Division of General Surgery, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung 435, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan.
Curr Oncol. 2023 Mar 9;30(3):3206-3216. doi: 10.3390/curroncol30030243.
Several studies have shown that liver resection (LR) confers better survival outcomes in intermediate- and advanced-stage hepatocellular carcinoma (HCC) patients. However, the postoperative recurrence rate is high, and little is known about the survival benefits of LR for recurrent HCC patients who have already received systemic treatment. This study aimed to evaluate the impact of LR on recurrent advanced-stage HCC patients who received sorafenib as a systemic treatment. In this study, 147 advanced HCC patients were enrolled between 1 January 2012 and 31 December 2019. Two study groups were classified, based on whether they underwent LR or not. To reduce the possible selection bias, a propensity score matching (PSM) analysis was performed. The primary study endpoint was set as overall survival (OS), and the secondary endpoint was set as progression-free survival (PFS). Our study results revealed that advanced HCC patients who received sorafenib with LR had a longer OS than did those without LR, whether before or after PSM (15.0 months vs. 6.0 months, HR 0.45, 95% CI 0.31-0.67, < 0.001; 15.0 months vs. 5.0 months, HR 0.46, 95% CI 0.28-0.76, = 0.001). Similar results were obtained in PFS, before or after PSM (4.14 months vs. 2.60 months, HR 0.60, 95% CI 0.40-0.89, = 0.01; 4.57 months vs. 2.63 months, HR 0.58, 95% CI 0.34-0.97, = 0.037). Multivariate analysis showed that the experience of LR was independent of other factors associated with better OS and PFS, whether before or after PSM ( < 0.05). Therefore, advanced HCC patients who have undergone liver resection should be encouraged to continue sorafenib treatment to improve prognosis.
几项研究表明，肝切除术（LR）在中晚期肝细胞癌（HCC）患者中可获得更好的生存结果。然而，术后复发率很高，对于已经接受系统治疗的复发性 HCC 患者，LR 的生存获益知之甚少。本研究旨在评估 LR 对已接受索拉非尼作为系统治疗的复发性晚期 HCC 患者的影响。
在这项研究中，纳入了 2012 年 1 月 1 日至 2019 年 12 月 31 日期间的 147 名晚期 HCC 患者。根据是否进行 LR 将患者分为两组。为了减少可能的选择偏倚，进行了倾向评分匹配（PSM）分析。主要研究终点设定为总生存期（OS），次要终点设定为无进展生存期（PFS）。
我们的研究结果表明，接受 LR 的索拉非尼治疗的晚期 HCC 患者的 OS 长于未接受 LR 的患者，无论是否进行 PSM（15.0 个月 vs. 6.0 个月，HR 0.45，95%CI 0.31-0.67，<0.001；15.0 个月 vs. 5.0 个月，HR 0.46，95%CI 0.28-0.76，=0.001）。在 PFS 方面也得到了相似的结果，无论是否进行 PSM（4.14 个月 vs. 2.60 个月，HR 0.60，95%CI 0.40-0.89，=0.01；4.57 个月 vs. 2.63 个月，HR 0.58，95%CI 0.34-0.97，=0.037）。多变量分析表明，LR 经验是 OS 和 PFS 优于其他因素的独立因素，无论是否进行 PSM（<0.05）。
因此，应鼓励接受过肝切除术的晚期 HCC 患者继续接受索拉非尼治疗以改善预后。
