术前 TACE 对肝细胞癌患者微血管侵犯发生率和长期肝切除术后生存的影响：倾向评分匹配分析。
Impact of preoperative TACE on incidences of microvascular invasion and long-term post-hepatectomy survival in hepatocellular carcinoma patients: A propensity score matching analysis.
机构信息
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
出版信息
Cancer Med. 2021 Mar;10(6):2100-2111. doi: 10.1002/cam4.3814. Epub 2021 Mar 1.
BACKGROUND
To study the influence of preoperative transcatheter arterial chemoembolization (TACE) on the incidence of microvascular invasion (MVI) and long-term survival outcomes in hepatocellular carcinoma (HCC) patients.
METHODS
Between January 1, 2010 and December 1, 2014, consecutive HCC patients who underwent curative liver resection were enrolled in this study. Univariable and multivariable regression analyses were used to identify independent predictive factors of MVI. Propensity score matching (PSM) was used to compare the incidences of MVI and prognosis between patients who did and did not receive preoperative TACE. Factors associated with Disease-Free Survival (DFS) and Overall survival (OS) were identified using Cox regression analyses.
RESULTS
Of 1624 patients, 590 received preoperative TACE. The incidence of MVI was significantly lower in patients with preoperative TACE than those without preoperative TACE (39.15% vs. 45.36%, p = 0.015). After PSM, the incidences of MVI were similar in the two groups (38.85% vs. 41.10%, p = 0.473). Multivariable regression analysis revealed preoperative TACE to have no impact on the incidence of MVI. Before PSM, survival of patients with preoperative TACE was significantly worse than those without preoperative TACE (p = 0.032 for DFS and p = 0.027 for OS). After PSM, the difference became insignificant (p = 0.465 for DFS and p = 0.307 for OS). After adjustment for other prognostic variables in the propensity-matched cohort, preoperative TACE was still found not to be associated with DFS and OS after HCC resection. Both before and after PSM, the prognosis of patients was not significantly different between the two groups for BCLC stages 0, A, and B.
CONCLUSIONS
Preoperative TACE did not influence the incidence of MVI and prognosis of patients with HCC who underwent 'curative' liver resection.
背景
研究经导管动脉化疗栓塞（TACE）术前对肝细胞癌（HCC）患者微血管侵犯（MVI）发生率和长期生存结果的影响。
方法
本研究纳入了 2010 年 1 月 1 日至 2014 年 12 月 1 日期间接受根治性肝切除术的连续 HCC 患者。采用单变量和多变量回归分析确定 MVI 的独立预测因素。采用倾向评分匹配（PSM）比较术前 TACE 治疗和未治疗患者的 MVI 发生率和预后。采用 Cox 回归分析确定与无病生存（DFS）和总生存（OS）相关的因素。
结果
在 1624 例患者中，有 590 例接受了术前 TACE。术前 TACE 组的 MVI 发生率明显低于未接受术前 TACE 组（39.15%比 45.36%，p=0.015）。PSM 后，两组 MVI 发生率相似（38.85%比 41.10%，p=0.473）。多变量回归分析显示，术前 TACE 对 MVI 的发生率没有影响。PSM 前，接受术前 TACE 治疗的患者的生存情况明显差于未接受术前 TACE 治疗的患者（DFS 的 p=0.032，OS 的 p=0.027）。PSM 后，差异无统计学意义（DFS 的 p=0.465，OS 的 p=0.307）。在倾向评分匹配队列中调整其他预后变量后，术前 TACE 与 HCC 切除术后的 DFS 和 OS 仍无相关性。PSM 前后，BCLC 分期为 0、A 和 B 的患者，两组间的预后差异均无统计学意义。
结论
术前 TACE 并不影响接受“根治性”肝切除术的 HCC 患者的 MVI 发生率和预后。
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