伴有微血管侵犯的HBV相关肝细胞癌的最佳术后辅助治疗策略：一项倾向评分分析
Optimal postoperative adjuvant treatment strategy for HBV-related hepatocellular carcinoma with microvascular invasion: a propensity score analysis.
作者信息
Wang Liming, Chen Bo, Li Zhuo, Yao Xuesong, Liu Mei, Rong Weiqi, Wu Fan, Lin Shengtao, Liu Yunhe, Zheng Yiling, Li Yexiong, Wang Weihu, Wu Jianxiong
机构信息
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Onco Targets Ther. 2019 Feb 15;12:1237-1247. doi: 10.2147/OTT.S179247. eCollection 2019.
BACKGROUND
Microvascular invasion (MVI) is the most important risk factor associated with early postoperative recurrence in patients with hepatocellular carcinoma (HCC). However, the efficacy of postoperative adjuvant treatment for preventing recurrence in HCC patients with MVI has not been assessed. This study investigated the efficacy of postoperative adjuvant radiotherapy (RT) and transcatheter arterial chemoembolization (TACE) in HCC patients with MVI.
MATERIALS AND METHODS
From July 2008 to December 2016, 117 hepatitis B virus (HBV)-related HCC patients with MVI were retrospectively divided into two groups based on postoperative adjuvant treatments. Propensity score matching (PSM) was performed to adjust for significant differences in baseline characteristics. Relapse-free survival (RFS) and overall survival (OS) of the two groups were analyzed before and after PSM.
RESULTS
Of all patients, the RT group had significantly smaller tumor size and milder MVI classification. PSM analysis created 46 pairs of patients. After matching, the two groups of patients were similar in baseline characteristics. Multivariate analysis indicated that tumor size, MVI classification, and postoperative treatment strategies were independently associated with RFS; tumor size and MVI classification were independently associated with OS. Similar multivariate analysis results were demonstrated after matching propensity score. Survival analysis revealed that the estimated median RFS and OS of patients with RT and TACE were 25.74±8.12 vs 9.18±1.67 months (=0.003) and 60.69±7.36 vs 36.53±5.34 months (=0.262), respectively. The RT group had significantly longer RFS than the TACE group.
CONCLUSION
Postoperative adjuvant RT offers better RFS for HCC patients with MVI than TACE.
背景
微血管侵犯（MVI）是肝细胞癌（HCC）患者术后早期复发的最重要危险因素。然而，对于伴有MVI的HCC患者，术后辅助治疗预防复发的疗效尚未得到评估。本研究探讨了术后辅助放疗（RT）和经动脉化疗栓塞术（TACE）对伴有MVI的HCC患者的疗效。
材料与方法
2008年7月至2016年12月，117例乙型肝炎病毒（HBV）相关的伴有MVI的HCC患者根据术后辅助治疗方法回顾性分为两组。采用倾向评分匹配（PSM）来调整基线特征的显著差异。对两组患者在PSM前后的无复发生存期（RFS）和总生存期（OS）进行分析。
结果
在所有患者中，RT组的肿瘤尺寸明显更小，MVI分级更轻。PSM分析产生了46对患者。匹配后，两组患者的基线特征相似。多因素分析表明，肿瘤尺寸、MVI分级和术后治疗策略与RFS独立相关；肿瘤尺寸和MVI分级与OS独立相关。倾向评分匹配后显示了相似的多因素分析结果。生存分析显示，RT组和TACE组患者的估计中位RFS分别为25.74±8.12个月和9.18±1.67个月（=0.003），估计中位OS分别为60.69±7.36个月和36.53±5.34个月（=0.262）。RT组的RFS明显长于TACE组。
结论
对于伴有MVI的HCC患者，术后辅助RT比TACE提供更好的RFS。
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