肝癌為何選擇射頻消融治療而非立體定向放療？

美國《臨床腫瘤學雜誌》2018年1月12日線上先發

http://ascopubs.org/doi/full/10.1200/JCO.2017.75.3228

在非手術治療的患者中針對局部肝細胞肝癌行射頻消融對比立體定向放療：（美國）全國癌症資料庫分析

目的

對於局部肝細胞肝癌（HCC）的治療， 目前尚缺乏對局部消融治療如何進行最佳選擇的指導資料。 由於這些治療方法的前瞻性對比資料有限， 因此， 我們使用（美國）“全國癌症資料庫”， 旨在比較射頻消融（RFA）對比立體定向放療（SBRT）的療效。

方法

我們進行了一項觀察性研究， 在I、II期非手術治療的肝細胞肝癌患者中， 比較射頻消融（RFA）對比立體定向放療（SBRT）的療效。 基於患者、醫療機構和腫瘤特點，

採用加權傾向評分和匹配傾向評分進行分析， 比較了總生存率。 進行了一項敏感性分析， 以評價嚴重纖維化/肝硬化的影響。 此外， 我們還進行了探索性分析， 以瞭解在相關臨床情況的患者亞組中， 射頻消融（RFA）和立體定向放療（SBRT）的療效。

結果

總體上， I、II期非手術治療的肝細胞肝癌患者分別有3684名（92.6%）接受了射頻消融（RFA）治療， 296名（7.4%）接受了立體定向放療（SBRT）。 經傾向匹配後， 射頻消融（RFA）組5年總生存率為29.8%（95%CI， 24.5-35.3%）， 而立體定向放療（SBRT）放療組為19.3%（95%CI， 13.5%-25.9%）（P<0.001）。 逆概率加權分析， 則結果相近。 在所有檢驗的亞組中， 射頻消融（RFA）均一致獲益， 尤其對嚴重纖維化/肝硬化的療效更好。

結論

我們的研究表明， 對於I、II期非手術治療的肝細胞肝癌患者， 與立體定向放療（SBRT）相比，

射頻消融（RFA）治療生存率更高。 儘管我們的結果受限於回顧性研究設計的偏倚， 但我們相信， 在目前沒有隨機臨床試驗的情況下， 當對局部不可切除的肝細胞肝癌推薦局部消融治療時， 應當考慮我們的結果。

Radiofrequency Ablation Versus Stereotactic Body Radiotherapy for Localized Hepatocellular Carcinoma in Nonsurgically Managed Patients: Analysis of the National Cancer Database

https://doi.org/10.1200/JCO.2017.75.3228

Purpose

Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database.

Methods

We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score–weighted and propensity score–matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets.

Results

Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group (P < .001). Inverse probability–weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis.

Conclusion

Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.