Long-Term Survival Analysis of Transarterial Chemoembolization Plus Radiotherapy vs. Radiotherapy for Hepatocellular Carcinoma With Macroscopic Vascular Invasion
Long-Term Survival Analysis of Transarterial Chemoembolization Plus Radiotherapy vs. Radiotherapy for Hepatocellular Carcinoma With Macroscopic Vascular Invasion
复制标题
经动脉化疗栓塞联合放疗与放疗治疗伴有肉眼可见血管侵犯的肝细胞癌的长期生存分析
DOI：
10.3389/fonc.2020.01205
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发表时间：
2020-07-31
影响因子：
4.7
通讯作者：
Li, Le-Qun
中科院分区：
文献类型：
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作者：
Su, Ting-Shi;Li, Li-Qing;Li, Le-Qun
背景：宏观血管侵犯（MVI）是肝细胞癌（HCC）的终末表现，预后极差。在中国和韩国的HCC指南中，采用经动脉化疗栓塞（TACE）或/和放疗（RT）治疗MVI。在目前的研究中，我们旨在比较TACE + RT与单独RT治疗局部晚期HCC合并MVI患者的长期预后。方法：本回顾性研究纳入148例肝癌合并MVI患者。在入组的患者中，49名患者接受了TACE + RT治疗，而99名患者单独接受RT作为单一疗法。使用单变量和倾向评分匹配分析评估总生存期（OS）、无进展生存期（PFS）和肝内控制。结果：随访期间死亡126例（85.1%）。中位随访时间RT组为55.0个月，TACE + RT组为57.0个月。TACE + RT组的OS和PFS优于RT组，但两组的肝内控制相当。在倾向评分匹配后的41例well-pair中，TACE + RT与更好的OS和PFS之间的相关性仍然存在（15.0个月vs 8.0个月，8.0个月vs 4.0个月，均P < 0.05）。TACE + RT组1、2、3、5年OS率分别为56.1、28.6、20.8、15.7，而RT组为31.5%、13.1%、9.8%、6.7% （P = 0.017）。TACE + RT组6个月、12个月和24个月的生存率分别为51.2、39.0和23.1%，而RT组为36.6%、13.9%和11.1% （P = 0.04）。在TACE + RT组中，2例患者（4.1%）出现放射性肝病（RILD）， 1例患者（2.0%）出现RT相关胃肠道（GI）出血。在放疗组中，9名患者（9.1%）出现了RILD， 2名患者（2.0%）出现了与放疗相关的胃肠道出血。结论：经动脉化疗栓塞+ RT具有良好的互补性，并发症不多于单纯RT，对于合并MVI的HCC， PFS和OS均优于单纯RT。
Background: Macroscopic vascular invasion (MVI) is a terminal manifestation of hepatocellular carcinoma (HCC) and carries an extremely poor prognosis. In Chinese and Korean HCC guidelines, transarterial chemoembolization (TACE), or/and radiotherapy (RT) is adopted for treatment of MVI. In the current study, we aimed to compare the long-term outcome of TACE + RT to that of RT alone in patients with local advanced HCC with MVI. Methods: In this retrospective study, 148 treatment-naive patients of HCC with MVI were enrolled. Of the patients enrolled, 49 received TACE + RT treatment, whereas 99 patients received RT alone as a monotherapy. Overall survival (OS), progression-free survival (PFS), and intrahepatic control were evaluated using univariable and propensity score–matched analyses. Results: During follow-up, 126 patients (85.1%) died. The median follow-up time was 55.0 months in the RT group and 57.0 months in the TACE + RT group. The TACE + RT group showed better OS and PFS than the RT group, but intrahepatic control was comparable in these two groups. Of 41 cases well-pairs after propensity score matching, the associations between TACE + RT and better OS and PFS remained (15.0 vs. 8.0 months, and 8.0 vs. 4.0 months, all P < 0.05). The 1-, 2-, 3-, and 5-years OS rates in the TACE + RT group were 56.1, 28.6, 20.8, and 15.7 vs. 31.5%, 13.1%, 9.8%, and 6.7% in the RT group, respectively (P = 0.017). The 6-, 12-, and 24-months rates in the TACE + RT group were 51.2, 39.0, and 23.1% vs. 36.6%, 13.9%, and 11.1% in the RT group, respectively (P = 0.04). Two patients (4.1%) experienced radiation-induced liver disease (RILD), and one (2.0%) experienced RT-related gastrointestinal (GI) bleed in the TACE + RT groups. Nine patients (9.1%) experienced RILD, and two (2.0%) experienced RT-related GI bleed in the RT groups. Conclusion: Transarterial chemoembolization + RT had well-complementarity with no more complications than RT alone, providing a better PFS and OS compared with RT-alone treatment for HCC with MVI.