Radiation Segmentectomy versus TACE Combined with Microwave Ablation for Unresectable Solitary Hepatocellular Carcinoma Up to 3 cm: A Propensity Score Matching Study
Radiation Segmentectomy versus TACE Combined with Microwave Ablation for Unresectable Solitary Hepatocellular Carcinoma Up to 3 cm: A Propensity Score Matching Study
复制标题
DOI：
10.1148/radiol.2016160718
复制
发表时间：
2017-06-01
期刊：
影响因子：
19.7
通讯作者：
Kim, Edward
中科院分区：
文献类型：
--
作者：
Biederman, Derek M.;Titano, Joseph J.;Kim, Edward
目的：比较放射节段切除(RS)和肝动脉化疗栓塞术(TACE)联合微波消融(MWA)治疗3 cm以下不能切除的孤立性肝细胞癌(HCC)的疗效。材料和方法：这项回顾性研究由机构审查委员会批准，免除了知情同意的要求。自2010年1月至2015年6月，共有417名肝癌患者和235名肝癌患者分别接受了RS和TACE MWA。对121名以前没有接受过局部区域治疗的患者(RS，41名；TACE MWA，80名；平均年龄65.4岁；84名男性[69.4%])和无血管侵犯或转移的孤立性肝细胞癌患者进行了回顾性研究。分析的结果包括与手术相关的并发症、实验室毒性水平、影像反应、进展时间(TTP)、90天死亡率和存活率。使用最近邻算法(1：1)进行倾向性评分匹配，以说明治疗前的临床、实验室和成像协变量。结果：配对前TACE组并发症发生率为8.9%，RS组并发症发生率为4.9%(P=.46)。完全缓解(CR)率RS组为82.9%，TACE组为82.5%(优势比，1.0；95%可信区间[CI]：0.4，2.8；P=.95)。初次CR后有41例进展(RS，11例；TACE MWA，30例)，其中10例(24%)被归类为目标进展(RS，1例；TACE MWA，9例)。中位总TTP：RS组为11.1个月(95%可信区间：8.8个月，25.6个月)，TACE MWA组为12.1个月(95%可信区间：7.7个月，19.1个月)(P&>0.99)。配对后，两组的总CR率(P=.94)、总有效率(P=.83)和总生存率(P>；.99)无显著差异。两组患者术后90d死亡率均为0。结论：3 cm以下的单发肝癌患者接受RS治疗后的影像反应和进展结果与TACE MWA治疗的患者相比无显著差异。(C)RSNA，2016年
Purpose: To compare the outcomes of radiation segmentectomy (RS) and transarterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of unresectable solitary hepatocellular carcinoma (HCC) up to 3 cm.Materials and Methods: This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. From January 2010 to June 2015, a total of 417 and 235 consecutive patients with HCC underwent RS and TACE MWA, respectively. A cohort of 121 patients who had not previously undergone local-regional therapy (RS, 41; TACE MWA, 80; mean age, 65.4 years; 84 men [69.4%]) and who had solitary HCC up to 3 cm without vascular invasion or metastasis was retrospectively identified. Outcomes analyzed included procedure-related complications, laboratory toxicity levels, imaging response, time to progression (TTP), 90-day mortality, and survival. Propensity score matching was conducted by using a nearest-neighbor algorithm (1: 1) to account for pretreatment clinical, laboratory, and imaging covariates. Postmatching statistical analysis was performed with conditional logistic regression for binary outcomes and the stratified log-rank test for time-dependent outcomes.Results: Before matching, the complication rate was 8.9% and 4.9% in the TACE MWA and RS groups, respectively (P = .46). The overall complete response (CR) rate was 82.9% for RS and 82.5% for TACE MWA (odds ratio, 1.0; 95% confidence interval [CI]: 0.4, 2.8; P = .95). There were 41 (RS, 11; TACE MWA, 30) instances of progression occurring after an initial CR, of which 10 (24%) were classified as target progression (RS, one; TACE MWA, nine). Median overall TTP was 11.1 months (95% CI: 8.8 months, 25.6 months) in the RS group and 12.1 months (95% CI: 7.7 months, 19.1 months) in the TACE MWA group (P > .99). After matching, the overall CR rate (P = .94), TTP (P = .83), and overall survival (P > .99) were not significantly different between the two groups. The 90-day postoperative mortality rate was 0% in both groups.Conclusion: Imaging response and progression outcomes of patients with solitary HCC up to 3 cm treated with RS were not significantly different when compared with those of patients treated with TACE MWA. (C) RSNA, 2016