辅助经动脉化疗栓塞治疗对根治性切除术后合并肝细胞癌和胆管细胞癌患者的无复发生存和总体生存无影响：倾向评分匹配分析。
Adjuvant Transarterial chemoembolization does not influence recurrence-free or overall survival in patients with combined hepatocellular carcinoma and Cholangiocarcinoma after curative resection: a propensity score matching analysis.
机构信息
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China.
出版信息
BMC Cancer. 2020 Jul 10;20(1):642. doi: 10.1186/s12885-020-07138-z.
BACKGROUND
The prognosis of patients with combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma (CHC) is usually poor, and effective adjuvant therapy is missing making it important to investigate whether these patients may benefit from adjuvant transarterial chemoembolization (TACE). We aimed to evaluate the efficiency of adjuvant TACE for long-term recurrence and survival after curative resection before and after propensity score matching (PSM) analysis.
METHODS
In this retrospective study, of 230 patients who underwent resection for CHC between January 1994 and December 2014, 46 (18.0%) patients received adjuvant TACE. Univariate and multivariate regression analyses were used to identify the independent predictive factors of survival. Cox regression analyses and log-rank tests were used to compare overall survival (OS) and disease-free survival (DFS) between patients who did or did not receive adjuvant TACE.
RESULTS
A total of 230 patients (mean age 52.2 ± 11.9 years; 172 men) were enrolled, and 46 (mean age 52.7 ± 11.1 years; 38 men) patients received TACE. Before PSM, in multivariate regression analysis, γ-glutamyl transpeptidase (γ-GT), tumour nodularity, macrovascular invasion (MVI), lymphoid metastasis, and extrahepatic metastasis were associated with OS. Alanine aminotransferase (ALT), MVI, lymphoid metastasis, and preventive TACE (HR: 2.763, 95% CI: 1.769-4.314, p < 0.001) were independent prognostic factors for DFS. PSM created 46 pairs of patients. Before PSM, adjuvant preventive TACE was not associated with an increased risk of OS (HR: 0.911, 95% CI: 0.545-1.520, p = 0.720) or DFS (HR: 3.345, 95% CI: 1.686-6.638, p = 0.001). After PSM, the 5-year OS and DFS rates were comparable in the TACE group and the non-TACE group (OS: 22.7% vs 14.9%, respectively, p = 0.75; DFS: 11.2% vs 14.4%, respectively, p = 0.06).
CONCLUSIONS
The present study identified that adjuvant preventive TACE did not influence DFS or OS after curative resection of CHC.
背景
肝细胞癌（HCC）合并肝内胆管细胞癌（CHC）患者的预后通常较差，缺乏有效的辅助治疗方法，因此研究这些患者是否可能从辅助经动脉化疗栓塞（TACE）中获益非常重要。我们旨在评估在进行倾向评分匹配（PSM）分析前后，辅助 TACE 对根治性切除术后长期复发和生存的疗效。
方法
本回顾性研究纳入了 1994 年 1 月至 2014 年 12 月期间接受 CHC 切除术的 230 例患者，其中 46 例（18.0%）患者接受了辅助 TACE。采用单因素和多因素回归分析确定生存的独立预测因素。采用 Cox 回归分析和对数秩检验比较接受和未接受辅助 TACE 的患者的总生存期（OS）和无病生存期（DFS）。
结果
共纳入 230 例患者（平均年龄 52.2±11.9 岁；172 例男性），其中 46 例（平均年龄 52.7±11.1 岁；38 例男性）接受了 TACE。在 PSM 前，多因素回归分析显示，γ-谷氨酰转肽酶（γ-GT）、肿瘤结节、大血管侵犯（MVI）、淋巴转移和肝外转移与 OS 相关。丙氨酸氨基转移酶（ALT）、MVI、淋巴转移和预防性 TACE（HR：2.763，95%CI：1.769-4.314，p<0.001）是 DFS 的独立预后因素。PSM 建立了 46 对患者。PSM 前，辅助预防性 TACE 与 OS（HR：0.911，95%CI：0.545-1.520，p=0.720）或 DFS（HR：3.345，95%CI：1.686-6.638，p=0.001）的风险增加无关。PSM 后，TACE 组和非 TACE 组的 5 年 OS 和 DFS 率相当（OS：分别为 22.7%和 14.9%，p=0.75；DFS：分别为 11.2%和 14.4%，p=0.06）。
结论
本研究表明，在接受 CHC 根治性切除术后，辅助预防性 TACE 并不影响 DFS 或 OS。
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