Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3 cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation. Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study. A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates, 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank testp= 0.652) or liver-related survival (log-rank testp= 0.495) over a median follow-up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%,p< 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80%p= 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival were similar (log rank testp= 0.355 andp= 0.390, respectively). Our study provides valuable real-world evidence that TACE when offered with appropriate follow-up treatment is a reasonable initial management strategy in very early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed to better define the role for TACE in BCLC 0/A HCC.
经皮消融术与手术切除及肝移植一同被推荐作为巴塞罗那临床肝癌（BCLC）0/A期、肿瘤直径≤3厘米肝细胞癌（HCC）患者的根治性治疗手段。然而在真实临床实践中，经动脉化疗栓塞（TACE）常被用于单发小肝癌的初始治疗，这与广泛认可的临床实践指南中将TACE定位为中晚期HCC治疗方式的描述存在差异。本研究通过真实世界倾向性匹配多中心队列研究，评估单发≤3厘米HCC患者接受初始TACE治疗与先行消融治疗在生存结局方面的差异。研究纳入2016年1月1日至2020年12月31日期间初诊为BCLC 0/A期、单发肿瘤≤3厘米且接受初始TACE或消融治疗的新诊断HCC患者。共纳入348例患者，其中147例接受初始TACE治疗，201例接受先行消融治疗。经关键协变量倾向评分匹配后，最终230例患者（每组115例）纳入分析。在中位随访43个月期间，两组患者的总生存率（时序检验p=0.652）与肝脏相关生存率（时序检验p=0.495）均无显著差异。虽然消融作为初始治疗的完全缓解率显著优于TACE（74% vs. 56%，p<0.004），但允许后续补充治疗后两组完全缓解率无统计学差异（86% vs. 80%，p=0.219）。在获得完全缓解的患者中，无复发生存率与局部无复发生存率均表现相似（时序检验p值分别为0.355和0.390）。本研究提供的真实世界证据表明，在极早期/早期HCC治疗中，TACE配合适当的后续治疗可作为合理的初始管理策略，其生存结局与先行消融治疗相当。未来需进一步研究以明确TACE在BCLC 0/A期HCC治疗中的精准定位。
肿瘤(癌症)患者之家