经化疗栓塞术达到病理完全缓解可改善肝癌根治性手术后的生存结局：反应的预测因素。

Pathologic complete response to chemoembolization improves survival outcomes after curative surgery for hepatocellular carcinoma: predictive factors of response.

机构信息

Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea.

Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea.

出版信息

HPB (Oxford). 2019 Dec;21(12):1718-1726. doi: 10.1016/j.hpb.2019.04.017. Epub 2019 Jun 3.

DOI:10.1016/j.hpb.2019.04.017

PMID:31171489

Abstract

BACKGROUND

We identified the predictive factors and prognostic significance of transarterial chemoembolization (TACE) for achieving pathologic complete response (pCR) before curative surgery for hepatocellular carcinoma (HCC) in hepatitis B-endemic areas.

METHODS

Among 753 HCC patients treated with surgery, 124 patients underwent preoperative TACE before liver resection (LR), and 166 before liver transplantation (LT) between 2005 and 2016. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. Pathologic response (PR) was defined as the mean percentage of necrotic area, and pCR was defined as the absence of viable tumor.

RESULTS

A total of 34 (27%) and 38 (23%) patients had pCR before LR and LT, respectively. Alpha-fetoprotein (AFP) < 100 ng/mL and single tumor were significant preoperative predictors of pCR. OS and RFS were significantly improved in patients with pCR or a PR ≥ 90%, but not in patients with PR ≥ 50% after LR and LT. On multivariate analyses, PR ≥ 90% remained an independent predictor of better OS and RFS in LR and LT groups.

CONCLUSION

Overall, our data clearly demonstrate that pCR predicts favorable prognosis after curative surgery for HCC, and predictors of pCR are AFP <100 ng/mL and single tumor.

摘要

背景

我们确定了乙型肝炎流行地区经动脉化疗栓塞术（TACE）治疗对肝癌（HCC）患者根治性手术获得病理完全缓解（pCR）的预测因素及其预后意义。

方法

在接受手术治疗的 753 例 HCC 患者中，124 例在肝切除术（LR）前接受了术前 TACE，166 例在肝移植（LT）前接受了 TACE，时间范围为 2005 年至 2016 年。分析了总生存期（OS）和无复发生存期（RFS）。病理反应（PR）定义为坏死面积的平均值，pCR 定义为无存活肿瘤。

结果

LR 和 LT 前分别有 34（27%）和 38（23%）例患者达到 pCR。甲胎蛋白（AFP）<100ng/ml 和单肿瘤是 pCR 的显著术前预测因素。在 pCR 或 PR≥90%的患者中，OS 和 RFS 显著改善，但在 LR 和 LT 后 PR≥50%的患者中未观察到这种改善。多因素分析显示，PR≥90%仍然是 LR 和 LT 组中 OS 和 RFS 更好的独立预测因素。