验证移植后肝癌寡复发患者接受根治性治疗的获益：倾向评分分析。

Verifying the Benefits of Radical Treatment in Posttransplant Hepatocellular Carcinoma Oligo-recurrence: A Propensity Score Analysis.

机构信息

Department of Surgery Queen Mary Hospital Hong Kong China Department of Surgery and State Key Laboratory for Liver Research The University of Hong Kong Hong Kong China.

出版信息

Liver Transpl. 2022 Jan;28(1):51-64. doi: 10.1002/lt.26251. Epub 2021 Nov 16.

DOI:10.1002/lt.26251

PMID:34351682

Abstract

This study verified whether radical treatment for hepatocellular carcinoma (HCC) oligo-recurrence after liver transplantation conveys survival benefits. A retrospective study of 144 patients with posttransplant HCC recurrence was performed. Propensity score matching was performed to adjust for baseline covariates between patients who received radical and palliative treatments. The primary endpoint was postrecurrence survival. A total of 50 patients (35%) received radical treatment for recurrence, and 76 (53%) and 18 (13%) patients received palliative and supportive treatments, respectively. Compared with the radical group, patients who received palliative treatment had more early recurrences (time from transplant 17 versus 11 months; P = 0.01) and more extensive disease in terms of tumor numbers (1 versus 4; P < 0.001), size of largest tumor (1.8 versus 2.5 cm; P = 0.046), numbers of involved organs (interquartile range [IQR], 1-1 versus 1-2; P = 0.02), and alpha-fetoprotein (AFP) level (7 versus 40 ng/mL; P = 0.01). Multivariate Cox regression analysis revealed that early recurrence (time from transplant hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.03; P = 0.001), larger recurrent tumor (HR, 1.12; 95% CI, 1.03-1.23; P = 0.01), liver recurrence (HR, 1.84; 95% CI, 1.17-2.90; P = 0.01), and log AFP level at recurrence (HR, 1.27; 95% CI, 1.07-1.52; P = 0.01) predicted poor survival. Mammalian target of rapamycin inhibitor (HR, 0.331; 95% CI, 0.213-0.548; P < 0.001) and radical treatment (HR, 0.342; 95% CI, 0.213-0.548; P < 0.001) were associated with improved survival. After 2-to-1 propensity score matching for covariates, the 50 patients who received curative treatment survived significantly longer than the 25 matched patients who received palliative treatment (median survival time, 30.9 ± 2.4 versus 19.5 ± 3.0 months; P = 0.01). Radical treatment conveys survival benefits to HCC oligo-recurrence after liver transplantation.

摘要

本研究旨在验证肝癌（HCC）肝移植后寡复发患者行根治性治疗是否具有生存获益。对 144 例 HCC 肝移植后复发患者进行回顾性研究。采用倾向评分匹配法对接受根治性和姑息性治疗患者的基线协变量进行调整。主要终点是复发后的生存情况。共 50 例（35%）患者接受了根治性治疗，76 例（53%）和 18 例（13%）患者接受了姑息性和支持性治疗。与根治性治疗组相比，接受姑息性治疗的患者复发时间更早（移植后 17 个月 vs 11 个月；P=0.01），肿瘤数量更多（1 个 vs 4 个；P<0.001）、最大肿瘤直径更大（1.8 cm vs 2.5 cm；P=0.046）、累及器官数更多（四分位间距，1-1 个 vs 1-2 个；P=0.02）、甲胎蛋白（AFP）水平更高（7 ng/mL vs 40 ng/mL；P=0.01）。多因素 Cox 回归分析显示，早期复发（移植后时间的风险比[HR]，1.02；95%置信区间[CI]，1.01-1.03；P=0.001）、复发性肿瘤更大（HR，1.12；95% CI，1.03-1.23；P=0.01）、肝内复发（HR，1.84；95% CI，1.17-2.90；P=0.01）和复发时 AFP 水平更高（HR，1.27；95% CI，1.07-1.52；P=0.01）均预示着预后不良。雷帕霉素靶蛋白抑制剂（HR，0.331；95% CI，0.213-0.548；P<0.001）和根治性治疗（HR，0.342；95% CI，0.213-0.548；P<0.001）与生存改善相关。对协变量进行 2 比 1 的倾向评分匹配后，50 例接受根治性治疗的患者中位生存时间明显长于 25 例接受姑息性治疗的匹配患者（30.9±2.4 个月 vs 19.5±3.0 个月；P=0.01）。根治性治疗可为 HCC 肝移植后寡复发患者带来生存获益。