Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, PR China; State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
Radiother Oncol. 2023 Mar;180:109462. doi: 10.1016/j.radonc.2022.109462. Epub 2023 Jan 9.
We evaluated the postoperative radiotherapy (PORT) effects on hepatocellular carcinoma (HCC) prognosis and recurrence in patients who underwent narrow-margin (<1.0 cm) hepatectomy (NH).
This two-arm cohort study based on the phase II study compared NH with or without PORT in patients with HCC. All patients underwent NH; 76 patients who received PORT following NH in the phase II study were assigned to the NH + RT group, and 171 who underwent NH alone were assigned to the NH group. Propensity score matching (PSM) was used to balance clinicopathological characteristic differences between groups.
Before PSM, the 5-year overall survival (OS) rates between groups differed significantly (72.2 % vs 60.7 %, P = 0.017). Moreover, the 5-year disease-free survival (DFS) rate was significantly higher in the NH + RT group (51.4 % vs 35.7 %, P = 0.002). After PSM, the between-group difference in OS rates remained high (P = 0.045); the 5-year OS rates were 74.7 % and 63.6 % in the NH + RT and NH groups, respectively. Similarly, the DFS rate remained significantly higher in the NH + RT group (P = 0.001); the 5-year DFS rates were 56.3 % and 31.6 %, respectively. Furthermore, both before and after PSM, patients in the NH + RT group showed significantly lower early, intrahepatic, and extrahepatic recurrence rates than those in the NH group.
PORT may have significant OS and DFS benefits in patients with HCC undergoing NH.
我们评估了术后放疗（PORT）对接受窄切缘（<1.0cm）肝切除术（NH）的肝细胞癌（HCC）患者预后和复发的影响。
这项基于 II 期研究的双臂队列研究比较了 NH 联合或不联合 PORT 治疗 HCC 患者的效果。所有患者均接受 NH；在 II 期研究中，76 例接受 NH 后 PORT 的患者被分配到 NH+RT 组，171 例单独接受 NH 的患者被分配到 NH 组。采用倾向评分匹配（PSM）平衡组间临床病理特征差异。
在 PSM 之前，两组间 5 年总生存率（OS）差异有统计学意义（72.2%比 60.7%，P=0.017）。此外，NH+RT 组的 5 年无疾病生存率（DFS）明显更高（51.4%比 35.7%，P=0.002）。PSM 后，两组间 OS 率的差异仍然较高（P=0.045）；NH+RT 组和 NH 组的 5 年 OS 率分别为 74.7%和 63.6%。同样，DFS 率在 NH+RT 组仍然显著更高（P=0.001）；5 年 DFS 率分别为 56.3%和 31.6%。此外，在 PSM 前后，NH+RT 组患者的早期、肝内和肝外复发率均明显低于 NH 组。
PORT 可能对接受 NH 的 HCC 患者的 OS 和 DFS 有显著获益。
