Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: a propensity score matching study
Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: a propensity score matching study
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单独经导管动脉化疗栓塞或联合消融治疗复发性中期肝细胞癌：倾向评分匹配研究
DOI：
10.1007/s00432-020-03254-2
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发表时间：
2020-05-25
影响因子：
3.6
通讯作者：
Yuan, Yunfei
中科院分区：
文献类型：
--
作者：
Wang, Chenwei;Liao, Yadi;Yuan, Yunfei
目的 治愈性肝切除术后复发很常见。有限的数据调查了经导管动脉化疗栓塞（TACE）联合消融治疗肝切除术后复发性中期肝细胞癌（HCC）的效果。我们的目的是比较 TACE 联合消融与单独 TACE 治疗肝切除术后复发性中期 HCC 的疗效。方法 中山大学附属肿瘤医院肝切除术后复发中期肝癌患者183例，其中单纯TACE患者111例，TACE联合消融（TACE-Ablation）患者72例。通过对数秩检验比较总生存期（OS）和无进展生存期（PFS）。倾向评分匹配（PSM）用于减少混杂偏差。结果 PSM 前，TACE 消融组和单独 TACE 组的 5 年 OS 率分别为 43.3% 和 27.9%（P = 0.001），5 年 PFS 率分别为 21.7% 和 13.0%（P < 0.001）。 PSM 后，TACE 消融仍比单独 TACE 获得更好的 5 年 OS（41.6% vs. 30.2%，P = 0.028）和 5 年 PFS 率（21.3% vs. 15.8%，P = 0.024）。 TACE-消融组患者的主要并发症发生率与单独 TACE 组相似，但 PSM 前后的次要并发症发生率较高。 Cox 回归分析确定单独 TACE 模式是 OS 和 PFS 的独立不利预测因子（均 P < 0.05）。结论 TACE联合消融治疗肝切除术后复发中期HCC在肿瘤控制和延长总生存方面安全性优于单独TACE。
Purpose The recurrence after curative hepatectomy is common. Limited data have investigated the effect of transcatheter arterial chemoembolization (TACE) combined with ablation in treating recurrent intermediate-stage hepatocellular carcinoma (HCC) after hepatectomy. We aim to compare the efficacy of TACE combined with ablation versus TACE alone in treating recurrent intermediate-stage HCC after hepatectomy. Methods A total of 183 patients with recurrent intermediate-stage HCC after hepatectomy were enrolled at Sun Yat-sen University Cancer Centre, including 111 patients who underwent TACE alone and 72 patients who underwent TACE combined with ablation (TACE-Ablation). Overall survival (OS) and progression-free survival (PFS) were compared by the log-rank test. Propensity score matching (PSM) was used to reduce the confounding bias. Results Before PSM, the 5-year OS rates were 43.3% vs. 27.9% (P = 0.001), and the 5-year PFS rates were 21.7% vs. 13.0% (P < 0.001) for TACE-Ablation and TACE-alone groups, respectively. After PSM, TACE-Ablation still resulted in better 5-year OS (41.6% vs. 30.2%, P = 0.028) and 5-year PFS rate (21.3% vs. 15.8%, P = 0.024) than that of TACE alone. Patients in TACE-Ablation group exhibited similar major complication rates to TACE-alone group but higher minor complication rates both before and after PSM. Cox regression analysis identified TACE-alone modality as an independently unfavourable predictor for OS and PFS (both P < 0.05). Conclusion TACE combined with ablation is safe and superior to TACE alone in tumour control and prolonging overall survival in recurrent intermediate-stage HCC after hepatectomy.