辅助 TACE 对肝癌患者肝切除术后预后的疗效：来自中国的多中心倾向评分匹配研究。
Efficacy of adjuvant TACE on the prognosis of patients with HCC after hepatectomy: a multicenter propensity score matching from China.
机构信息
Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China.
Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), No. 1017, Dongmen North Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China.
出版信息
BMC Cancer. 2023 Apr 7;23(1):325. doi: 10.1186/s12885-023-10802-9.
BACKGROUND
The survival benefit of adjuvant transarterial chemoembolization (TACE) in patients with hepatectomy for hepatocellular carcinoma (HCC) after hepatectomy remains controversial. We aimed to investigate the survival efficacy of adjuvant TACE after hepatectomy for HCC.
METHODS
1491 patients with HCC who underwent hepatectomy between January 2018 and September 2021 at four medical centers in China were retrospectively analyzed, including 782 patients who received adjuvant TACE and 709 patients who did not receive adjuvant TACE. Propensity score matching (PSM) (1:1) was performed to minimize selection bias, which balanced the clinical characteristics of the two groups.
RESULTS
A total of 1254 patients were enrolled after PSM, including 627 patients who received adjuvant TACE and 627 patients who did not receive adjuvant TACE. Patients who received adjuvant TACE had higher disease-free survival (DFS, 1- ,2-, and 3-year: 78%-68%-62% vs. 69%-57%-50%, p < 0.001) and overall survival (OS, 1- ,2-, and 3-year: 96%-88%-80% vs. 90%-77%-66%, p < 0.001) than those who did not receive adjuvant TACE (Median DFS was 39 months). Among the different levels of risk factors affecting prognosis [AFP, Lymphocyte-to-monocyte ratio, Maximum tumor diameter, Number of tumors, Child-Pugh classification, Liver cirrhosis, Vascular invasion (imaging), Microvascular invasion, Satellite nodules, Differentiation, Chinese liver cancer stage II-IIIa], the majority of patients who received adjuvant TACE had higher DFS or OS than those who did not receive adjuvant TACE. More patients who received adjuvant TACE accepted subsequent antitumor therapy such as liver transplantation, re-hepatectomy and local ablation after tumor recurrence, while more patients who did not receive adjuvant TACE accepted subsequent antitumor therapy with TACE after tumor recurrence (All p < 0.05).
CONCLUSIONS
Adjuvant TACE may be a potential way to monitor early tumor recurrence and improve postoperative survival in patients with HCC.
背景
辅助经动脉化疗栓塞（TACE）在肝癌（HCC）患者行肝切除术后的生存获益仍存在争议。本研究旨在探讨辅助 TACE 在 HCC 患者肝切除术后的生存疗效。
方法
回顾性分析 2018 年 1 月至 2021 年 9 月期间中国四家医疗中心的 1491 例 HCC 患者，包括 782 例接受辅助 TACE 和 709 例未接受辅助 TACE 的患者。采用倾向评分匹配（PSM）（1:1）以尽量减少选择偏倚，平衡两组的临床特征。
结果
PSM 后共纳入 1254 例患者，其中 627 例接受辅助 TACE，627 例未接受辅助 TACE。接受辅助 TACE 的患者无病生存率（DFS，1-、2-和 3 年：78%-68%-62% vs. 69%-57%-50%，p<0.001）和总生存率（OS，1-、2-和 3 年：96%-88%-80% vs. 90%-77%-66%，p<0.001）均高于未接受辅助 TACE 的患者（中位 DFS 为 39 个月）。在影响预后的不同危险因素水平[甲胎蛋白（AFP）、淋巴细胞与单核细胞比值、最大肿瘤直径、肿瘤数量、Child-Pugh 分级、肝硬化、血管侵犯（影像学）、微血管侵犯、卫星结节、分化、中国肝癌分期 II-IIIa]中，大多数接受辅助 TACE 的患者的 DFS 或 OS 均高于未接受辅助 TACE 的患者。接受辅助 TACE 的患者更多地接受了肝移植、再次肝切除和局部消融等后续抗肿瘤治疗，而未接受辅助 TACE 的患者更多地接受了 TACE 等后续抗肿瘤治疗（均 p<0.05）。
结论
辅助 TACE 可能是监测 HCC 患者术后早期肿瘤复发并提高生存的潜在方法。
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