Simultaneous versus sequential transcatheter arterial chemoembolization combined with microwave ablation for hepatocellular carcinoma: A retrospective propensity score-matched analysis.

IF 3.6 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hepatobiliary & Pancreatic Diseases International Pub Date : 2025-02-14 DOI:10.1016/j.hbpd.2025.02.001

Hong-Yu Wang, Gui-Xiong Zhang, Wen-Zhe Fan, Jin-Wei Li, Shu-Fang Hao, Yu-Shu Ouyang, Jia-Ping Li, Wen-Dao Liu

{"title":"Simultaneous versus sequential transcatheter arterial chemoembolization combined with microwave ablation for hepatocellular carcinoma: A retrospective propensity score-matched analysis.","authors":"Hong-Yu Wang, Gui-Xiong Zhang, Wen-Zhe Fan, Jin-Wei Li, Shu-Fang Hao, Yu-Shu Ouyang, Jia-Ping Li, Wen-Dao Liu","doi":"10.1016/j.hbpd.2025.02.001","DOIUrl":null,"url":null,"abstract":"Background: Transcatheter arterial chemoembolization (TACE) combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma (HCC). However, prolonged time intervals can lead to recanalization and neoangiogenesis, which may interfere with the synergistic effects of combination therapy. This study aimed to investigate whether TACE simultaneously combined with microwave ablation (MWA) is more effective than sequential therapy in patients with HCC.Methods: A total of 129 HCC patients who underwent TACE combined with MWA were included in this study. Based on the time interval between the first combination therapy of TACE and MWA, patients were divided into the simultaneous and sequential groups. Propensity score matching (PSM) was performed to reduce bias between the groups. Overall survival (OS), time-to-progression (TTP), tumor response, and liver function were compared.Results: Before PSM, the simultaneous group had a higher tumor load. Following PSM, 36 and 40 patients remained in the simultaneous and sequential groups, respectively. The median TTP and OS were 12.9 vs. 10.6 months (P = 0.262) and 44.0 vs. 26.5 months (P = 0.313) for the simultaneous and sequential groups, respectively. After 4-8 weeks, there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group, respectively (P = 0.504). The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups, respectively (P = 0.882). These results did not differ in BCLC stratified subgroups. Patients with small tumor sizes (≤ 5 cm), tumor nodules ≤ 3, well-defined boundaries, and early-stage tumors were more likely to achieve complete response (all P < 0.05). After 4-8 weeks, the liver function was significantly improved compared to that before or one day after treatment.Conclusions: TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.","PeriodicalId":55059,"journal":{"name":"Hepatobiliary & Pancreatic Diseases International","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatobiliary & Pancreatic Diseases International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hbpd.2025.02.001","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Transcatheter arterial chemoembolization (TACE) combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma (HCC). However, prolonged time intervals can lead to recanalization and neoangiogenesis, which may interfere with the synergistic effects of combination therapy. This study aimed to investigate whether TACE simultaneously combined with microwave ablation (MWA) is more effective than sequential therapy in patients with HCC.

Methods: A total of 129 HCC patients who underwent TACE combined with MWA were included in this study. Based on the time interval between the first combination therapy of TACE and MWA, patients were divided into the simultaneous and sequential groups. Propensity score matching (PSM) was performed to reduce bias between the groups. Overall survival (OS), time-to-progression (TTP), tumor response, and liver function were compared.

Results: Before PSM, the simultaneous group had a higher tumor load. Following PSM, 36 and 40 patients remained in the simultaneous and sequential groups, respectively. The median TTP and OS were 12.9 vs. 10.6 months (P = 0.262) and 44.0 vs. 26.5 months (P = 0.313) for the simultaneous and sequential groups, respectively. After 4-8 weeks, there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group, respectively (P = 0.504). The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups, respectively (P = 0.882). These results did not differ in BCLC stratified subgroups. Patients with small tumor sizes (≤ 5 cm), tumor nodules ≤ 3, well-defined boundaries, and early-stage tumors were more likely to achieve complete response (all P < 0.05). After 4-8 weeks, the liver function was significantly improved compared to that before or one day after treatment.

Conclusions: TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

背景：对于肝细胞癌（HCC）患者，经导管动脉化疗栓塞术（TACE）联合消融术的临床疗效优于单一疗法。然而，时间间隔过长会导致再通化和新血管生成，这可能会干扰联合疗法的协同效应。本研究旨在探讨在HCC患者中，TACE同时联合微波消融（MWA）是否比连续治疗更有效：本研究共纳入了 129 例接受 TACE 联合 MWA 治疗的 HCC 患者。根据首次TACE和MWA联合治疗的时间间隔，将患者分为同时组和连续组。为减少组间偏差，进行了倾向评分匹配（PSM）。比较了总生存期（OS）、进展时间（TTP）、肿瘤反应和肝功能：结果：在 PSM 之前，同步组的肿瘤负荷较高。PSM 后，同步组和顺序组分别有 36 和 40 名患者。同时组和顺序组的中位 TTP 和 OS 分别为 12.9 个月 vs. 10.6 个月（P = 0.262）和 44.0 个月 vs. 26.5 个月（P = 0.313）。4-8 周后，同步组有 16 名完全应答者和 17 名部分应答者，序贯组分别有 15 名和 22 名患者（P = 0.504）。同步组和序贯组中位完全应答持续时间分别为 11.3 个月和 9.2 个月（P = 0.882）。这些结果在 BCLC 分层亚组中没有差异。肿瘤体积小（≤5厘米）、肿瘤结节≤3个、边界清晰和早期肿瘤的患者更有可能获得完全应答（所有P均<0.05）。4-8周后，肝功能较治疗前或治疗后1天明显改善：结论：TACE同时联合MWA安全有效，但不优于序贯疗法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Hepatobiliary & Pancreatic Diseases International 医学-胃肠肝病学

CiteScore

5.40

自引率

6.10%

发文量

152

审稿时长

3.0 months

期刊介绍： Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.