title: Radiation Segmentectomy versus TACE Combined with Microwave Ablation for Unresectable Solitary Hepatocellular Carcinoma Up to 3 cm: A Propensity Score Matching Study.
abstract: Purpose To compare the outcomes of radiation segmentectomy (RS) and transarterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of unresectable solitary hepatocellular carcinoma (HCC) up to 3 cm. Materials and Methods This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. From January 2010 to June 2015, a total of 417 and 235 consecutive patients with HCC underwent RS and TACE MWA, respectively. A cohort of 121 patients who had not previously undergone local-regional therapy (RS, 41; TACE MWA, 80; mean age, 65.4 years; 84 men [69.4%]) and who had solitary HCC up to 3 cm without vascular invasion or metastasis was retrospectively identified. Outcomes analyzed included procedure-related complications, laboratory toxicity levels, imaging response, time to progression (TTP), 90-day mortality, and survival. Propensity score matching was conducted by using a nearest-neighbor algorithm (1:1) to account for pretreatment clinical, laboratory, and imaging covariates. Postmatching statistical analysis was performed with conditional logistic regression for binary outcomes and the stratified log-rank test for time-dependent outcomes. Results Before matching, the complication rate was 8.9% and 4.9% in the TACE MWA and RS groups, respectively (P = .46). The overall complete response (CR) rate was 82.9% for RS and 82.5% for TACE MWA (odds ratio, 1.0; 95% confidence interval [CI]: 0.4, 2.8; P = .95). There were 41 (RS, 11; TACE MWA, 30) instances of progression occurring after an initial CR, of which 10 (24%) were classified as target progression (RS, one; TACE MWA, nine). Median overall TTP was 11.1 months (95% CI: 8.8 months, 25.6 months) in the RS group and 12.1 months (95% CI: 7.7 months, 19.1 months) in the TACE MWA group (P > .99). After matching, the overall CR rate (P = .94), TTP (P = .83), and overall survival (P > .99) were not significantly different between the two groups. The 90-day postoperative mortality rate was 0% in both groups. Conclusion Imaging response and progression outcomes of patients with solitary HCC up to 3 cm treated with RS were not significantly different when compared with those of patients treated with TACE MWA.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Biederman
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Titano
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Vivian L
authors.initials: VL
authors.lastname: Bishay
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Raisa J
authors.initials: RJ
authors.lastname: Durrani
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Etan
authors.initials: E
authors.lastname: Dayan
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Nora
authors.initials: N
authors.lastname: Tabori
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Francis S
authors.initials: FS
authors.lastname: Nowakowski
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
authors.affiliation: From the Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave, MC Level, New York, NY 10029-6574.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies