经解剖性肝切除术后辅助经导管动脉化疗栓塞治疗肝细胞癌患者的生存获益。

Survival benefit of adjuvant transcatheter arterial chemoembolization for patients with hepatocellular carcinoma after anatomical hepatectomy.

机构信息

General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.

The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.

出版信息

Expert Rev Gastroenterol Hepatol. 2023 Apr;17(4):395-403. doi: 10.1080/17474124.2023.2192479. Epub 2023 Mar 20.

DOI:10.1080/17474124.2023.2192479

PMID:36939280

Abstract

BACKGROUND & AIMS: Although anatomical hepatectomy (AH) is widely used in the treatment of hepatocellular carcinoma (HCC), the prognosis is still unsatisfactory. The present study aimed to evaluate the survival benefit of adjuvant transcatheter arterial chemoembolization (TACE) for patients with HCC after AH.

METHODS

A total of 832 patients were stratified into with adjuvant TACE (443, 53.2%) and without adjuvant TACE group (389, 46.8%) AH. Propensity score matching (PSM) was performed to control for confounding factors, and multivariable Cox regression was performed to determine the independent risk factors.

RESULTS

After PSM, the results showed that the adjuvant TACE group had better overall survival (OS) and recurrence-free survival (RFS). Among the patients with tumor recurrence, adjuvant TACE was associated with a high rate of early-stage tumor at recurrence, a lower recurrence rate around the frontal margin and extrahepatic metastases, and a higher rate of receiving curative treatment. Multivariable Cox regression analysis showed that adjuvant TACE was an independent prognostic factor for OS (HR 0.673, P = 0.001) and RFS (HR 0.650, P = 0.001).

CONCLUSIONS

Patients with HCC after AH can benefit from postoperative adjuvant TACE. Therefore, adjuvant TACE should be considered for patients with a high risk of recurrence.

摘要

背景与目的

尽管解剖性肝切除术（AH）广泛应用于肝细胞癌（HCC）的治疗，但预后仍不理想。本研究旨在评估 AH 后辅助经导管动脉化疗栓塞（TACE）对 HCC 患者生存获益的影响。

方法

将 832 例患者分为接受辅助 TACE（443 例，53.2%）和未接受辅助 TACE（389 例，46.8%）AH 两组。采用倾向评分匹配（PSM）控制混杂因素，多变量 Cox 回归分析确定独立危险因素。

结果

PSM 后结果显示，辅助 TACE 组患者的总生存（OS）和无复发生存（RFS）更好。在肿瘤复发的患者中，辅助 TACE 与早期肿瘤、复发周边区域及肝外转移率较低、接受根治性治疗率较高有关。多变量 Cox 回归分析显示，辅助 TACE 是 OS（HR 0.673，P = 0.001）和 RFS（HR 0.650，P = 0.001）的独立预后因素。