Initial Trans-Arterial Chemo-Embolisation (TACE) Is Associated with Similar Survival Outcomes as Compared to Upfront Percutaneous Ablation Allowing for Follow-Up Treatment in Those with Single Hepatocellular Carcinoma (HCC) ≤ 3 cm: Results of a Real-World Propensity-Matched Multi-Centre Australian Cohort Study

被引：0

作者：

Abdelmalak, Jonathan ^{[1
,2
,3
]}

Strasser, Simone I. ^{[4
]}

Ngu, Natalie L. ^{[4
]}

Dennis, Claude ^{[4
]}

Sinclair, Marie ^{[3
]}

Majumdar, Avik ^{[3
]}

Collins, Kate ^{[3
]}

Bateman, Katherine ^{[3
]}

Dev, Anouk ^{[5
]}

Abasszade, Joshua H. ^{[5
]}

Valaydon, Zina ^{[6
]}

Saitta, Daniel ^{[6
]}

Gazelakis, Kathryn ^{[6
]}

Byers, Susan ^{[6
]}

Holmes, Jacinta ^{[7
,8
]}

Thompson, Alexander J. ^{[7
,8
]}

Howell, Jessica ^{[7
,8
]}

Pandiaraja, Dhivya ^{[7
]}

Bollipo, Steven ^{[9
]}

Sharma, Suresh ^{[9
]}

Joseph, Merlyn ^{[9
]}

Sawhney, Rohit ^{[10
,11
]}

Nicoll, Amanda ^{[10
,11
]}

Batt, Nicholas ^{[10
]}

Tang, Myo J. ^{[1
]}

Riordan, Stephen ^{[12
]}

Hannah, Nicholas ^{[13
]}

Haridy, James ^{[13
]}

Sood, Siddharth ^{[13
]}

Lam, Eileen ^{[2
,14
]}

Greenhill, Elysia ^{[2
,14
]}

Lubel, John ^{[1
,2
]}

Kemp, William ^{[1
,2
]}

Majeed, Ammar ^{[1
,2
]}

Zalcberg, John ^{[14
,15
]}

Roberts, Stuart K. ^{[1
,2
]}

机构：

[1] Alfred Hlth, Dept Gastroenterol, Melbourne, Vic 3004, Australia

[2] Monash Univ, Sch Translat Med, Dept Med, Melbourne, Vic 3004, Australia

[3] Austin Hosp, Dept Gastroenterol, Heidelberg, Vic 3084, Australia

[4] Royal Prince Alfred Hosp, AW Morrow Gastroenterol & Liver Ctr, Camperdown, NSW 2050, Australia

[5] Monash Hlth, Dept Gastroenterol, Clayton, Vic 3168, Australia

[6] Western Hlth, Dept Gastroenterol, Footscray, Vic 3011, Australia

[7] St Vincents Hosp Melbourne, Dept Gastroenterol, Fitzroy, Vic 3065, Australia

[8] Univ Melbourne, St Vincents Hosp Melbourne, Dept Med, Parkville, Vic 3052, Australia

[9] John Hunter Hosp, Dept Gastroenterol, New Lambton Hts, NSW 2305, Australia

[10] Eastern Hlth, Dept Gastroenterol, Box Hill, Vic 3128, Australia

[11] Eastern Hlth Clin Sch, Dept Med, Box Hill, Vic 3128, Australia

[12] Prince Wales Hosp, Dept Gastroenterol, Randwick, NSW 2031, Australia

[13] Royal Melbourne Hosp, Dept Gastroenterol, Parkville, Vic 3052, Australia

[14] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic 3004, Australia

[15] Alfred Hlth, Dept Med Oncol, Melbourne, Vic 3004, Australia

来源：

CANCERS | 2024年 / 16卷 / 17期

关键词：

hepatocellular carcinoma; single; small; early; ablation; TACE; BODY RADIATION-THERAPY; TRANSARTERIAL CHEMOEMBOLIZATION; RADIOFREQUENCY ABLATION;

D O I：

10.3390/cancers16173010

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 test p = 0.652) or liver-related survival (log-rank test p = 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 test p = 0.355 and p = 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.

引用

页数：31

共 1 条

[1] Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study
Abdelmalak, Jonathan
Strasser, Simone I.
Ngu, Natalie
Dennis, Claude
Sinclair, Marie
Majumdar, Avik
Collins, Kate
Bateman, Katherine
Dev, Anouk
Abasszade, Joshua H.
Valaydon, Zina
Saitta, Daniel
Gazelakis, Kathryn
Byers, Susan
Holmes, Jacinta
Thompson, Alexander J.
Pandiaraja, Dhivya
Bollipo, Steven
Sharma, Suresh
Joseph, Merlyn
Nicoll, Amanda
Batt, Nicholas
Sawhney, Rohit
Tang, Myo J.
Lubel, John
Riordan, Stephen
Hannah, Nicholas
Haridy, James
Sood, Siddharth
Lam, Eileen
Greenhill, Elysia
Majeed, Ammar
Kemp, William
Zalcberg, John
Roberts, Stuart K.
CANCERS, 2023, 15 (24)

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