术后辅助索拉非尼可改善 R0 肝切除术后伴微血管侵犯的肝细胞癌患者的生存结局：倾向评分匹配分析。
Postoperative adjuvant sorafenib improves survival outcomes in hepatocellular carcinoma patients with microvascular invasion after R0 liver resection: a propensity score matching analysis.
机构信息
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Department of Molecular Diagnosis, Clinical Medical College, Yangzhou University, Yangzhou, China.
出版信息
HPB (Oxford). 2019 Dec;21(12):1687-1696. doi: 10.1016/j.hpb.2019.04.014. Epub 2019 May 29.
BACKGROUND
Microvascular invasion (MVI) is a major determinant of survival outcome for hepatocellular carcinoma (HCC). This study aimed to investigate the efficacy of postoperative adjuvant Sorafenib (PA-Sorafenib) in HCC patients with MVI after R0 liver resection (LR).
METHODS
The data of patients who underwent R0 LR for HCC with histologically confirmed MVI at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. The survival outcomes for patients who underwent PA-Sorafenib were compared with those who underwent R0 LR alone. Propensity score matching (PSM) analysis was performed.
RESULTS
728 HCC patients had MVI in the resected specimens after R0 resection, with 581 who underwent LR alone and 147 patients who received in additional adjuvant sorafenib. PSM matched 113 patients in each of these two groups. The overall survival (OS) and recurrence free survival (RFS) were significantly better for patients in the PA-sorafenib group (for OS: before PSM, P = 0.003; after PSM, P = 0.007), (for RFS: before PSM, P = 0.029; after PSM, P = 0.001), respectively. Similar results were obtained in patients with BCLC 0-A, BCLC B and Child-Pugh A stages of disease.
CONCLUSIONS
PA-Sorafenib was associated with significantly better survival outcomes than LR alone for HCC patients with MVI.
背景
微血管侵犯（MVI）是肝癌（HCC）患者生存结果的主要决定因素。本研究旨在探讨索拉非尼术后辅助治疗（PA-Sorafenib）对 R0 肝切除（LR）后伴有 MVI 的 HCC 患者的疗效。
方法
回顾性分析东方肝胆外科医院经病理证实为 MVI 的 HCC 患者行 R0 LR 的资料。比较接受 PA-Sorafenib 治疗与单纯接受 R0 LR 治疗的患者的生存结果。采用倾向评分匹配（PSM）分析。
结果
728 例 HCC 患者在 R0 切除术后的标本中存在 MVI，其中 581 例接受单纯 LR 治疗，147 例接受额外的辅助索拉非尼治疗。PSM 将两组患者各匹配 113 例。PA-sorafenib 组的总生存期（OS）和无复发生存期（RFS）明显优于 LR 组（OS：PSM 前，P=0.003；PSM 后，P=0.007），（RFS：PSM 前，P=0.029；PSM 后，P=0.001）。在 BCLC 0-A、BCLC B 和 Child-Pugh A 期疾病患者中也得到了类似的结果。
结论
与单纯 LR 相比，PA-Sorafenib 可显著改善伴有 MVI 的 HCC 患者的生存结果。
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