原发性肝癌患者经肝动脉化疗栓塞术后胃食管静脉曲张与预后不良的关系：倾向评分匹配分析。
Association between esophagogastric varices in hepatocellular carcinoma and poor prognosis after transarterial chemoembolization: A propensity score matching analysis.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2020 Feb;119(2):610-620. doi: 10.1016/j.jfma.2019.09.003. Epub 2019 Sep 19.
BACKGROUND/PURPOSE: Whether esophagogastric varices (EGV) can determine the outcome of patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) remains unknown. This study aimed to assess the impact of EGV on the prognosis of HCC patients after TACE.
METHODS
From 2007 to 2012, we retrospectively enrolled 251 treatment-naïve HCC patients who underwent TACE and received esophagogastroduodenoscopy when HCC was diagnosed. The prognostic factors were analyzed using a Cox proportional hazards model and propensity score-matching analysis.
RESULTS
There were 120 (47.8%) patients with EGV. Compared to those without EGV, patients with EGV had worse liver functional reserve. After a median follow-up of 14.7 months (25th-75th percentiles, 6.4-35.6 months), 152 patients died. The cumulative 5-year overall survival (OS) rates were 11.2% and 38.8% in patients with and without EGV, respectively (p < 0.001). Multivariate analysis showed that presence of EGV, presence of ascites, tumor size >5 cm, serum alpha-fetoprotein >20 ng/mL, progressive disease by modified Response Evaluation Criteria in Solid Tumors, Assessment for Retreatment with TACE score ≥2.5, and higher albumin-bilirubin grades were the independent predictors of poor OS. Subgroup analysis also demonstrated that EGV was associated with poor OS in most of the subgroups. After propensity score matching, the EGV group still had a lower OS rate than their counterparts (p = 0.004).
CONCLUSION
HCC patients with EGV had worse liver functional reserve compared to those without EGV. Moreover, EGV was an independent risk factor to predict poor prognosis in patients with HCC after TACE.
背景/目的：经动脉化疗栓塞术（TACE）后，是否存在食管胃静脉曲张（EGV）可影响肝细胞癌（HCC）患者的预后尚不清楚。本研究旨在评估 EGV 对 TACE 后 HCC 患者预后的影响。
方法
2007 年至 2012 年，我们回顾性纳入 251 例初次接受 TACE 治疗且在诊断 HCC 时接受胃镜检查的 HCC 患者。采用 Cox 比例风险模型和倾向评分匹配分析进行预后因素分析。
结果
共有 120 例（47.8%）患者存在 EGV。与无 EGV 患者相比，有 EGV 患者的肝功能储备更差。中位随访 14.7 个月（25 百分位数至 75 百分位数，6.4-35.6 个月）后，152 例患者死亡。有和无 EGV 患者的 5 年累积总生存率（OS）分别为 11.2%和 38.8%（p<0.001）。多因素分析显示，存在 EGV、存在腹水、肿瘤直径>5cm、血清甲胎蛋白（AFP）>20ng/ml、改良实体瘤反应评估标准（mRECIST）评估为进展、TACE 再治疗评估评分（mRECIST）≥2.5、白蛋白-胆红素（ALBI）分级较高是 OS 不良的独立预测因素。亚组分析也表明，EGV 与大多数亚组的 OS 不良相关。在倾向评分匹配后，EGV 组的 OS 率仍低于对照组（p=0.004）。
结论
与无 EGV 患者相比，存在 EGV 的 HCC 患者肝功能储备更差。此外，EGV 是 TACE 后 HCC 患者预后不良的独立危险因素。
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