中国肝细胞癌患者经动脉化疗栓塞难治性与预后的关系：一项大型回顾性队列研究
Association between transarterial chemoembolization refractoriness and prognosis in Chinese patients with hepatocellular carcinoma: a large retrospective cohort study.
作者信息
Sun Qinxue, Wu Ziliang, Yin Xi, Li Feng, Liu Ri
机构信息
Department of Interventional Radiology, Ningbo Medical Center LiHuiLi Hospital (The Affiliated LiHuiLi Hospital of Ningbo University), Ningbo, Zhejiang, China.
Department of Radiology, Mental Health Institute of Inner Mongolia Autonomous Region (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region), Hohhot, Inner Mongolia, China.
出版信息
Front Oncol. 2025 Jan 20;14:1483949. doi: 10.3389/fonc.2024.1483949. eCollection 2024.
BACKGROUND
Hepatocellular carcinoma (HCC) is commonly treated with transarterial chemoembolization (TACE) in intermediate stages. Existing international definitions of TACE refractoriness may not fully suit Chinese patients. The Chinese College of Interventionalists (CCI) proposed a tailored definition, but its impact on HCC prognosis is still limited.
METHODS
This study included 844 patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC from a multicenter dataset. Propensity score matching (PSM) was used to minimize baseline differences between the TACE-Refractoriness (n = 54) and TACE-Non-Refractoriness (n = 108) groups. Kaplan-Meier survival analysis and multivariate Cox regression models were performed to evaluate the association between TACE-Refractoriness and OS. Subgroup analyses were conducted across key clinical and tumor-related characteristics.
RESULTS
Kaplan-Meier survival analysis indicated that patients classified as TACE-Refractory exhibited significantly shorter OS compared to those categorized as TACE-Non-Refractory in both the original and matched cohorts ( < 0.001). Furthermore, multivariate analysis identified TACE refractoriness as a significant predictor of poorer OS, yielding an adjusted hazard ratio (HR) of 5.96 (95% CI: 3.39-10.5, < 0.001). Subgroup analysis further demonstrated the robustness of these findings across subgroups, except in female patients (HR = 3.0, 95% CI: 0.72-12.52; =0.131).
CONCLUSIONS
CCI-defined TACE refractoriness is associated with reduced OS in patients with BCLC stage B HCC undergoing TACE.
背景
肝细胞癌（HCC）中期通常采用经动脉化疗栓塞术（TACE）治疗。现有的TACE难治性国际定义可能并不完全适用于中国患者。中国介入医师学会（CCI）提出了一个量身定制的定义，但其对HCC预后的影响仍然有限。
方法
本研究纳入了来自多中心数据集的844例巴塞罗那临床肝癌（BCLC）B期HCC患者。采用倾向评分匹配（PSM）来最小化TACE难治组（n = 54）和TACE非难治组（n = 108）之间的基线差异。进行Kaplan-Meier生存分析和多变量Cox回归模型，以评估TACE难治性与总生存期（OS）之间的关联。对关键临床和肿瘤相关特征进行亚组分析。
结果
Kaplan-Meier生存分析表明，在原始队列和匹配队列中，被归类为TACE难治性的患者的OS明显短于被归类为TACE非难治性的患者（<0.001）。此外，多变量分析确定TACE难治性是OS较差的一个重要预测因素，调整后的危险比（HR）为5.96（95%CI：3.39 - 10.5，<0.001）。亚组分析进一步证明了这些发现在各亚组中的稳健性，但在女性患者中除外（HR = 3.0，95%CI：0.72 - 12.52；P = 0.131）。
结论
CCI定义的TACE难治性与接受TACE治疗的BCLC B期HCC患者的OS降低相关。
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