Stereotactic Body Radiation Therapy vs. Transarterial Chemoembolization in Inoperable Barcelona Clinic Liver Cancer Stage a Hepatocellular Carcinoma: A Retrospective, Propensity-Matched Analysis
Stereotactic Body Radiation Therapy vs. Transarterial Chemoembolization in Inoperable Barcelona Clinic Liver Cancer Stage a Hepatocellular Carcinoma: A Retrospective, Propensity-Matched Analysis
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立体定向全身放射治疗与经动脉化疗栓塞治疗无法手术的巴塞罗那诊所肝癌 A 期肝细胞癌：回顾性倾向匹配分析
DOI：
10.3389/fonc.2020.00347
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发表时间：
2020-03-24
影响因子：
4.7
通讯作者：
Li, Le-Qun
中科院分区：
文献类型：
--
作者：
Su, Ting-Shi;Liang, Ping;Li, Le-Qun
背景和目的：目前尚不清楚立体定向体部放射治疗（SBRT）或经动脉化疗栓塞（TACE）是治疗不能手术的早期肝细胞癌（HCC）的更好方法。本研究旨在回顾性比较SBRT与TACE在无法手术的巴塞罗那临床肝癌（BCLC）-A期HCC患者中的疗效。材料和方法：在这项多机构的回顾性研究中，共纳入了326例不能手术的BCLC-A期HCC患者。共有167名患者最初接受了SBRT，159名患者最初接受了TACE。在单变量和倾向评分匹配分析中评价总生存期（OS）、局部控制（LC）、肝内控制（IC）和无进展生存期（PFS）。结果：SBRT组中位肿瘤直径小于TACE组（3.4cm vs.7.2cm，P < 0.001）。在选择95对患者进行倾向评分匹配后，SBRT的LC、IC和PFS优于TACE，但OS相当。SBRT组的累积1年、3年和5年OS率分别为85.7%、65.1%和62.8%，TACE组分别为83.6%、61.0%和50.4%（P = 0.29）。SBRT组的累积1、3和5年PFS分别为63.4%、35.9%和27.5%，TACE组分别为53.5%、27.4%和14.2%（P = 0.049）。SBRT组的累积1年、3年和5年LC分别为86.8%、62.5%和56.9%，TACE组分别为69.3%、53.3%和36.6%（P = 0.0047）。SBRT组的累积1年、3年和5年IC分别为77.3%、45.9%和42.4%，TACE组分别为57.3%、34.1%和17.7%（P = 0.003）。在多变量分析中，治疗（SBRT vs. TACE）是与局部和肝内控制相关的显著协变量（HR = 1.59; 95% CI：1.03-2.47; P = 0.04; HR = 1.61; 95% CI：1.13-2.29; P = 0.009）。结论：SBRT是治疗不能手术的BCLC-A期HCC的一种替代TACE的方法，具有更好的局部和肝内控制。建议进行对照临床试验，以充分评估这种新方案的实际效果。
Background and Objective: It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. Materials and Methods: In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. Results: There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, P < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively (P = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively (P = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively (P = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively (P = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03–2.47; P = 0.04; HR = 1.61; 95% CI: 1.13–2.29; P = 0.009). Conclusions: SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.