Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Cancer Med. 2019 Apr;8(4):1530-1539. doi: 10.1002/cam4.2038. Epub 2019 Mar 12.
The role of transarterial chemoembolization (TACE) as the standard treatment for intermediate-stage hepatocellular carcinoma (HCC) is being challenged by increasing studies supporting liver resection (LR); but evidence of survival benefits of LR is lacking. We aimed to compare the overall survival (OS) of LR with that of TACE for the treatment of intermediate-stage HCC in cirrhotic patients.
A Markov model, comparing LR with TACE over 15 years, was developed based on the data from 31 literatures. Additionally, external validation of the model was performed using a data set (n = 1735; LR: 701; TACE: 1034) from a tertiary center with propensity score matching method. We conducted one-way and two-way sensitivity analyses, in addition to a Monte Carlo analysis with 10 000 patients allocated into each arm.
The mean expected survival times and survival rates at 5 years were 77.8 months and 47.1% in LR group, and 48.6 months and 25.7% in TACE group, respectively. Sensitivity analyses found that initial LR was the most favorable treatment. The 95% CI for the difference in OS was 2.42-2.46 years between the two groups (P < 0.001). In the validation set, the 5-year survival rates after LR were significantly better than those after TACE before (40.2% vs. 25.9%, P < 0.001) and after matching (43.2% vs 30.9%, P < 0.001), which was comparable to the model results.
For cirrhotic patients with resectable intermediate-stage HCC, LR may provide survival benefit over TACE, but large-scale studies are required to further stratify patients at this stage for different optimal treatments.
越来越多的研究支持肝切除术（LR）作为中晚期肝细胞癌（HCC）的标准治疗方法，这对经动脉化疗栓塞术（TACE）的作用提出了挑战；但是缺乏 LR 生存获益的证据。我们旨在比较 LR 和 TACE 治疗肝硬化患者中晚期 HCC 的总生存期（OS）。
基于 31 项文献数据，建立了一个比较 LR 和 TACE 在 15 年内的 Markov 模型。此外，使用来自一家三级中心的数据（n=1735；LR：701；TACE：1034）通过倾向评分匹配方法对模型进行外部验证。我们进行了单因素和双因素敏感性分析，以及一项在每个治疗组分配 10000 名患者的 Monte Carlo 分析。
LR 组的平均预期生存时间和 5 年生存率分别为 77.8 个月和 47.1%，TACE 组分别为 48.6 个月和 25.7%。敏感性分析发现，初始 LR 是最有利的治疗方法。两组 OS 差异的 95%CI 为 2.42-2.46 年（P<0.001）。在验证组中，LR 后的 5 年生存率明显优于 TACE 治疗前（40.2% vs. 25.9%，P<0.001）和匹配后（43.2% vs. 30.9%，P<0.001），与模型结果相当。
对于可切除的中晚期 HCC 肝硬化患者，LR 可能比 TACE 提供生存获益，但需要进行大规模研究，进一步对这一阶段的患者进行分层，以确定不同的最佳治疗方法。
