| BackgroundInterventional locoregional therapy is the first-line therapy for solitary large hepatocellular carcinomas(HCCs).And there are more and more articles indicate that combined locoregional treatment have better results than conventional simple transarterial chemoembolization(TACE)treatment for solitary large HCCs.Although,the management of solitary large HCCs remains controversial,It is becoming a tendency that the treatment strategy transform from simple to combined local treatment.And TACE plus Percutaneous transhepatic Chemotherapy-Lipiodol injection treatment(PTCLI)or Mircowave ablation(MWA)respectively are both hotspot research at present,and both achieved better results than conventional way.This study was conducted to compare the outcomes of treatment by TACE plus PTCLI and TACE plus MWA respectively,for solitary HCCs MWA measuring 5-10 cm.And such retrospective study could not be found in the literature published to date.To In this retrospective study,we compared therapeutic effects and complications of two combined local treatment in patients with large HCCs by retrospective analysis of patients with TACE plus PTCLI or MWA.PurposeThis retrospective study was conducted to compare the efficacy of TACE plus MWA with that of TACE plus PTCLI in treating large solitary HCCs(5-10 cm),which included the target tumor deactivation-rate,the rates of overall survival postoperative adverse reactions,such as pain,emesis and fever.Materials and MethodsThis retrospective review included 419 patients with large solitary HCCs sized 5-10 cm who underwent TACE plus MWA(the T-M group)or TACE plus PTCLI(the T-P group)as primary treatment from February 2006 to November 2015.331 patients in the T-P group and 87 patients in the T-M group in total.According to the inclusion and exclusion criteria,116 patients in total subordinated to our study.72 patients in the T-P group,including 65men and 7 women and the mean age was 52 years(range:29-70years).60 right lobe liver tumors,8 left lobe liver tumors and 4 caudate lobe tumors.52 patients were Child-Pugh class A,and 20 were Child-Pugh class B,72 target tumors sized 5.1-10.0 cm,mean size was 8.2 cm.And 28 patients with portal branches cancerous thrombus,36 patients with tumor metastasis.44 patients in the T-M group,which included 41 men and 2 women and the mean age was 57 years(range:39-82years).There are 39 right lobe liver tumors,3 left lobe liver tumors and 1 caudate lobe tumor.27 patients were Child-Pugh class A,16 were Child-Pugh class B.44 target tumors sized 5.0-10.0 cm,mean size was 7.5 cm.And 16 patients with portal branches cancerous thrombus,20 patients with tumor metastasis.TACE is the basic treatment of 2 groups,MWA or PTCLI were used as reinforce therapy.Follow up these patient's local treatment operation volume,complications,target tumor deactivation,overall survival and causes of death.Pearson's chi-squared test or Fisher's exact test were used to compare discrete variables.Cumulative survival and disease-free survival were estimated using the Kaplan-Meier survival method.A P-value of<0.05 signified statistical significance Statistical analyses were performed using SPSS Version 20.0.ResultsThere were no statistical difference between the T-M group and the T-P group in age,sex,tumor size,Child-Pugh staging and Barcelona staging.72 sessions of TACE plus PTCLI treatment were successfully performed on 72 patients,and 44 sessions of TACE plus MWA were successfully performed on 44 patients.398 TACEs in total were performed in the T-P group,mean 5.5 times per patient,the dose of CALE were from 1ml to 40ml.224 times TACE in total were performed in the T-M group,mean 5.2 times per patient,the dose of CALE were from 4ml to 40ml.There were no statistical difference between 2 groups in the amount of TACE(P=0.437)and the dose of CALE(P=0.727).There were 148 times of PTCLI in the T-P group,(132 times with DSA guided puncture,16 times with CT guided puncture),and the dose of CALE were from 2ml to 20ml.64 times of MWA in the T-M group in total,mean 1.5 times.There were 70 MWA needles in total,and the ablation power were between 50W to 60W(mean 56.1W).The ablation time was between 1.5minutes to 10 minutes.There was statistical difference between the T-M group and the T-P group in combined operation volume(P=0.000).the TACE?PTCLI and MWA technique success rates were 100%.Rates of overall survival at 1,2 and 3 years were 77.8%?55.6%?47.2%in the T-P group,and 72.7%,50.0%,45.5%in the T-M group(P=0.532).Divided 2 group's patients into young and middle-aged(<60 years)and the old(?60 years)to stratified analysis,young and middle-aged patients in two group(Figl-7),but the old patients group did differ significantly(Figl-8).And the target tumor deactivation or not differ significantly in terms of overall survival(P=0.000).Target tumor deactivation rates were 58.3%(42/72)?31.8%(14/44),respectively,and the two groups did not differ significantly in terms of target tumor deactivation(P=0.005).The recurrent rate after tumor deactivation were 52.4%(22/42),50%(6/14),respectively.There was no complication happened in both 2 groups.For the adverse reactions,18 patients had intra-operative/postoperative pain(8.3%),14 patients had fever(19.4%)and no emesis in the T-P group.8 patients had intra-operative/postoperative pain(22.3%),18 fever(40.9%)and 4 patients had emesis in the T-M group(P=0.009).For the causes of death,29 patients died of liver failure(40.3%),7 esophageal variceal bleeding(9.7%),3 extra-hepatic metastasis(4.2%),1 myocardial infarction(1.4%)and 1 large hemorrhage in liver transplantation after target tumor deactivation(1.4%)in the T-P group.26 patients died of liver failure(59.1%),2 lung metastasis(4.5%),2 multiple organ failure(4.5%)in the T-M group;Conclusions1.TACE plus PTCLI treatment and TACE plus MWA for solitary large HCCs are safe and effective.2.The clinical efficacy of TACE plus PTCLI treatment for solitary large HCCs is superior to TACE plus MWA in old patients(?60 years),and the former group has lower adverse reaction rates.So it can be spread used.TACE plus PTCLI can be a preferential option?TACE plus PTCLI can prolong survival,especially for the old patients.3.The 2 groups did not differ significantly in the term of tumor recurrence in situ after the target tumor deactivation.The major death cause of patients with solitary large HCC is liver failure and the related complications caused by tumor progression in liver.and it is also the major factors which influence the patient's overall survival.4.There was no complication happened in both 2 groups,Both TACE plus MWA or TACE plus PTCLI treatment for solitary large HCCs are safe and effective.But the adverse reaction rate in TACE plus PTCLI is lower. |
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