Liu Yadi, Sun Shuangshuang, Chu Zhaoyin, Liu Caixia, Chen Lina, Ruan Zhengshang
Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Front Oncol. 2024 Mar 19;14:1324392. doi: 10.3389/fonc.2024.1324392. eCollection 2024.
Significant advancements in systemic treatment for hepatocellular carcinoma have been made in recent years. However, the optimal timing of systemic treatment before or after surgery remains unknown. This study aims to evaluate the impact of sequencing systemic treatment and surgical intervention on the long-term prognosis of hepatocellular carcinoma patients.
In our study, we analyzed data from patients diagnosed with primary liver cancer (2004-2015) extracted from the SEER database. Patients who underwent both systemic treatment and surgical intervention were selected, divided into preoperative and postoperative systemic therapy groups. The primary endpoint of the study is overall survival(OS), and the secondary endpoint is cancer-specific survival (CSS). Propensity score matching (PSM) reduced the influence of confounding factors, while Kaplan-Meier curves and a multivariable Cox proportional hazards model accounted for variables during survival analysis.
A total of 1918 eligible HCC patients were included, with 1406 cases in the preoperative systemic treatment group and 512 cases in the postoperative systemic treatment group. Survival analysis showed that both the preoperative group demonstrated longer median overall survival (OS) and median cancer-specific survival (CSS) before and after PSM. After conducting multivariate COX regression analysis with stepwise adjustment of input variables, the postoperative systemic treatment group continued to exhibit a higher risk of all-cause mortality (HR: 1.84, 95% CI: 1.55-2.1) and cancer-specific mortality (HR: 2.10, 95% CI: 1.73-2.54). Subgroup analysis indicated consistent results for overall survival (OS) across different subgroups.
Hepatocellular carcinoma patients from the SEER database who received preoperative systemic therapy had superior OS and CSS compared to those who received postoperative systemic therapy.
近年来，肝细胞癌的全身治疗取得了重大进展。然而，手术前或手术后全身治疗的最佳时机仍不清楚。本研究旨在评估全身治疗与手术干预的先后顺序对肝细胞癌患者长期预后的影响。
在我们的研究中，我们分析了从监测、流行病学和最终结果（SEER）数据库中提取的2004年至2015年诊断为原发性肝癌患者的数据。选择接受过全身治疗和手术干预的患者，分为术前全身治疗组和术后全身治疗组。本研究的主要终点是总生存期（OS），次要终点是癌症特异性生存期（CSS）。倾向评分匹配（PSM）减少了混杂因素的影响，而生存分析期间，Kaplan-Meier曲线和多变量Cox比例风险模型考虑了变量。
共纳入1918例符合条件的肝癌患者，术前全身治疗组1406例，术后全身治疗组512例。生存分析表明，术前组在PSM前后均显示出较长的中位总生存期（OS）和中位癌症特异性生存期（CSS）。在对输入变量进行逐步调整的多变量COX回归分析后，术后全身治疗组全因死亡率（HR：1.84，95%CI：1.55-2.1）和癌症特异性死亡率（HR：2.10，95%CI：1.73-2.54）仍然较高。亚组分析表明，不同亚组的总生存期（OS）结果一致。
与接受术后全身治疗的患者相比，SEER数据库中接受术前全身治疗的肝细胞癌患者的OS和CSS更佳。
