Feng Long-Hai, Zhu Yu-Yao, Zhou Jia-Min, Wang Miao, Xu Wei-Qi, Zhang Ti, Mao An-Rong, Cong Wen-Ming, Dong Hui, Wang Lu
Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2023 May 24;13:1104492. doi: 10.3389/fonc.2023.1104492. eCollection 2023.
To identify whether adjuvant transarterial chemoembolization (TACE) can improve prognosis in HCC patients with a low risk of recurrence (tumor size ≤ 5 cm, single nodule, no satellites, and no microvascular or macrovascular invasions) after hepatectomy.
The data of 489 HCC patients with a low risk of recurrence after hepatectomy from Shanghai Cancer Center (SHCC) and Eastern Hepatobiliary Surgery Hospital (EHBH) were retrospectively reviewed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier curves and Cox proportional hazards regression models. The effects of selection bias and confounding factors were balanced using propensity score matching (PSM).
In the SHCC cohort, 40 patients (19.9%, 40/201) received adjuvant TACE, and in the EHBH cohort, 113 patients (46.2%, 133/288) received adjuvant TACE. Compared to the patients without adjuvant TACE after hepatectomy, patients receiving adjuvant TACE had significantly shorter RFS (P=0.022; P=0.014) in both cohorts before PSM. However, no significant difference existed in OS (P=0.568; P=0.082). Multivariate analysis revealed that serum alkaline phosphatase and adjuvant TACE were independent prognostic factors for recurrence in both cohorts. Furthermore, significant differences existed in tumor size between the adjuvant TACE and non-adjuvant TACE groups in the SHCC cohort. There were differences in transfusion, Barcelona Clinic Liver Cancer stage and tumor-node-metastasis stage in the EHBH cohort. These factors were balanced by PSM. After PSM, patients with adjuvant TACE after hepatectomy still had significantly shorter RFS than those without (P=0.035; P=0.035) in both cohorts, but there was no difference in OS (P=0.638; P=0.159). Adjuvant TACE was the only independent prognostic factor for recurrence in multivariate analysis, with hazard ratios of 1.95 and 1.57.
Adjuvant TACE may not improve long-term survival and might promote postoperative recurrence in HCC patients with a low risk of recurrence after hepatectomy.
明确辅助性经动脉化疗栓塞术（TACE）能否改善肝切除术后复发风险低（肿瘤大小≤5 cm、单结节、无卫星灶、无微血管或大血管侵犯）的肝癌患者的预后。
回顾性分析上海交通大学医学院附属上海儿童医学中心（SHCC）和海军军医大学附属东方肝胆外科医院（EHBH）489例肝切除术后复发风险低的肝癌患者的数据。采用Kaplan-Meier曲线和Cox比例风险回归模型分析无复发生存期（RFS）和总生存期（OS）。使用倾向评分匹配（PSM）平衡选择偏倚和混杂因素的影响。
在SHCC队列中，40例患者（19.9%，40/201）接受了辅助性TACE，在EHBH队列中，113例患者（46.2%，133/288）接受了辅助性TACE。在PSM之前，与肝切除术后未接受辅助性TACE的患者相比，接受辅助性TACE的患者在两个队列中的RFS均显著缩短（P=0.022；P=0.014）。然而，OS无显著差异（P=0.568；P=0.082）。多因素分析显示，血清碱性磷酸酶和辅助性TACE是两个队列中复发的独立预后因素。此外，SHCC队列中辅助性TACE组和非辅助性TACE组的肿瘤大小存在显著差异。EHBH队列中在输血、巴塞罗那临床肝癌分期和肿瘤-淋巴结-转移分期方面存在差异。这些因素通过PSM得到平衡。PSM后，肝切除术后接受辅助性TACE的患者在两个队列中的RFS仍显著短于未接受辅助性TACE的患者（P=0.035；P=0.035），但OS无差异（P=0.638；P=0.159）。在多因素分析中，辅助性TACE是复发的唯一独立预后因素，风险比分别为1.95和1.57。
辅助性TACE可能无法改善肝切除术后复发风险低的肝癌患者的长期生存，且可能促进术后复发。
