Efficacy of Adjuvant Transarterial Chemoembolization after Radical Hepatectomy in Solitary Hepatocellular Carcinoma Patients: A Retrospective Study
Efficacy of Adjuvant Transarterial Chemoembolization after Radical Hepatectomy in Solitary Hepatocellular Carcinoma Patients: A Retrospective Study
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DOI：
10.1080/08941939.2021.2021334
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发表时间：
2022-01
影响因子：
1.9
通讯作者：
Guifang Zeng;Baojia Zou;Yongliang Li;E. Lin;Xialei Liu;Pei-ping Li;Jiafan Chen;Bai-meng Zhang;Ying-bin Jia;C. Cai;Jian Li
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文献类型：
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作者：
Guifang Zeng;Baojia Zou;Yongliang Li;E. Lin;Xialei Liu;Pei-ping Li;Jiafan Chen;Bai-meng Zhang;Ying-bin Jia;C. Cai;Jian Li
背景：越来越多的研究表明，具有高危复发因素的肝细胞癌（HCC）患者术后辅助经动脉化疗栓塞（PA-TACE）具有延缓癌症复发的潜在作用，获益最大。然而，目前尚不清楚是否孤立性HCC （SHCC）患者，特别是那些没有高风险复发因素的患者也应该接受PA-TACE治疗。本研究旨在分析PA-TACE对其治疗效果。方法：回顾性纳入我院123例单行根治性肝切除术（未行肝移植组，n = 39）或随后行PA-TACE （PA-TACE组，n = 84）的SHCC患者。采用Cox比例风险回归模型、Kaplan-Meier法和log-rank检验分析预后危险因素、无病生存期（DFS）和总生存期（OS）。结果：肝硬化是SHCC患者唯一的独立危险因素。总体而言，PA-TACE组OS无改善（P = 0.977）， DFS较no -TACE组差（P = 0.045）。与此一致，在亚组分析中，微血管侵袭（MVI）阴性、肿瘤大小≤5 cm、术前甲胎蛋白(AFP) < 400 ng/ml的SHCC患者的OS （P = 0.466、P = 0.864、P = 0.488）与No TACE组相似，但DFS更差（P = 0.035、P = 0.040、P = 0.019）。此外，两组SHCC合并肝硬化患者的DFS和OS差异无统计学意义（P = 0.342, P = 0.941）。结论：PA-TACE不能改善SHCC患者的长期生存，甚至可能促进其术后肿瘤复发，特别是对于mvi阴性、肿瘤大小≤5 cm、术前AFP < 400 ng/ml的患者。
Abstract Background: More and more studies have suggested that hepatocellular carcinoma (HCC) patients with high-risk recurrence factors can benefit the most from postoperative adjuvant transarterial chemoembolization (PA-TACE) for its potential effect in delaying cancer recurrence. However, it remains unclear if solitary HCC (SHCC) patients particularly those without high-risk recurrence factors should also receive PA-TACE. This study aimed to analyze the efficacy of PA-TACE in them. Methods: Retrospectively, we enrolled 123 SHCC patients who either received radical hepatectomy alone (No TACE group, n = 39) or followed by PA-TACE (PA-TACE group, n = 84) in our institution. Prognostic risk factors, disease-free survival (DFS), and overall survival (OS) were analyzed using the Cox proportional hazard regression model, the Kaplan-Meier method, and the log-rank test. Results: Liver cirrhosis was the only independent risk factor for SHCC patients. Overall, the PA-TACE group had no improved OS (P = 0.977) but worse DFS compared with the No TACE group (P = 0.045). Consistently, in subgroup analysis, SHCC patients with negative microvascular invasion (MVI), tumor size ≤ 5 cm and preoperative alpha-fetoprotein (AFP) < 400 ng/ml had similar OS (P = 0.466, P = 0.864, P = 0.488, respectively) but even worse DFS (P = 0.035, P = 0.040, P = 0.019, respectively) than those in the No TACE group. Besides, there was no significant difference in DFS and OS between the two groups of SHCC patients with liver cirrhosis (P = 0.342, P = 0.941, respectively). Conclusions: PA-TACE may not improve the long-term survival of SHCC patients, but may even potentially promote their postoperative tumor recurrence, especially for those with MVI-negative, tumor size ≤ 5 cm, and preoperative AFP < 400 ng/ml.