氩氦刀冷冻消融与经动脉化疗栓塞联合仑伐替尼治疗不可切除肝细胞癌的疗效与安全性比较OA

Objective To compare the efficacy and safety of argon-helium cryoablation(CRYO)combined with lenvatinib(LEN)and transarterial chemoembolization(TACE)combined with LEN in the treatment of unresectable hepatocellular carcinoma(uHCC).Methods This was a retrospective cohort study.A total of 234 patients with uHCC admitted to the Hepatology Medical Center of Chinese PLA General Hospital from May 2020 to March 2023 were enrolled,including 107 patients treated with TACE+LEN(TACE+LEN group)and 127 patients treated with CRYO+LEN(CRYO+LEN group).A 1:1 propensity score matching(PSM)was used to balance baseline characteristics,and 192 patients were finally enrolled.Study endpoints included overall survival(OS),progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),and adverse events(AEs).Survival differences were analyzed using Kaplan-Meier method,and independent prognostic factors were screened using Cox regression and LASSO regression analyses.Results After PSM,baseline characteristics were well balanced between the two groups(P>0.05).Of the 192 patients,178(92.7%)were male,182(94.8%)had liver cirrhosis,149(77.6%)were Child-Pugh class A,and 130(67.7%)were at Barcelona Clinic Liver Cancer(BCLC)stage C.No significant differences were observed between CRYO+LEN and TACE+LEN groups in median OS(24.2 months vs.22.0 months,HR=1.10,P=0.635),median PFS(8.7 months vs.11.9 months,HR=0.89,P=0.477),ORR(53.1%vs.53.1%,P=1.000),or DCR(78.1%vs.86.5%,P=0.186).Multivariate Cox regression analysis identified hepatitis B virus(HBV)infection(HR=0.231,P=0.014),Child-Pugh class(HR=1.757,P=0.017),maximum tumor diameter(HR=1.908,P=0.003),and subsequent anti-programmed cell death protein-1(PD-1)therapy(HR=0.652,P=0.045)as independent factors influencing OS.CRYO+LEN group had higher incidences of pleural effusion(6.2%vs.0%,P=0.038)and skin frostbite(8.3%vs.0%,P=0.011),while TACE+LEN group was more prone to abdominal pain(7.3%vs.0%,P=0.021)and non-infectious fever(24%vs.5.2%,P=0.001).There were no significant differences in other AEs between the two groups(P>0.05).Conclusions CRYO combined with LEN demonstrates similar clinical benefits and manageable safety profiles to TACE combined with LEN in the treatment of uHCC,providing an effective alternative therapeutic option for patients unsuitable for TACE.