The Efficacy Of Combination Treatment Of Transarterial Chemoembolization With Iodine 125 Seeds Implantation For Early-intermediate Hepatocellular Carcinoma

Objective: To analyze the efficacy of combination treatment of transarterial chemoembolization(TACE)with iodine 125 seeds implantation in the treatment of early and intermediate(Barcelona Clinic Liver Cancer A and B,BCLC A and B)hepatocellular carcinoma(HCC),and compare with the combination treatment of TACE with radiofrequency ablation(RFA).Methods: From January 2014 to May 2018,134 patients with early and intermediate HCC,who received the combination treatment of TACE with iodine 125 seeds implantation or TACE with RFA in our hospital were retrospectively analyzed,and the efficacy between the two groups were compared.Among them,47 patients received the combination treatment of TACE with iodine 125 seeds implantation and 87 patients received TACE with RFA.Before the operation of TACE,there was significant difference of the baseline characteristics TACE numbers,tumor numbers and BCLC stage.Then,the propensity score matching(PSM)analysis was used to reduced selection bias.The characteristics age,alanine aminotransferase(ALT),hemoglobin,platelets,lymphocyte,neutrophil,leukocyte,liver resection,gender,hepatitis B virus(HBV),alpha fetoprotein(AFP),TACE numbers,tumor numbers,tumor size,Child-Pugh class and BCLC stage were included PSM analysis.At last,47 pairs of patients were generated and included into follow-up statistical analysis.Results: Before PSM,there was no significant statistical difference of the median overall survival(OS),progression-free survival(PFS)and objective response rate(ORR)between patients with the treatment of TACE with RFA and TACE with iodine 125 seeds implantation(m OS: 42 months vs 37 months,P=0.551;m PFS: 18 months vs 15 months,P=0.526;ORR: 71.3% vs 74.5%,P=0.692).In the subgroup analysis,there was no significant difference of m OS(36 months vs 41 months;P=0.881)and m PFS(15 months vs 18 months;P=0.306)between the patients with the treatment of TACE with iodine 125 seeds implantation and TACE with RFA who did not receive liver resection before being included in the study.After adjusted for age,gender,liver resection,Child-Pugh,BCLC stage and AFP level,the patients with the treatment of TACE with iodine 125 seeds implantation had not higher risk of death(HR: 0.725;95%CI: 0.423,1.241,P=0.241)and risk of tumor recurrence(HR:1.008;95%CI: 0.666,1.526,P=0.969)than patients with TACE with RFA.After PSM,there was no significant statistical difference of m OS,m PFS and ORR between the patients with the treatment of TACE with iodine 125 seeds implantation and TACE with RFA(m OS: 37 months vs 41 months,P=0.535;m PFS: 15 months vs 17 months,P=0.848;ORR: 74.5% vs 66.7%,P=0.264).In the subgroup analysis,there was no significant difference of m OS(36 months vs 33 months;P=0.522)and m PFS(15 months vs 16 months;P=0.816)between the patients with the treatment of TACE with iodine 125 seeds implantation and TACE with RFA who did not receive liver resection before being included in the study.After adjusted for relevant factors,the treatment of TACE with iodine 125 seeds implantation did not increase the risk of death(HR: 0.860;95%CI: 0.477,1.552,P=0.618)and tumor recurrence(HR:1.319;95%CI: 0.829,2.099,P=0.243)of patients than the treatment of TACE with RFA.Conclusion: Early-intermediate HCC patients with the treatment of TACE with iodine 125 seeds implantation had similar survival benefit compared with patients with the treatment of TACE with RFA,and the treatment of TACE with iodine 125 seeds implantation did not increase the risk of death and tumor recurrence of patients.