Yan Huzheng, Zhao Chenghao, Liu Mingming, Liu Huan, Mu Luwen, Xiang Zhanwang, Huang Mingsheng
Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
J Hepatocell Carcinoma. 2025 Aug 12;12:1795-1805. doi: 10.2147/JHC.S534039. eCollection 2025.
This study aimed to compare the efficacy and safety of transarterial chemoembolization followed by radiofrequency ablation (cTACE-RFA) versus RFA alone in patients with early-stage hepatocellular carcinoma (HCC) within the Milan criteria.
A retrospective analysis included 343 patients with Milan criteria-compliant HCC. After 1:1 propensity score matching (PSM), 93 patients underwent cTACE-RFA, and 93 received RFA alone. Primary endpoints were overall survival (OS) and local progression-free survival (LPFS).
The TACE-RFA group demonstrated significantly superior 1-, 3-, and 5-year LPFS rates (84.9%, 58.1%, 36.6%) compared to the RFA group (75.3%, 44.1%, 16.1%; HR=0.54, 95% CI: 0.37-0.79, P=0.001). However, no significant 1-, 3-, and 5-year OS difference (HR = 1.06, 95% CI: 0.61-1.83, p = 0.843) was observed between cTACE-RFA (95.7%, 80.6%, 59.1%) and RFA alone group (96.8%, 78.5%, 61.3%). Subgroup analyses revealed significant OS improvements with cTACE-RFA in tumor with high-risk locations (HR = 0.38; 95% CI: 0.17-0.85, p = 0.018) and diameter 3-5 cm: (HR = 0.28; 95% CI: 0.12-0.64, p = 0.003). cTACE-RFA group also was observed significant LPFS improvements for tumors in high-risk locations (HR=0.48, 95% CI: 0.30-0.77, p=0.002) or 3-5 cm in size (HR=0.25, 95% CI: 0.15-0.41, p<0.001). Complication rates were comparable, with no procedure-related mortality and similar severe adverse event incidences (P=0.516).
cTACE-RFA significantly prolongs LPFS compared to RFA alone in early HCC, particularly for tumors >3 cm or in high-risk locations, without increasing major complications.
本研究旨在比较经动脉化疗栓塞后行射频消融术（cTACE-RFA）与单纯射频消融术（RFA）在符合米兰标准的早期肝细胞癌（HCC）患者中的疗效和安全性。
一项回顾性分析纳入了343例符合米兰标准的HCC患者。经过1:1倾向评分匹配（PSM）后，93例患者接受了cTACE-RFA，93例仅接受了RFA。主要终点为总生存期（OS）和局部无进展生存期（LPFS）。
与RFA组（75.3%、44.1%、16.1%；HR=0.54，95%CI：0.37-0.79，P=0.001）相比，TACE-RFA组在1年、3年和5年的LPFS率上显著更高（分别为84.9%、58.1%、36.6%）。然而，cTACE-RFA组（95.7%、80.6%、59.1%）与单纯RFA组（96.8%、78.5%、61.3%）在1年、3年和5年的OS方面未观察到显著差异（HR = 1.06，95%CI：0.61-1.83，p = 0.843）。亚组分析显示，对于高危部位（HR = 0.38；95%CI：0.17-0.85，p = 0.018）和直径3-5 cm的肿瘤，cTACE-RFA可显著改善OS：（HR = 0.28；95%CI：0.12-0.64，p = 0.003）。在cTACE-RFA组中，对于高危部位（HR=0.48，95%CI：0.30-0.77，p=0.002）或大小为3-5 cm（HR=0.25，95%CI：0.15-0.41，p<0.001）的肿瘤，LPFS也有显著改善。并发症发生率相当，无手术相关死亡，严重不良事件发生率相似（P=0.516）。
在早期肝癌中，与单纯RFA相比，cTACE-RFA可显著延长LPFS，尤其是对于直径>3 cm或位于高危部位的肿瘤，且不增加主要并发症。
