to compare survival outcomes of patients with single medium-sized hepatocellular carcinomas (hccs) who underwent treatment with transarterial chemoembolization, radiofrequency (rf) ablation, or a combination of the 2 therapies.
materials and methods丨between 2000 and 2016, 538 patients underwent combined chemoembolization and rf ablation (n = 109), chemoembolization alone (n = 314), or rf ablation alone (n = 115) as first-line treatment for a single medium-sized (3.1-5.0 cm) hcc. baseline demographic data (age, sex, etiology, eastern cooperative oncology group performance status, presence of liver cirrhosis, and serum bilirubin, albumin, and α-fetoprotein levels) were similar among groups except for child-pugh class, albumin level, and tumor size. propensity-score analysis with inverse probability weighting (ipw) was used to reduce any bias in treatment selection and other potential confounding factors.
纳入2000-2016年间的538例单发中型(3.1-5.0 cm) hcc患者，他们分别接受了化疗栓塞联合rf消融治疗(n = 109)、单纯行化疗栓塞治疗(n = 314)或单纯行rf消融(n = 115)作为一线治疗。除了child-pugh分级、白蛋白水平和肿瘤大小有显著差异外，各组间基线人口数据(年龄、性别、病因、美国东部肿瘤协作组体能状态、肝硬化情况、血清胆红素和甲胎蛋白水平)相似。使用逆概率加权(ipw)倾向性评分分析以减少治疗方式的选择及其他潜在混杂因素的任何偏差。
median follow-up time was 46.2 months. before ipw, overall survival (os) durations were significantly different among the 3 groups (median, 85 months for combined therapy, 56.5 months for chemoembolization alone, and 52.1 months for rf ablation alone; p = .01). the 10-year os rates were 40.1%, 25.5%, and 19.5% for the combined, chemoembolization-only, and rf ablation-only groups, respectively. after ipw, os remained superior in the combined chemoembolization/rf ablation group compared with the monotherapy groups (10-y os, 41.8% with combined therapy, 28.4% with chemoembolization alone, and 11.9% with rf ablation alone; p = .022).
中位随访时间46.2个月。ipw前，三组总生存(os) (中位生存时间：联合治疗85个月、单纯行化疗栓塞56.5个月、单纯行rf消融52.1个月)存在显著性差异(p = . 01)。联合治疗组、单纯行化疗栓塞组和单纯行rf消融组10年os率分别为40.1%、25.5%和19.5%。ipw后，化疗栓塞/rf消融联合治疗组的os率仍优于单一治疗组(10年os率：联合治疗41.8%、单纯行化疗栓塞28.4%、单纯行rf消融11.9%)(p = .022)。
chemoembolization plus rf ablation may provide better survival outcomes than chemoembolization or rf ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized hccs.