单纯肝切除术与早期经动脉化疗栓塞术治疗伴微血管侵犯肝细胞癌患者的预后比较：一项回顾性队列研究
Prognosis comparison between hepatocellular carcinoma patients with microvascular invasion who received hepatectomy alone and those who underwent early PA-TACE: a retrospective cohort study.
作者信息
Ma Zhiping, Zhou Wei, Huang Heqing, Yao Yunhai
机构信息
Department of Infectious Disease, the First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Infectious Disease, Huai'an Hospital of Huai'an City, Huai'an, China.
出版信息
J Gastrointest Oncol. 2024 Jun 30;15(3):1112-1121. doi: 10.21037/jgo-24-282. Epub 2024 Jun 17.
BACKGROUND
Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) can achieve longer overall survival (OS) and disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI). We investigated whether this treatment strategy could benefit these patients by mediating the dysfunctional immunological status. Therefore, a retrospective cohort study was conducted to investigate the effect of early PA-TACE in HCC patients with MVI by measuring the levels of T helper cell 17 (Th17) and regulatory T cell (Treg).
METHODS
This study retrospectively included 472 patients with HCC undergoing hepatectomy between December 2015 and December 2018, and 115 patients with MVI confirmed by postoperative pathology were enrolled and divided into two groups of TACE group and non-TACE group according to whether TACE was performed. HCC patients with MVI. The proportion of Treg and Th17 cells in peripheral blood was measured one day before and four weeks after TACE. All patients in the two groups were followed up until death or until the study ended in December 2023. The rates of OS and progression-free survival (PFS) in patients with MVI were compared between those who received hepatectomy alone and those who underwent early PA-TACE.
RESULTS
Among 115 HCC patients with MVI from 472 patients, the study enrolled 51 patients with PA-TACE into the TACE group and 42 patients without TACE into the non-TACE group. There were no statistical differences in baseline data between the two groups (all P>0.05). The frequency of Treg among CD4+ T cells in HCC patients with PA-TACE was significantly lower than baseline (7.34%±3.61% . 5.82%±2.76%, P<0.001), and the frequency of Th17 among CD4 T cells in these patients was significantly higher than baseline (0.49%±0.28% . 0.50%±0.25%, P<0.001). Among all the patients, the median OS was 61.8 months. The OS rate and PFS rate at 12, 36, and 60 months in the TACE group were significantly higher than those in the non-TACE group (all P<0.05).
CONCLUSIONS
PA-TACE may have roles in improving survival outcomes, and restoring immune homeostasis in HCC patients with MVI after hepatectomy.
背景
术后辅助经动脉化疗栓塞术（PA-TACE）可使伴有微血管侵犯（MVI）的肝细胞癌（HCC）患者获得更长的总生存期（OS）和无病生存期（DFS）。我们研究了这种治疗策略是否能通过调节免疫功能障碍状态使这些患者获益。因此，进行了一项回顾性队列研究，通过检测辅助性T细胞17（Th17）和调节性T细胞（Treg）水平来研究早期PA-TACE对伴有MVI的HCC患者的影响。
方法
本研究回顾性纳入了2015年12月至2018年12月期间接受肝切除术的472例HCC患者，其中115例术后病理证实伴有MVI的患者被纳入研究，并根据是否进行TACE分为TACE组和非TACE组。检测伴有MVI的HCC患者TACE术前1天和术后4周外周血中Treg和Th17细胞的比例。两组所有患者均随访至死亡或至2023年12月研究结束。比较单纯接受肝切除术的患者和接受早期PA-TACE的患者中MVI患者的OS率和无进展生存期（PFS）率。
结果
在472例患者中的115例伴有MVI的HCC患者中，本研究将51例行PA-TACE的患者纳入TACE组，42例未行TACE的患者纳入非TACE组。两组基线数据无统计学差异（均P>0.05）。行PA-TACE的HCC患者CD4+T细胞中Treg的频率显著低于基线水平（7.34%±3.61%对5.82%±2.76%，P<0.001），这些患者CD4 T细胞中Th17的频率显著高于基线水平（0.49%±0.28%对0.50%±0.25%，P<0.001）。所有患者中，中位OS为61.8个月。TACE组12、36和60个月时的OS率和PFS率均显著高于非TACE组（均P<0.05）。
结论
PA-TACE可能在改善伴有MVI的HCC患者肝切除术后的生存结局及恢复免疫稳态方面发挥作用。
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