = 0.008），RFS率更高（1年：75.0% [95% CI：64.1 - 84.0%]，2年：67.5% [95% CI：56.1 - 77.6%]，而RFA组分别为60.9% [95% CI：52.1 - 69.2%]，51.9% [95% CI：43.1 - 60.6%]；P = 0.003）。然而，两组的2年OS相当（IRE组为100% [95.5 - 100%]，RFA组为99.1% [95.9 - 100%]；P = 0.990）。IPTW调整分析证实了这些结果。我们确定治疗方式是LTP（RFA与IRE的HR [95% CI]：2.46 [1.05, 5.74]，P = 0.037）和RFS（RFA与IRE的HR [95% CI]：1.62 [1.01, 2.61]，P = 0.046）的独立影响因素。然而，两组的并发症发生率（6.3%对9.8%）和中位住院时间（3天对3天）相似（均P > 0.05）。
对于符合米兰标准的包膜下HCC患者，与RFA相比，IRE显示出LTP和RFS显著改善。这些结果可能表明IRE是这种肿瘤亚型的一种可行治疗选择。
