米兰标准内肝细胞癌中经动脉化疗栓塞术序贯射频消融与单纯射频消融的比较

TACE Sequential to Radiofrequency Ablation versus RFA Alone in Hepatocellular Carcinoma Within Milan Criteria.

作者信息

Yan Huzheng, Zhao Chenghao, Liu Mingming, Liu Huan, Mu Luwen, Xiang Zhanwang, Huang Mingsheng

机构信息

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.

出版信息

J Hepatocell Carcinoma. 2025 Aug 12;12:1795-1805. doi: 10.2147/JHC.S534039. eCollection 2025.

DOI:10.2147/JHC.S534039

PMID:40822086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12357602/

Abstract

OBJECTIVE

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.

METHODS

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).

RESULTS

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).

CONCLUSION

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.

摘要

目的

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。

方法

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）。

结果

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）。