Prognostic predictors for patients with hepatocellular carcinoma receiving adjuvant transcatheter arterial chemoembolization
Prognostic predictors for patients with hepatocellular carcinoma receiving adjuvant transcatheter arterial chemoembolization
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接受辅助经导管动脉化疗栓塞术的肝细胞癌患者的预后预测因素
DOI：
10.1097/meg.0000000000001346
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发表时间：
2019-07-01
影响因子：
2.1
通讯作者：
Liu, Chang
中科院分区：
文献类型：
--
作者：
Gu, Jingxian;Zhang, Xing;Liu, Chang
目的探讨肝切除术后肝细胞癌患者术后辅助经导管动脉化疗栓塞（PA-TACE）的临床疗效，并进一步确定PA-TACE获益最多的患者。患者和方法在肝切除术患者和未接受PA-TACE的患者之间采用1:2的倾向性评分匹配。采用Kaplan-Meier分析比较两组患者的总生存率和无复发生存率。采用单因素COX回归和分层分析筛选和确定PA-TACE患者的生存预测因素。确定的预测标记在外部队列中得到验证。结果PA-TACE组116例，对照组232例。匹配序列的生存曲线显示PA-TACE具有明显的保护作用（log-rank P = 0.009和0.008），总生存期和无复发生存期的风险比分别为0.599（95%可信区间：0.420-0.855）和0.623（95%可信区间：0.449-0.866）。确定的PA-TACE预后预测因子包括TNM分期、肿瘤大小和数量、乙型肝炎感染、脾直径、术前血清a-胎蛋白、碱性磷酸酶、。-谷氨酰转肽酶和单核细胞，以及三个风险标志（天冬氨酸转氨酶与丙氨酸转氨酶比率，中性粒细胞与淋巴细胞比率和全身免疫炎症指数）。结论本研究验证了肝细胞癌术后辅助经导管动脉化疗栓塞的治疗效果，并确定了PA-TACE的最佳候选者，包括晚期肿瘤、门脉高压症、术前血清a胎蛋白、碱性磷酸酶、高水平的患者。谷氨酰转肽酶和单核细胞。
Objectives We aimed to confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in patients with hepatocellular carcinoma after liver resection, and further identify the patients who could benefit most from PA-TACE.Patients and methods Propensity score matching at a ratio of 1 : 2 was used between hepatectomy patients with and without receiving PA-TACE. Kaplan-Meier analysis was performed to compare overall survival and recurrence-free survival between two groups. Univariate COX regression and stratified analyses were performed to screen and identify survival predictors for PA-TACE patients. The identified predictive markers were validated in an external cohort.Results The propensity analysis matched 116 patients in PA-TACE group to 232 in the control group. Visible protective effect of PA-TACE was shown by survival curves in matched series (log-rank P = 0.009 and 0.008), with hazard ratio of being 0.599 (95% confidence interval: 0.420-0.855) and 0.623 (95% confidence interval: 0.449-0.866), respectively, for overall survival and recurrence-free survival. The identified prognostic predictors for PA-TACE included TNM stage, tumor size and number, hepatitis B infection, spleen diameter, preoperative serum a-fetoprotein, alkaline phosphatase,.-glutamyl transpeptidase and monocyte, and three risk signatures (aspartate aminotransferase-to-alanine aminotransferase ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index).Conclusion The treatment effectiveness of adjuvant transcatheter arterial chemoembolization for patients with hepatocellular carcinoma after surgery was validated in this study, and the best candidates for PA-TACE were identified as well, including patients with late-stage tumor, portal hypertension, and high preoperative serum levels of a-fetoprotein, alkaline phosphatase,.glutamyl transpeptidase, and monocytes.