Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China.
J Gastroenterol Hepatol. 2020 Dec;35(12):2220-2228. doi: 10.1111/jgh.15060. Epub 2020 May 14.
Prognosis of infiltrative hepatocellular carcinoma (iHCC) is poor, and the treatments selection based on efficacy is unclear. We performed this multicenter study to compare the efficacy of hepatic resection and transarterial chemoembolization (TACE) in treating patients with iHCC.
We retrospectively analyzed the overall survivals (OS) in 319 patients with iHCC who were initially treated by hepatic resection (n = 133) or TACE (n = 186) at four tertiary centers. Fifty-eight patients in the TACE group were assessed as resectable and compared with the hepatic resection group in subgroup analysis. A propensity score matched (PSM) analysis was performed to reduce selection bias. Cox regression was performed to identify significant factors associated with OS.
The median OS time was significantly longer in the hepatic resection group than that in the TACE group, before and after PSM (before PSM, 17.5 vs 7.3 months, P < 0.0001; after PSM, 14.0 vs 7.3 months, P < 0.0001). The multivariable analysis indicated TACE as a risk factor of OS (hazard ratio = 2.233, 95% confidence interval = 1.492 to 3.341, P < 0.0001), as well as portal venous tumor thrombosis grades 3-4 and alpha fetal protein (AFP) > 400 ng/mL. In the subgroup analysis, the better efficacy of hepatic resection over TACE persisted regardless of the grade of portal venous tumor thrombosis and the level of AFP. As for resectable patients, hepatic resection still showed significant survival benefit (before PSM, 17.5 vs 11.2 months, P = 0.0013; after PSM, 14.0 vs 10.9 months, P = 0.0304).
Hepatic resection might be the better choice for patients with iHCC due to its better survival benefit than TACE.
浸润性肝细胞癌（iHCC）的预后较差，其疗效为基础的治疗选择尚不明确。我们进行了这项多中心研究，比较了肝切除术和肝动脉化疗栓塞术（TACE）治疗 iHCC 患者的疗效。
我们回顾性分析了在四家三级中心接受肝切除术（n=133）或 TACE（n=186）初始治疗的 319 例 iHCC 患者的总生存期（OS）。TACE 组中有 58 例患者评估为可切除，并在亚组分析中与肝切除术组进行比较。采用倾向评分匹配（PSM）分析减少选择偏倚。采用 Cox 回归分析确定与 OS 相关的显著因素。
在 PSM 前后，肝切除术组的 OS 时间明显长于 TACE 组（PSM 前，17.5 与 7.3 个月，P<0.0001；PSM 后，14.0 与 7.3 个月，P<0.0001）。多变量分析表明，TACE 是 OS 的危险因素（风险比=2.233，95%置信区间=1.492 至 3.341，P<0.0001），以及门静脉肿瘤血栓分级 3-4 级和α胎蛋白（AFP）>400ng/mL。在亚组分析中，无论门静脉肿瘤血栓分级和 AFP 水平如何，肝切除术的疗效均优于 TACE。对于可切除患者，肝切除术仍显示出显著的生存获益（PSM 前，17.5 与 11.2 个月，P=0.0013；PSM 后，14.0 与 10.9 个月，P=0.0304）。
由于肝切除术比 TACE 具有更好的生存获益，因此可能是 iHCC 患者的更好选择。
