Surgical resection versus thermal ablation after intra-arterial conversion therapy for unresectable hepatocellular carcinoma: a multicenter retrospective one as per the STROBE guidelines.

IF 3 3区医学 Q2 ONCOLOGY International Journal of Hyperthermia Pub Date : 2024-01-01 Epub Date: 2024-07-23 DOI:10.1080/02656736.2024.2380001

Yusen Du, Chao An, Wendao Liu

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Abstract

Purpose: Intra-arterial conversion therapy (ICT) is a promising option for patients with unresectable hepatocellular carcinoma (uHCC). However, the selection of sequential therapeutic modalities is still controversial. This study compared the efficacy and safety of surgical resection (SR) versus thermal ablation (TA) after patients with uHCC received ICT.

Methods: From May 2008 to November 2021, 3553 consecutive patients were reviewed and 791 patients were downstaged to receive TA or SR. Among them, 340 patients received SR, and 451 received TA after ICTs. The propensity score matching (PSM) method was applied to reduce selection bias between groups. Cumulative overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan-Meier method with the log-rank test. The occurrence of complications and adverse events (AEs) were compared using chi-square test.

Results: After PSM 1:1 (n = 185 in both groups), the 10-year OS and PFS rates for patients who underwent SR were comparable to those of patients who underwent TA (OS: 45.2% vs. 36.1%; p = 0.190; PFS: 19.3% vs. 15.9%; p = 0.533). A total of 237 (29.9%) patients (203 males; mean age:57.1 ± 11.0 years) received downstaging therapy, and long-term OS and PFS remained comparable between the two groups (p = 0.718, 0.636, respectively). However, the cumulative OS and PFS rates in the downstaged cohort were significantly higher than those in the nondownstaged cohort (both ps < 0.001). Additionally, there was no difference in major complications between the two groups (SR: 6.3% vs. TA: 8.6%; p = 0.320).

Conclusions: TA might be an acceptable first-line alternative to SR after patients with uHCC receive ICT, especially patients unsuitable for SR. Better long-term survival was observed among patients in the downstaged cohort compared to those who failed to downstage.

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不可切除肝细胞癌动脉内转化疗法后的手术切除与热消融：根据 STROBE 指南进行的多中心回顾性研究。

目的：对于无法切除的肝细胞癌（uHCC）患者来说，动脉内转化疗法（ICT）是一种很有前景的选择。然而，如何选择连续治疗方式仍存在争议。本研究比较了uHCC患者接受ICT治疗后手术切除（SR）与热消融（TA）的疗效和安全性：方法：2008 年 5 月至 2021 年 11 月，研究人员对 3553 例连续患者进行了回顾性分析，并对 791 例患者进行了分期，以确定其接受 TA 或 SR 治疗。其中，340名患者接受了SR治疗，451名患者在接受ICT治疗后接受了TA治疗。为减少组间选择偏倚，采用了倾向评分匹配（PSM）方法。累积总生存期（OS）和无进展生存期（PFS）采用 Kaplan-Meier 法和对数秩检验进行比较。并发症和不良事件（AEs）的发生率采用卡方检验进行比较：PSM 1:1后（两组均为185人），接受SR治疗的患者的10年OS和PFS率与接受TA治疗的患者相当（OS：45.2% vs. 36.1%；P = 0.190；PFS：19.3% vs. 15.9%；P = 0.533）。共有 237 名（29.9%）患者（203 名男性；平均年龄：57.1 ± 11.0 岁）接受了降期治疗，两组患者的长期 OS 和 PFS 仍具有可比性（P = 0.718，0.636，分别为 0.718 和 0.636）。然而，降期治疗组的累积OS和PFS率明显高于未降期治疗组（两组Ps均为0.320）：结论：TA可能是uHCC患者（尤其是不适合SR的患者）接受ICT后可接受的SR一线替代方案。与未能降期的患者相比，降期患者的长期生存率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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