经肝动脉化疗栓塞术完全缓解后行肝切除术治疗中期肝细胞癌的生存获益：一项回顾性、多中心队列研究。

Survival benefit of liver resection following complete response to transarterial chemoembolization for intermediate-stage hepatocellular carcinoma: a retrospective, multicenter, cohort study.

机构信息

Department of Liver Surgery.

Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou.

出版信息

Int J Surg. 2024 Feb 1;110(2):1019-1027. doi: 10.1097/JS9.0000000000000942.

DOI:10.1097/JS9.0000000000000942

PMID:38006301

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10871594/

Abstract

BACKGROUND

High rate of tumor recurrence jeopardized the long-term survival of hepatocellular carcinoma (HCC) patients with complete response to transarterial chemoembolization (TACE). This study aims to evaluate the survival benefit of liver resection (LR) following the complete response to TACE for intermediate-stage HCC.

METHODS

A total of 281 intermediate-stage HCC patients with complete response to TACE followed by persistent observation (TACE group) or LR (TLR group) from 01 January 2011 to 31 December 2021 from three institutions in China were included. Overall survival (OS) and disease-free survival (DFS) of patients were compared between the two groups by propensity score-matching (PSM).

RESULTS

After PSM, the 1-year, 3-year, and 5-year OS rates were 91.4, 71.5, and 57.1% in the TACE group, and 96.6, 81.8, and 72.1% in the TLR group. The 1-year, 3-year, and 5-year DFS rates were 50.6, 22.6, and 6.8% in the TACE group, and 77.3, 56.3, and 38.7% in the TLR group. Compared with the TACE group, the TLR group showed significantly longer OS (HR, 0.528; 95% CI: 0.315-0.887; P =0.014) and DFS (HR, 0.388; 95% CI: 0.260-0.580; P <0.001). In patients beyond up-to-seven criterion, no difference was observed with OS (HR, 0.708; 95% CI: 0.354-1.419; P =0.329). LR following the complete response to TACE was safety.

CONCLUSIONS

This study suggests that intermediate-stage HCC patients could benefit from LR following the complete response to TACE, resulting in longer OS and DFS. In addition, patients beyond up-to-seven could not benefit from the LR treatments.

摘要

背景

高肿瘤复发率危及完全经动脉化疗栓塞（TACE）治疗后完全缓解的肝细胞癌（HCC）患者的长期生存。本研究旨在评估完全缓解 TACE 后行肝切除术（LR）对中期 HCC 的生存获益。

方法

本研究纳入了 2011 年 1 月至 2021 年 12 月期间，来自中国三个机构的 281 例完全缓解 TACE 后持续观察（TACE 组）或行 LR（TLR 组）的中期 HCC 患者。通过倾向评分匹配（PSM）比较两组患者的总生存（OS）和无病生存（DFS）。

结果

PSM 后，TACE 组 1 年、3 年和 5 年 OS 率分别为 91.4%、71.5%和 57.1%，TLR 组分别为 96.6%、81.8%和 72.1%。TACE 组 1 年、3 年和 5 年 DFS 率分别为 50.6%、22.6%和 6.8%，TLR 组分别为 77.3%、56.3%和 38.7%。与 TACE 组相比，TLR 组的 OS（HR，0.528；95%CI：0.315-0.887；P=0.014）和 DFS（HR，0.388；95%CI：0.260-0.580；P<0.001）显著延长。对于超过 7 分标准的患者，OS 无差异（HR，0.708；95%CI：0.354-1.419；P=0.329）。TACE 完全缓解后行 LR 是安全的。