手术切除显著提高肝细胞癌患者的总生存率：倾向评分匹配分析。
Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis.
机构信息
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
出版信息
BMC Gastroenterol. 2021 May 14;21(1):220. doi: 10.1186/s12876-021-01807-4.
BACKGROUND
The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.
METHODS
Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.
RESULTS
In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child-Pugh (C-P) class; (3) SR, hepatitis B virus (HBV) infection, and C-P class; and (4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.
CONCLUSIONS
SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.
背景
对于不同巴塞罗那临床肝癌（BCLC）分期的肝细胞癌（HCC），手术切除（SR）的获益仍不清楚。我们研究了不同 BCLC 分期 HCC 患者的总生存期（OS）的风险因素和 SR 相对于非手术治疗的生存获益。
方法
共纳入 2316 例 HCC 患者，记录其临床病理数据和 OS。采用 Kaplan-Meier 法和 Cox 回归分析进行 OS 分析。进行倾向评分匹配（PSM）分析。
结果
66（2.8%）、865（37.4%）、575（24.8%）和 870（35.0%）例患者分别为 BCLC 分期 0、A、B 和 C 期疾病。此外，所有患者中有 1302（56.2%）例，BCLC 分期 0、A、B 和 C 期疾病患者中分别有 37（56.9%）例、472（54.6%）例、313（54.4%）例和 480（59.3%）例患者死亡。总队列的中位随访时间为 20 个月（范围 0-96），分为 52（8-96）、32（1-96）、19（0-84）和 12（0-79）个月分别为 BCLC 分期 0、A、B 和 C 队列。OS 的危险因素为（1）SR 和肝硬化；（2）SR、肝硬化和 Child-Pugh（C-P）分级；（3）SR、乙型肝炎病毒（HBV）感染和 C-P 分级；和（4）SR、HBV 感染和 C-P 分级，分别为 BCLC 分期 0、A、B 和 C 队列。与非 SR 治疗相比，SR 在所有队列中均显著提高了生存率。SR 与非 SR 治疗的 5 年 OS 率分别为 44.0%与 28.7%、72.2%与 42.6%、42.6%与 36.2%、44.6%与 23.5%和 41.4%与 15.3%（所有 P 值均<0.05），分别为总队列和 BCLC 分期 0、A、B 和 C 队列。PSM 后，与非 SR 治疗相比，SR 在不同 BCLC 分期均显著提高了生存率。
结论
SR 为不同 BCLC 分期的 HCC 患者带来了显著的生存获益，应被视为某些 HCC 患者的推荐治疗方法，尤其是 BCLC 分期 B 和 C 期疾病患者。
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