Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
World J Surg Oncol. 2020 Jun 2;18(1):119. doi: 10.1186/s12957-020-01887-8.
It is still controversial whether hepatocellular carcinoma (HCC) patients with lymph node invasion should receive surgery treatment. This study aimed to evaluate the efficacy of surgery (liver resection and local tumor destruction treatments) in HCC patients with regional lymph node metastasis.
The study utilized data from the Surveillance, Epidemiology, and End Results-18 (SEER-18) cancer registry. Patients for whom the treatment type was not clear or those with distant metastasis or without regional lymph nodule invasion were excluded. For survival analysis, patients with the survival months coded as 0 and 999 were excluded. All 1434 patients were included in the analysis. Among them, 168 patients were treated surgically and the other 1266 received non-surgery therapy. Propensity score matching (PSM) model was used to reduce selection bias.
Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) of patients treated surgically were longer than that of receiving non-surgery treatment (mOS 20 months, 95% CI 15.3-24.7 vs. 7 months, 95% CI 6.4-7.6, P < 0.001; mCSS 21 months, 95% CI 115.5-26.5 vs. 6 months, 95% CI 5.3-6.7, P < 0.001). Subgroup analysis found no significant differences in mOS and mCSS between liver resection and non-liver resection surgery cohorts (P = 0.886 and P = 0.813, respectively). Similar results were obtained in the PSM analysis. The mOS and mCSS in the surgery group were longer than those in the non-surgery group (mOS 20 months vs. 7 months, P < 0.001; mCSS 20 months vs. 6 months, P < 0.001). The multivariate analysis documented that surgery was an independent predictor for OS and CSS before and after PSM.
HCC patients with invasion of regional lymph nodules may get more survival benefit from surgery than other types of treatment.
肝癌（HCC）患者发生淋巴结侵犯时是否应接受手术治疗仍存在争议。本研究旨在评估手术（肝切除术和局部肿瘤破坏治疗）治疗 HCC 伴区域淋巴结转移患者的疗效。
本研究利用了 Surveillance, Epidemiology, and End Results-18（SEER-18）癌症登记处的数据。排除治疗类型不明确或存在远处转移或无区域淋巴结侵犯的患者。对于生存分析，排除生存月编码为 0 和 999 的患者。所有 1434 例患者均纳入分析。其中 168 例接受手术治疗，其余 1266 例接受非手术治疗。采用倾向评分匹配（PSM）模型以减少选择偏倚。
在 PSM 之前，手术治疗患者的中位总生存期（mOS）和中位癌症特异性生存期（mCSS）均长于接受非手术治疗的患者（mOS 20 个月，95%CI 15.3-24.7 与 7 个月，95%CI 6.4-7.6，P < 0.001；mCSS 21 个月，95%CI 115.5-26.5 与 6 个月，95%CI 5.3-6.7，P < 0.001）。亚组分析发现肝切除术和非肝切除术两组间 mOS 和 mCSS 无显著差异（P = 0.886 和 P = 0.813）。PSM 分析也得到了类似的结果。手术组的 mOS 和 mCSS 均长于非手术组（mOS 20 个月与 7 个月，P < 0.001；mCSS 20 个月与 6 个月，P < 0.001）。多因素分析显示，PSM 前后手术是 OS 和 CSS 的独立预测因素。
与其他治疗类型相比，区域淋巴结侵犯的 HCC 患者可能从手术中获得更多生存获益。
