Unresectable Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Combined With Microwave Ablation vs. Combined With Cryoablation
Unresectable Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Combined With Microwave Ablation vs. Combined With Cryoablation
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不可切除的肝细胞癌：经导管动脉化疗栓塞联合微波消融与联合冷冻消融
DOI：
10.3389/fonc.2020.01285
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发表时间：
2020-08-07
影响因子：
4.7
通讯作者：
Li, Jiaping
中科院分区：
文献类型：
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作者：
Wei, Jialiang;Cui, Wei;Li, Jiaping
背景：经导管动脉化疗栓塞（TACE）联合消融已被广泛用于治疗不可切除的肝细胞癌（HCC）。然而，TACE应该与何种技术相结合以使其更有效仍然是未知的。目的：回顾性评价TACE联合微波消融（MWA）与TACE联合冷冻消融（CRA）治疗不可切除HCC的疗效和安全性。材料与方法：2011年1月至2018年12月，将108例确诊为不可切除HCC的患者分为TACE-MWA组（n = 48）和TACE-CRA组（n = 60）。比较两组患者的总生存期（OS）和进展时间（TTP）。为了减少潜在的偏差，进行了倾向评分匹配（PSM）。观察并发症。构建Kaplan-Meier生存曲线，采用log-rank检验进行比较。结果：两组患者基线特征基本平衡。TACE-MWA组的中位OS为20.9个月（95% CI 14.3-27.6个月），TACE-CRA组的中位OS为13.0个月（95% CI 8.8-17.1个月）（P = 0.096）。TACE-MWA组中位TTP为8.8个月（95% CI 4.3-13.4个月），TACE-CRA组中位TTP为9.3个月（95% CI 7.1-11.5个月）（P = 0.675）。PSM结束后，每组保留48例患者。TACE-MWA组和TACE-CRA组的中位生存期分别为20.9个月（95% CI 14.3-27.6个月）和13.5个月（95% CI 8.4-18.6个月，P = 0.100）。TACE-MWA组和TACE-CRA组的中位TTP分别为8.8个月（95% CI 4.3-13.4个月）和8.6个月（95% CI 3.1-14.2个月，P = 0.909）。TACE-MWA组消融相关并发症的总发生率低于TACE-CRA组（66.7% vs. 88.3%, P = 0.006）。多因素分析显示，门静脉肿瘤血栓（PVTT）的存在和肝内肿瘤最大直径是影响OS和TTP预后的重要因素。结论：TACE-MWA与TACE-CRA治疗不可切除HCC的疗效具有可比性。由于并发症发生率较低，特别是在血小板减少方面，TACE-MWA更有希望。需要进一步的前瞻性随机对照试验来验证我们的发现。
Background: Transcatheter arterial chemoembolization (TACE) combined with ablation has been widely used for treating unresectable hepatocellular carcinoma (HCC). However, the technique with which TACE should be combined for it to be more effective remains unknown. Purpose: To retrospectively evaluate the efficacy and safety of TACE combined with microwave ablation (MWA) vs. TACE combined with cryoablation (CRA) in treating unresectable HCC. Materials and Methods: From January 2011 to December 2018, 108 patients diagnosed with unresectable HCC were divided into either the TACE-MWA group (n = 48) or TACE-CRA group (n = 60). Overall survival (OS) and time to progression (TTP) were compared between the two groups. To reduce potential bias, a propensity score matching (PSM) was performed. Complications were observed. Kaplan-Meier survival curves were constructed and compared using the log-rank test. Results : The baseline characteristics of the two groups were balanced. The median OS was 20.9 months (95% CI 14.3–27.6 months) in the TACE-MWA group and 13.0 months (95% CI 8.8–17.1 months) in the TACE-CRA group (P = 0.096). The median TTP was 8.8 months (95% CI 4.3–13.4 months) in the TACE-MWA group and 9.3 months (95% CI 7.1–11.5 months) in the TACE-CRA group (P = 0.675). After PSM, 48 patients remained in each group. The median OS in the TACE-MWA and TACE-CRA groups was 20.9 months (95% CI 14.3–27.6 months), and 13.5 months (95% CI 8.4–18.6 months, P = 0.100), respectively. The median TTP in the TACE-MWA and TACE-CRA groups was 8.8 months (95% CI 4.3–13.4 months), and 8.6 months (95% CI 3.1–14.2 months, P = 0.909), respectively. The overall incidence rate of ablation-related complications was lower in the TACE-MWA group than in the TACE-CRA group (66.7 vs. 88.3%, P = 0.006). Multivariate analysis showed that the presence of portal vein tumor thrombus (PVTT) and the maximum diameter of intrahepatic tumor were significant prognostic factors for OS and TTP. Conclusion: The efficacy of TACE-MWA and TACE-CRA in the treatment of unresectable HCC was comparable. TACE-MWA was more promising because of a lower complication rate, especially with regard to thrombocytopenia. Further prospective randomized controlled trials are required to validate our findings.