肿瘤大小影响伴有微血管侵犯的肝细胞癌患者辅助经动脉化疗栓塞的疗效。
Tumor Size Affects Efficacy of Adjuvant Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Microvascular Invasion.
机构信息
Department of Liver Surgery, Liver Cancer Institute and Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Fudan University, Shanghai, People's Republic of China.
Department of Liver Surgery, Liver Cancer Institute and Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Fudan University, Shanghai, People's Republic of China
出版信息
Oncologist. 2019 Apr;24(4):513-520. doi: 10.1634/theoncologist.2018-0305. Epub 2018 Dec 14.
BACKGROUND
Patients with hepatocellular carcinoma (HCC) and microvascular invasion (mVI) have shown dismal postoperative prognosis; however, whether adjuvant transarterial chemoembolization (TACE) can improve their outcomes remains unclear.
MATERIALS AND METHODS
We retrospectively identified 549 eligible patients to form the crude cohort and adopted propensity score matching method to assemble another cohort of 444 patients with similar baseline characteristics. We assessed the effects of adjuvant TACE by stratified analyses and multivariate Cox analyses in two cohorts.
RESULTS
There was significant interaction between tumor size and adjuvant TACE with respect to overall survival (OS; = .006 for interaction). In the matched cohort, patients who received adjuvant TACE showed higher rates of 5-year OS (72.4% vs. 50.9%, = .005) and 5-year recurrence-free survival (50.5% vs. 36.4%, = .003) in the tumor ≤5 cm subgroup, but not in the tumor >5 cm subgroup (32.3% vs. 24.9%, = .350 and 18.8% vs. 19.7%, = .180). The independent protective role of adjuvant TACE on OS was observed in patients with tumor ≤5 cm (adjusted odds ratio [OR] = 0.59, 95% confidence interval [CI] 0.36-0.97) but not in patients with tumor >5 cm (adjusted OR = 1.17, 95% CI 0.84-1.62). The effects of adjuvant TACE did not change materially while the analysis was performed in the crude cohort.
CONCLUSION
For patients with HCC and mVI, adjuvant TACE was associated with improved outcomes, but not for those with tumor >5 cm, according to the current protocol.
IMPLICATIONS FOR PRACTICE
The outcomes of patients with hepatocellular carcinoma and microvascular invasion who received adjuvant transarterial chemoembolization were inconsistent in this study. According to the current protocol, adjuvant transarterial chemoembolization was associated with improved prognosis in patients with microvascular invasion, except for those with tumor >5 cm. Multivariate Cox models confirmed adjuvant transarterial chemoembolization was an independent protective factor in the tumor ≤5 cm subgroup but not in the tumor >5 cm subgroup.
背景
患有肝细胞癌（HCC）和微血管侵犯（mVI）的患者术后预后较差；然而，辅助经动脉化疗栓塞（TACE）是否能改善其预后尚不清楚。
材料和方法
我们回顾性地确定了 549 名符合条件的患者组成粗队列，并采用倾向评分匹配方法将另一组 444 名具有相似基线特征的患者组成匹配队列。我们通过分层分析和多变量 Cox 分析评估了辅助 TACE 的效果。
结果
在两个队列中，肿瘤大小与辅助 TACE 之间存在显著的交互作用，总生存（OS）方面的交互作用（P=.006）。在匹配队列中，在肿瘤≤5cm 亚组中，接受辅助 TACE 的患者 5 年 OS（72.4%比 50.9%，P=.005）和 5 年无复发生存率（50.5%比 36.4%，P=.003）更高，但在肿瘤>5cm 亚组中并非如此（32.3%比 24.9%，P=.350 和 18.8%比 19.7%，P=.180）。在肿瘤≤5cm 的患者中，辅助 TACE 对 OS 的独立保护作用是观察到的（调整后的优势比[OR] = 0.59，95%置信区间[CI] 0.36-0.97），而在肿瘤>5cm 的患者中则不然（调整后的 OR = 1.17，95% CI 0.84-1.62）。当在粗队列中进行分析时，辅助 TACE 的效果没有实质性变化。
结论
根据目前的方案，对于患有 HCC 和 mVI 的患者，辅助 TACE 与改善结局相关，但对于肿瘤>5cm 的患者则不然。
意义
本研究中，接受辅助经动脉化疗栓塞的肝细胞癌伴微血管侵犯患者的结局不一致。根据目前的方案，辅助经动脉化疗栓塞与微血管侵犯患者的预后改善相关，但肿瘤>5cm 患者除外。多变量 Cox 模型证实，辅助 TACE 在肿瘤≤5cm 亚组中是一个独立的保护因素，但在肿瘤>5cm 亚组中则不是。
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