Zhang Yingqiang, Huang Guihua, Wang Yu, Liang Lijian, Peng Baogang, Fan Wenzhe, Yang Jianyong, Huang Yonghui, Yao Wang, Li Jiaping
Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Oncologist. 2016 Dec;21(12):1442-1449. doi: 10.1634/theoncologist.2016-0094. Epub 2016 Aug 2.
This study evaluated long-term outcomes of salvage surgery as additional therapy following downstaging of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) in patients with initially unresectable HCC.
A retrospective analysis was performed of 831 consecutive patients with unresectable HCC who underwent TACE as initial treatment between June 2004 and December 2014. Of these, 82 patients with downstaged resectable HCC were enrolled in this study: 43 received salvage surgery (S group) and the remaining 39, who refused salvage resection, were the control group (T group). The primary endpoint was overall survival (OS).
The median OS in the S and T groups was 49 and 31 months, respectively (p = .027). The 2-, 4-, and 5-year survival rates were 93%, 47%, and 26% in the S group and 74%, 18%, and 10% in the T group, respectively (p = .019). Treatment modality (hazard ratio [HR], 0.337; 95% confidential interval [CI], 0.184-0.616; p < .001) and response to TACE (complete vs. partial; HR, 3.154; 95% CI, 1.709-5.822; p < .001) were independent prognostic factors for survival. The median OS for patients in the complete response and partial response (PR) subgroups was 50 and 49 months, respectively, in the S group and 54 and 24 months, respectively, in the T group (p = .699 and p < .001, respectively). The median OS for HCC patients with macroscopic vascular invasion (MVI) was 58 and 30 months in the S and T groups, respectively (p = .024).
Salvage surgery after downstaging of unresectable HCC had a survival benefit only for patients with MVI or a PR to TACE.
The results of this study suggest that salvage liver resection after downstaging of unresectable hepatocellular carcinoma in patients with a complete response to transarterial chemoembolization (TACE) has a comparable long-term outcome in this good-prognosis group. Salvage liver resection may provide a better long-term outcome compared with TACE alone, but only in patients with macroscopic vascular invasion or those with a partial response to TACE.
本研究评估了对于初始不可切除的肝细胞癌（HCC）患者，经动脉化疗栓塞术（TACE）使肿瘤降期后，挽救性手术作为额外治疗的长期疗效。
对2004年6月至2014年12月期间连续接受TACE作为初始治疗的831例不可切除HCC患者进行回顾性分析。其中，82例降期后可切除的HCC患者纳入本研究：43例接受了挽救性手术（S组），其余39例拒绝挽救性切除，为对照组（T组）。主要终点为总生存期（OS）。
S组和T组的中位OS分别为49个月和31个月（p = 0.027）。S组的2年、4年和5年生存率分别为93%、47%和26%，T组分别为74%、18%和10%（p = 0.019）。治疗方式（风险比[HR]，0.337；95%置信区间[CI]，0.184 - 0.616；p < 0.001）和对TACE的反应（完全缓解与部分缓解；HR，3.154；95% CI，1.709 - 5.822；p < 0.001）是生存的独立预后因素。S组完全缓解和部分缓解（PR）亚组患者的中位OS分别为50个月和49个月，T组分别为54个月和24个月（分别为p = 0.699和p < 0.001）。S组和T组中伴有肉眼可见血管侵犯（MVI）的HCC患者的中位OS分别为58个月和30个月（p = 0.024）。
不可切除HCC降期后的挽救性手术仅对伴有MVI或对TACE有PR的患者有生存获益。
本研究结果表明，对于经动脉化疗栓塞术（TACE）完全缓解的不可切除肝细胞癌患者，降期后的挽救性肝切除术在这个预后良好的组中具有相当的长期疗效。与单纯TACE相比，挽救性肝切除术可能提供更好的长期疗效，但仅适用于伴有肉眼可见血管侵犯或对TACE有部分反应的患者。
