| Objective The aim of this study was to investigate whether the short-term efficacy and safety of transhepatic artery chemoembolization(TACE)combined with radiofrequency ablation(RFA)was superior to TACE alone in the treatment of primary liver cancer(PLC)at stage Ⅰa-Ⅱa of Chinese hepatocellular carcinoma stage(CNLC),and to analyze it using propensity score matching(PSM).Methods The clinical data of 180 patients with primary hepatocellular carcinoma diagnosed as CNLC stage Ⅰa-Ⅱa in Ning Xia Medical University General Hospital between01/01/2018 and 01/02/2022 who met the inclusion criteria were included in this study.The patients were divided into two groups according to the differences in treatment: 62 patients in the combination group(TACE combined with RFA)and 118 patients in the simple group(TACE alone).General clinical data,laboratory indices,number of lesions,lesion size,lesion location,and CNLC stage were collected from patients admitted to both groups.Using the modified efficacy evaluation criteria for solid tumors(m RECIST),the treatment effects of patients in both groups were evaluated at 1,3,and 6 months,and the objective remission rate(ORR)and disease control rate(DCR)were compared and analyzed;the changes of liver function indexes(TBIL,AST,ALT)and serum alpha-fetoprotein(AFP)before and after treatment were observed in both groups,and the were compared;the postoperative adverse reactions and postoperative hospitalization time of the two groups were recorded and analyzed.There were significant differences(P<0.05)in CNLC staging,hemoglobin(HGB),and gamma-glutamyl transpeptidase(GGT)among the preoperative baseline value variables between the two groups,and to reduce selective bias,PSM was used to balance the baseline value variables between the two groups in this study,and a total of 46 matched pairs of patients were obtained for follow-up analysis after including the preoperative baseline value variables in the propensity score matching.Results A total of 180 patients were analyzed,including 62 patients in the TACE combined with RFA group and 118 patients in the TACE alone group,and a total of 46 pairs of patients were included in the analysis after the application of PSM.1.Before PSM:(1)short-term efficacy: the efficacy of the two groups was evaluated after 1 month of treatment;the CR,PR,SD and PD of the combined group were 74.2%,4.8%,16.1% and 4.8%,respectively;compared with the CR,PR,SD and PD of the simple group were 45.8%,21.2%,29.7% and 3.4%,respectively;there was a significant differences between the two groups(P=0.000,P=0.004,P=0.046);the combination group had higher CR and lower PR and SD: 74.2% vs 45.8%,4.8% vs 21.2%,16.1% vs 29.7%;assessing the efficacy of the two groups after 3 months of treatment,the CR,PR,SD and PD in the combination group were 69.4%,6.5%,16.1%,8.1%;compared with 38.3%,21.7%,28.7%,11.3% in the simple group CR,PR,SD,PD,respectively,there was a statistically significant difference between the CR,PR and ORR of the two groups(P=0.000,P=0.009,P=0.035);evaluating the two groups of patients after 6 months of treatment,the combined group CR,PR,SD,and PD were 58.3%,8.3%,20.0%,and 13.3%,respectively;compared with 33.9%,18.8%,25.0%,and 22.3% in the simple group,respectively,there was a significant difference in CR between the two groups of patients(P=0.002).(2)AFP decreased in both groups after one month of treatment,and there was a significant difference(P=0.000),and there was a statistically significant difference(P=0.023)in postoperative AFP levels between the groups comparing the two groups,and the combined group had lower AFP levels relative to the simple group: 6.4200(2.8325,14.8900)ng/m L vs.11.2800(3.9325.(67.4750)ng/m L.(3)At 1week postoperatively,TBIL,AST,and ALT were increased in both groups to different degrees(P<0.05),and the increase of AST and ALT in the combined group was significantly higher than that in the simple group,and there was a statistically significant postoperative comparison between the two groups;at 1 month postoperatively,the levels of TBIL and AST in the combined group in both groups were basically the same as those before surgery(P>0.05)In contrast,the levels of serum ALT in both groups and serum AST in the control group were significantly lower than those before surgery(P<0.05),and the difference between the groups was not significant(P>0.05).(4)There was no event of death due to treatment in both the combined group and the simple group.The adverse effects nausea and vomiting were statistically different between the two groups(P=0.011),with the combined group having a smaller incidence of nausea and vomiting(6.45% vs.21.19%).(5)The number of postoperative hospital days was similar in both groups(P>0.05).2.After PSM:(1)To assess the efficacy of the two groups of patients after 1 month of treatment,the CR,PR,SD,and PD in the combined group were: 71.7%,6.5%,17.4%,and4.3%,respectively;compared to the CR,PR,SD,and PD in the simple group: 43.5%,17.4%,37.0%,and 2.2%,respectively,with statistically significant differences between the two groups of patients in CR and SD(P =0.006,P=0.035),with higher CR and lower SD in the combined group: 71.7% vs 43.5%,17.4% vs 37.0%;assessing the efficacy of the two groups after 3 months of treatment,the CR,PR,SD,and PD in the combined group were: 65.2%,8.7%,17.4%,and 8.7%,respectively;comparing the CR,PR,SD,and PD were: 35.6%,15.6%,31.1%,17.8%,respectively,with statistical differences between the CR and ORR of patients in the two groups(P=0.005,P=0.025);evaluating patients in both groups after 6months of treatment,CR,PR,SD,PD in the combined group were: 52.3%,11.4%,22.7%,13.6%,respectively;comparing the simple group CR,PR,SD,and PD were: 34.1%,13.6%,29.5%,and 22.7%,respectively,with no significant difference between the two groups(P>0.05).(2)Patients in the study group had a statistically significant decrease in AFP 1month after treatment with statistical significance(P=0.000).(3)The total bilirubin,AST and ALT of liver function indexes in both groups increased to a certain extent within 1 week after surgery,and the difference was statistically significant(P<0.05),and there was a significant difference between the two groups at 1 week after surgery(P<0.05),and the AST and ALT in the combined group were higher than those in the simple group;there was no significant difference between the TBIL and AST of patients in both groups at 1 month after surgery compared with those before surgery(P> 0.05),and the ALT level in the two groups was significantly lower than that before surgery(P<0.05);the difference between the two groups was not significant(P>0.05).(4)There was no significant difference between the two groups in terms of adverse reactions such as abdominal pain,nausea and vomiting,fever and abdominal distension(P>0.05).(5)There was no difference in the length of hospital stay after treatment between the two groups(P>0.05).Conclusion1.TACE combined with RFA for patients with CNLC stage Ⅰa-Ⅱa primary hepatocellular carcinoma showed good short-term efficacy,with a high complete remission rate at 1 month postoperatively and a better complete remission rate and objective remission rate at 3 months postoperatively than with TACE alone;however,the long-term efficacy is not definite.2.The combined group could reduce the level of alpha-fetoprotein(AFP)more effectively at 1 month after surgery.3.TACE combined with RFA for CNLC stage Ⅰa-Ⅱa primary hepatocellular carcinoma can cause higher degree of liver function impairment in the short term relative to TACE treatment alone,but liver function can recover or improve 1 month after surgery,and compared with single TACE treatment,it will not increase the occurrence of adverse effects and postoperative hospitalization days,and the treatment safety is high. |
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