Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.
BMC Cancer. 2018 Jun 7;18(1):643. doi: 10.1186/s12885-018-4557-5.
The optimal therapeutic strategy in UICC stage T3 hepatocellular carcinoma (HCC) patients that maximizes both safety and long-term outcome has not yet been determined. Our aim was to compare clinical outcomes following hepatic resection (HR) versus transarterial chemoembolization (TACE) for stage T3 HCC.
From 2005 to 2013, 1179 patients with T3 HCC who underwent HR or TACE were divided into two groups, HR group (n = 280) or TACE group (n = 899). The clinical outcomes were compared before and after propensity score matching.
The propensity model matched 244 patients in each group for further analyses. After matching, medium overall survival (OS), 1, 3, and 5-year OS rates in TACE group were 11.8 (95%CI, 9.9-13.7) months, 49.6, 16.5, and 8.4%, respectively; which in HR group were 17.8 (95% CI, 14.8-20.8) months, 63.1, 33.3, and 26.4%, respectively; (log rank = 19.908, P < 0.01). Patients in HR group were more likely to develop pleural effusion, compared with those in TACE group (0.4% vs. 5.3%, P = 0.01). However, no significant differences in other adverse events (AEs) were found between two groups. Similar results were also demonstrated prior to the matched analysis. Multivariate analysis indicated that prothrombin time (PT), tumor size, tumor numbers, UICC staging status, and initial treatment were independent prognostic factors.
Our study revealed that TACE was an option for UICC T3 HCC patients. However, HR seemed to be safe and yield a survival benefit compared with TACE, especially for patients with a good underlying liver function.
在最大化安全性和长期疗效的前提下，UICC 分期 T3 肝细胞癌（HCC）患者的最佳治疗策略尚未确定。我们旨在比较肝切除术（HR）与经肝动脉化疗栓塞术（TACE）治疗 T3 HCC 的临床结局。
2005 年至 2013 年间，1179 例 T3 HCC 患者分别行 HR 或 TACE 治疗，分为 HR 组（n=280）和 TACE 组（n=899）。比较两组患者治疗前后的临床结局。
倾向评分匹配后，每组各匹配 244 例患者进行进一步分析。匹配后，TACE 组患者的中位总生存期（OS）、1、3 和 5 年 OS 率分别为 11.8（95%CI，9.9-13.7）个月、49.6%、16.5%和 8.4%，HR 组患者分别为 17.8（95%CI，14.8-20.8）个月、63.1%、33.3%和 26.4%（log rank=19.908，P<0.01）。HR 组患者发生胸腔积液的比例（0.4%）显著低于 TACE 组（5.3%）（P=0.01），但两组患者其他不良反应（AE）的发生率无显著差异。在匹配分析之前，也得到了相似的结果。多因素分析表明，凝血酶原时间（PT）、肿瘤大小、肿瘤数量、UICC 分期和初始治疗是独立的预后因素。
本研究表明 TACE 是治疗 UICC T3 HCC 患者的一种选择，但 HR 似乎比 TACE 更安全且生存获益更大，尤其是对于肝功能良好的患者。
