Purpose

To compare the safety and effectiveness of transarterial radioembolization (TARE) and transarterial chemoembolization with drug-eluting embolic agents combined with percutaneous ablation (transarterial chemoembolization [TACE] + ablation) in the treatment of treatment-naïve, unresectable, solitary hepatocellular carcinoma (HCC) of ≥3 cm.

Materials and Methods

Twenty-nine patients with treatment-naïve, unresectable, solitary HCC of ≥3 cm received combined TACE + ablation, and 40 patients received TARE at a single institution. Local tumor response, tumor progression-free survival (PFS), overall survival, need for reintervention, bridge to transplant, and major complications were compared. Clinical variables and outcomes were compared before and after propensity score matching (PSM).

Results

Before PSM, patients who underwent TARE had a larger tumor size (3.7 vs 5.5 cm; P = .0005) and were older (61.5 vs 69.3 years; P = .0014). After PSM, there was no difference in baseline characteristics between the 2 groups, with the mean tumor sizes measuring 3.9 and 4.1 cm in the TACE + ablation and TARE cohorts, respectively. After PSM (n = 19 in each group), no statistically significant difference was observed in local radiological response (disease control rates, 100% vs 94.7%; P = .31), survival (subdistribution hazard ratio [SHR], 0.71; 95% confidence interval [CI], 0.28–1.80; P = .469), PFS (SHR, 0.61; 95% CI, 0.21–1.71; P = .342), bridge to transplant (21.1% vs 31.6%, P = .46), and major adverse event rates (15.8% vs 10.5%, P = .63) between the 2 groups. The mean total number of locoregional interventions was higher in the TACE + ablation cohort (1.9 vs 1.3 sessions, P = .02), with an earlier median reintervention trend (SHR, 0.61; 95% CI, 0.20–1.32; P = .167).

Conclusions

The present study showed that TARE and the combination of TACE and ablation are comparable in safety and effectiveness for treating treatment-naïve, unresectable, solitary HCC of ≥3 cm.

中文翻译：

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经动脉放射栓塞术与经动脉化疗栓塞术加经皮消融术治疗不可切除的 ≥ 3 cm 孤立性肝细胞癌：一项倾向评分匹配研究

目的

比较经动脉放射栓塞术 (TARE) 和经动脉化疗栓塞联合药物洗脱栓塞剂联合经皮消融术（经动脉化疗栓塞术 [TACE] + 消融术）治疗初治、不可切除的孤立性肝细胞癌 (HCC) 的安全性和有效性≥3 厘米。

材料和方法

29 名初治、不可切除、≥3 cm 的孤立性 HCC 患者接受了联合 TACE + 消融，40 名患者在单一机构接受了 TARE。比较了局部肿瘤反应、肿瘤无进展生存期 (PFS)、总生存期、需要再干预、过渡到移植和主要并发症。比较倾向评分匹配 (PSM) 前后的临床变量和结果。

结果

在 PSM 之前，接受 TARE 治疗的患者肿瘤更大（3.7 对 5.5 厘米；P  = .0005）并且年龄更大（61.5 对 69.3 岁；P  = .0014）。PSM 后，两组之间的基线特征没有差异，TACE + 消融和 TARE 队列的平均肿瘤大小分别为 3.9 和 4.1 cm。PSM 后（每组 n = 19），在局部放射学反应（疾病控制率，100% vs 94.7%；P = .31）、生存率（亚分布 风险比 [SHR]，0.71；95）方面未观察到统计学上的显着差异% 置信区间 [CI]，0.28–1.80；P  = .469），PFS（SHR，0.61；95% CI，0.21–1.71；P  = .342），过渡到移植（21.1% 对 31.6%，P = .46），以及 两组之间的主要不良事件发生率（15.8% 对 10.5%， P = .63）。TACE + 消融队列中局部区域干预的平均总数更高（1.9 与 1.3 次，P  = .02），中位再干预趋势更早（SHR，0.61；95% CI，0.20–1.32；P  = .167 ).

结论

本研究表明，TARE 与 TACE 和消融的组合在治疗初治、不可切除、≥ 3 cm 的孤立性 HCC 的安全性和有效性方面具有可比性。