背景:本研究旨在评估125I近距离放射治疗联合经动脉化疗栓塞(TACE)和微波消融(MWA)治疗高危部位不可切除肝细胞癌(HCC)的安全性和有效性。
方法:在1:2倾向评分匹配(PSM)后,这项回顾性研究分析了49例接受TACE+MWA+125I近距离放射治疗的患者(A组)和98例仅接受TACE+MWA治疗的患者(B组).评估的结果是无进展生存期(PFS),总生存期(OS),和治疗并发症。采用Cox比例风险回归分析比较两组生存情况。
结果:A组患者的PFS长于B组(7.9vs.3.3个月,P=0.007)。两组间中位OS差异无统计学意义(P=0.928)。客观反应率(ORR),高危地区肿瘤的疾病控制率,肝内肿瘤的ORR为67.3%,93.9%,51.0%,分别,A组,38.8%,79.6%和29.6%,分别,B组(P<0.001,P=0.025和P=0.011)。TACE-MWA-125I(HR=0.479,P<0.001)是影响PFS的重要有利预后因素。门静脉癌栓是影响PFS的独立预后因素(HR=1.625,P=0.040)。巴塞罗那临床肝癌(BCLC)分期(BCLCCvs.B)是影响OS的独立因素(HR=1.941,P=0.038)。两组并发症发生率相似,A组腹痛发生率降低(P=0.007)。
结论:TACE-MWA-125I比TACE-MWA在高危部位不可切除的肝细胞癌患者中导致更长的PFS和更好的肿瘤控制。
This study aimed to evaluate the safety and efficacy of 125I brachytherapy combined with transarterial chemoembolization (TACE) and microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC) in high-risk locations.
After 1:2 propensity score matching (PSM), this retrospectively study analyzed 49 patients who underwent TACE +MWA+125I brachytherapy (group A) and 98 patients who only received TACE +MWA (group B). The evaluated outcomes were progression-free survival (PFS), overall survival (OS), and treatment complications. Cox proportional hazards regression analysis survival was used to compare the two groups.
The patients in group A showed a longer PFS than group B (7.9 vs. 3.3 months, P = 0.007). No significant differences were observed in median OS between the two groups (P = 0.928). The objective response rate (ORR), disease control rate of tumors in high-risk locations, and the ORR of intrahepatic tumors were 67.3%, 93.9%, and 51.0%, respectively, in group A, and 38.8%, 79.6% and 29.6%, respectively, in group B (P < 0.001, P = 0.025 and P = 0.011, respectively). TACE-MWA-125I (HR = 0.479, P < 0.001) was a significant favorable prognostic factor that affected PFS. The present of portal vein tumor thrombosis was an independent prognostic factor for PFS (HR = 1.625, P = 0.040). The Barcelona clinic liver cancer (BCLC) stage (BCLC C vs. B) was an independent factor affecting OS (HR = 1.941, P = 0.038). The incidence of complications was similar between the two groups, except that the incidence of abdominal pain was reduced in the group A (P = 0.007).
TACE-MWA-125I resulted in longer PFS and better tumor control than did TACE-MWA in patients with unresectable hepatocellular carcinoma in high-risk locations.