Hsu Po-Jung, Wu Szu-Yuan, Chen Wan-Ming, Chang Yu-Cheng, Chou Ta-Chun, Chiang Ming-Feng, Lee Ming-Che, Soong Ruey-Shyang
Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University No. 111, Sec. 3, Xinglong Road, Wenshan District, Taipei 116, Taiwan.
Division of Transplantation Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University Taipei 116, Taiwan.
Am J Cancer Res. 2024 Jul 15;14(7):3555-3564. doi: 10.62347/BXDX8100. eCollection 2024.
This study aimed to evaluate the impact of different pre-transplant local treatments on the survival of liver transplantation (LTx) recipients with BCLC Stage A Hepatocellular Carcinoma (HCC). We analyzed data from the Taiwan Cancer Registry and National Health Insurance Research Databases spanning 2012 to 2018. Employing propensity score matching, patients were categorized into three groups: those receiving local treatments (180 patients), hepatectomy (179 patients), and combined treatments (180 patients). The primary outcomes were overall mortality and HCC-specific death, assessed using time-varying Cox regression models and Kaplan-Meier survival analysis. During a median follow-up period of 3.92 years, all-cause mortality rates were observed as 74.44% for local treatments, 42.46% for hepatectomy, and 65.00% for combined treatments. HCC-specific mortality rates followed a similar pattern at 65.00%, 39.11%, and 59.44%, respectively. Adjusted hazard ratios demonstrated significantly elevated mortality risks associated with local and combined treatments compared to hepatectomy. Notably, the 2-year overall and HCC-specific survival rates were highest in the hepatectomy group, surpassing those observed in both the combined treatment and local treatment groups. The findings of our study highlight that for patients with BCLC Stage A HCC, undergoing hepatectomy prior to LTx is associated with superior survival outcomes compared to solely local treatments. This underscores the importance of considering hepatectomy as a vital component of the treatment strategy in this patient population.
本研究旨在评估不同的移植前局部治疗对巴塞罗那临床肝癌（BCLC）分期为A期的肝细胞癌（HCC）肝移植（LTx）受者生存的影响。我们分析了台湾癌症登记处和国民健康保险研究数据库中2012年至2018年的数据。采用倾向评分匹配法，将患者分为三组：接受局部治疗的患者（180例）、肝切除术的患者（179例）和联合治疗的患者（180例）。主要结局为总死亡率和HCC特异性死亡，使用时变Cox回归模型和Kaplan-Meier生存分析进行评估。在中位随访期3.92年期间，观察到局部治疗的全因死亡率为74.44%，肝切除术为42.46%，联合治疗为65.00%。HCC特异性死亡率也呈现类似模式，分别为65.00%、39.11%和59.44%。调整后的风险比显示，与肝切除术相比，局部治疗和联合治疗的死亡风险显著升高。值得注意的是，肝切除术组的2年总生存率和HCC特异性生存率最高，超过了联合治疗组和局部治疗组。我们的研究结果表明，对于BCLC A期HCC患者，肝移植前进行肝切除术与单纯局部治疗相比，生存结局更佳。这凸显了在这一患者群体中将肝切除术视为治疗策略重要组成部分的重要性。
