TACE Combined with HIFU Versus Surgical Resection for Single Hepatocellular Carcinoma with Child-Pugh B Cirrhosis in Overall Survival and Progression-Free Survival: A Retrospective Study.
TACE Combined with HIFU Versus Surgical Resection for Single Hepatocellular Carcinoma with Child-Pugh B Cirrhosis in Overall Survival and Progression-Free Survival: A Retrospective Study.
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TACE 联合 HIFU 与手术切除治疗单发肝细胞癌伴 Child-Pugh B 型肝硬化的总体生存期和无进展生存期：一项回顾性研究。
DOI：
10.1177/15330338211060180
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发表时间：
2021-01
影响因子：
2.8
通讯作者：
Ma R
中科院分区：
文献类型：
--
作者：
Zhang Q;Wang Y;Zhang J;Zhang W;Gong J;Ma R
目的：比较经导管动脉化疗栓塞术（TACE）联合高强度聚焦超声（HIFU）与手术切除治疗单发性肝细胞癌（HCC）合并Child-Pugh B型肝硬化的有效性、安全性和生存结局。方法：对某三级教学医院2010年7月至2018年7月诊断为单发HCC合并Child-Pugh B型肝硬化的146例患者进行医院回顾性研究。共有49例患者接受了TACE联合HIFU（联合组），97例患者接受了手术切除（切除组）。其中，22例接受TACE联合HIFU治疗的患者和45例接受手术切除的患者为小HCC（肿瘤直径≤3cm）。比较两组患者的总生存（OS）时间、无进展生存（PFS）时间及术后并发症。结果：在单一HCC肿瘤队列中，两组之间的OS无显着差异[风险比（HR） = 0.6379； 95%置信区间（95% CI） = 0.3737至1.089； P = .0995]，而切除组在PFS方面明显优于联合组（HR = 0.3545；95% CI = 0.2176-0.5775；P < .0001）。切除组1年、3年、5年复发率分别为30.9%、55.7%、86.6%，联合组分别为53.1%、77.6%、89.8%。在小肝癌肿瘤队列中，两组的 OS 也没有差异（HR = 0.8808；95% CI = 0.3295-2.355；P = .06396），而切除组在 PFS 方面明显优于联合组（HR = 0.4273；95%） CI = 0.1927-0.9473；P = .0363)。切除组1年、3年、5年复发率分别为28.9%、53.3%、93.3%，联合组分别为40.9%、68.2%、81.8%。此外，联合组并发症发生率为38.8%，显着低于切除组的56.7%（P = .041），且联合组全身麻醉时间短于切除组（P = .001）。其中，两组I级并发症（Clavien-Dindo分级）发生率无差异（P = .866）。结论：对于单发或单发小肝癌患者，TACE联合HIFU在长期生存率方面可能不逊色于手术切除，而手术切除在延缓复发方面仍具有一定优势。此外，TACE与HIFU联合应用比手术切除具有更高的安全性。
Objective: To compare the effectiveness, safety and survival outcome of transcatheter arterial chemoembolization (TACE) combined with high-intensity focused ultrasound (HIFU) versus surgical resection for treating single hepatocellular carcinoma (HCC) with Child-Pugh B cirrhosis. Methods: A hospital-based retrospective study with 146 patients diagnosed with single HCC with Child-Pugh B cirrhosis from July 2010 to July 2018 was conducted in a tertiary teaching hospital. A total of 49 patients underwent TACE combined with HIFU (the combined group), and 97 patients underwent surgical resection (the resection group). Of them, 22 patients undergoing TACE combined with HIFU and 45 patients undergoing surgical resection had small HCC (tumor diameter ≤3 cm). The overall survival (OS) time, progression-free survival (PFS) time and postoperative complications were compared between the two groups. Results: In the single HCC tumor cohort, there was no significant difference in OS between the two groups [hazard ratio (HR) = 0.6379; 95% confidence interval (95% CI) = 0.3737 to 1.089; P = .0995], while the resection group showed an obvious superiority to the combined group regarding PFS (HR = 0.3545; 95% CI = 0.2176-0.5775; P < .0001). The 1-year, 3-year and 5-year recurrence rates were 30.9%, 55.7%, 86.6% in the resection group and 53.1%, 77.6%, 89.8% in the combined group, respectively. In the small HCC tumor cohort, there was also no difference in OS between the two groups (HR = 0.8808; 95% CI = 0.3295-2.355; P = .06396), while the resection group showed an obvious superiority to the combined group regarding PFS (HR = 0.4273; 95% CI = 0.1927-0.9473; P = .0363). The 1-year, 3-year and 5-year recurrence rates were 28.9%, 53.3%, 93.3% in the resection group and 40.9%, 68.2%, 81.8% in the combined group, respectively. Furthermore, the incidence of complications of the combined group was 38.8%, which was significantly less than the 56.7% of the resection group (P = .041), and the duration of general anesthesia in the combined group was shorter than that in the resection group (P = .001). Therein, there was no difference in the incidence of grade I complications (Clavien-Dindo classification) between the two groups (P = .866). Conclusion: For patients with single or single small HCCs, TACE combined with HIFU may not be inferior to surgical resection in terms of the long-term survival rate, while surgical resection still has a definite advantage in terms of delaying recurrence. In addition, the combination of TACE and HIFU has higher safety than surgical resection.
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