Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastroentology, West China Hospital, Sichuan University, Chengdu, China.
Oncol Res. 2022 Dec 6;30(1):23-33. doi: 10.32604/or.2022.026044. eCollection 2022.
Treatment of hepatocellular carcinoma (HCC) in the caudate lobe is technically challenging. This retrospective study was designed to evaluate the clinical outcome of both superselective transcatheter arterial chemoembolization (TACE) and liver resection (LR) for HCC occurring exclusively in the caudate lobe. From January 2008 to September 2021, a total of 129 patients were diagnosed with HCC of the caudate lobe. The Cox proportional hazard model was used to analyze the potential clinical factors and established prognostic nomograms with interval validation. Of the total number of patients, 78 received TACE and 51 received LR. The overall survival (OS) rates (TACE . LR) at 1, 2, 3, 4, and 5 years were 83.9% . 71.0%; 74.2% . 61.3%; 58.1% . 48.4%; 45.2% . 45.2%; and 32.3% . 25.0%, respectively. However, subgroup analysis revealed that TACE was superior to LR for treating patients with stage IIb Chinese liver cancer (CNLC-IIb) in the entire cohort ( = 0.002). Interestingly, no difference was found between TACE and LR in the treatment outcomes of CNLC-IIa HCC ( = 0.6). Based on Child-Pugh A and B calculations, TACE tended to lead to a better OS than LR ( = 0.081 and 0.16, respectively). Multivariate analysis showed that Child-Pugh score, CNLC stage, ascites, alpha fetoprotein (AFP), tumor size, and anti-HCV are related to OS. Predictive nomograms for 1, 2, and 3 years were performed. Based on this study, TACE may provide a longer OS than liver resection for patients with CNLC-IIb HCC of the caudate lobe. Because this suggestion is limited by the study design and relatively small sample size, additional randomized controlled trials are needed.
治疗尾状叶肝细胞癌（HCC）在技术上具有挑战性。本回顾性研究旨在评估单纯发生于尾状叶的 HCC 患者接受超选择性经导管肝动脉化疗栓塞（TACE）和肝切除术（LR）的临床疗效。2008 年 1 月至 2021 年 9 月，共诊断出 129 例尾状叶 HCC 患者。采用 Cox 比例风险模型分析潜在的临床因素，并建立了具有间隔验证的预后列线图。在所有患者中，78 例接受 TACE 治疗，51 例接受 LR 治疗。TACE 和 LR 的总生存率（OS）（TACE. LR）在 1、2、3、4 和 5 年时分别为 83.9%. 71.0%；74.2%. 61.3%；58.1%. 48.4%；45.2%. 45.2%；32.3%. 25.0%。然而，亚组分析显示，在整个队列中，TACE 治疗 CNLC-IIb 期 HCC 患者的效果优于 LR（ = 0.002）。有趣的是，在 CNLC-IIa HCC 患者的治疗结果中，TACE 和 LR 之间没有差异（ = 0.6）。根据 Child-Pugh A 和 B 评分，TACE 似乎比 LR 更能延长 OS（ = 0.081 和 0.16）。多变量分析显示，Child-Pugh 评分、CNLC 分期、腹水、甲胎蛋白（AFP）、肿瘤大小和抗-HCV 与 OS 相关。进行了 1、2 和 3 年的预测列线图。基于本研究，对于尾状叶 CNLC-IIb HCC 患者，TACE 可能提供比肝切除术更长的 OS。由于这一建议受到研究设计和相对较小的样本量的限制，需要进行更多的随机对照试验。
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