Rong Weiqi, Yu Weibo, Wang Liming, Wu Fan, Zhang Kai, Chen Bo, Miao Chengli, Liu Liguo, An Songlin, Tao Changcheng, Wang Weihu, Wu Jianxiong
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
Chin J Cancer Res. 2020 Oct 31;32(5):645-653. doi: 10.21147/j.issn.1000-9604.2020.05.09.
A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma (HCC) after narrow-margin hepatectomy (<1 cm). This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.
Patients with central HCC after narrow-margin hepatectomy (<1 cm) were prospectively assigned to adjuvant radiotherapy group and control group. Patients' outcome, adverse events, long-term recurrence and survival rates were investigated.
The 1-, 5-, and 10-year recurrence-free survival (RFS) rates were 81.0%, 43.9%, and 38.7%, respectively in adjuvant radiotherapy group and 71.7%, 35.8%, and 24.2%, respectively in control group (log-rank test, P=0.09). The 1-, 5-, and 10-year overall survival (OS) rates were 96.6%, 54.7%, and 42.8%, respectively in adjuvant radiotherapy group and 90.2%, 55.1%, and 30.0%, respectively in control group (log-rank test, P=0.20). The 1-, 5-, and 10-year RFS rates for patients with small HCC (≤5 cm) were 91.1%, 51.6%, and 48.4%, respectively in adjuvant radiotherapy group and 80.0%, 36.6%, and 26.6%, respectively in control group (log-rank test, P=0.03). Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group (log-rank test, P=0.05).
Our updated results showed a sustained clinical benefit on reducing recurrence, improving long-term survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy. Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.
一项前瞻性随机对照研究探讨了辅助放疗对切缘狭窄（<1 cm）的中央型肝细胞癌（HCC）患者的可行性和疗效。本研究提供了更新的10年真实世界证据，以进一步明确辅助放疗的作用。
将切缘狭窄（<1 cm）的中央型HCC患者前瞻性地分为辅助放疗组和对照组。对患者的结局、不良事件、长期复发率和生存率进行了研究。
辅助放疗组的1年、5年和10年无复发生存（RFS）率分别为81.0%、43.9%和38.7%，对照组分别为71.7%、35.8%和24.2%（对数秩检验，P = 0.09）。辅助放疗组的1年、5年和10年总生存（OS）率分别为96.6%、54.7%和42.8%，对照组分别为90.2%、55.1%和30.0%（对数秩检验，P = 0.20）。小肝癌（≤5 cm）患者的辅助放疗组1年、5年和10年RFS率分别为91.1%、51.6%和48.4%，对照组分别为80.0%、36.6%和26.6%（对数秩检验，P = 0.03）。里程碑分析表明，辅助放疗组的小肝癌患者在治疗后的第二个五年中，与对照组相比，OS有显著改善（对数秩检验，P = 0.05）。
我们更新后的结果显示，辅助放疗对切缘狭窄肝切除术后的小中央型HCC在减少复发、改善长期生存方面具有持续的临床益处。长期生存数据还表明，肝切除术是部分中央型HCC患者的最佳治疗方法。
