Postoperative Adjuvant Trans-Arterial Chemoembolization for Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus
Postoperative Adjuvant Trans-Arterial Chemoembolization for Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus
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肝细胞癌合并门静脉癌栓患者术后辅助经动脉化疗栓塞
DOI：
10.1245/s10434-018-6438-1
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发表时间：
2018-07-01
影响因子：
3.7
通讯作者：
Ye, Qinghai
中科院分区：
文献类型：
--
作者：
Liu, Shuang;Guo, Lei;Ye, Qinghai
BackgroundIt仍然不确定肝细胞癌（HCC）和门静脉癌栓（PVTT）患者是否受益于术后辅助经动脉化疗栓塞（PA-TACE）。MethodsWe回顾性地确定了540例患者，形成粗队列，并采用倾向评分匹配分析，组装另一个队列的464例患者具有相似的基线特征。在探索性亚组中进行单变量和多变量考克斯分析以确定PA-TACE对总生存期（OS）的独立影响。结果在整个研究人群中，单变量分析显示PA-TACE与较长的OS相关[比值比（OR）= 0.55，p = 0.001]，分层分析表明PVTT类型与PA-TACE对OS的影响存在相互作用（相互作用p= 0.057）。匹配后，PA-TACE组和对照组的所有特征均均衡（allp> 0.05）。多变量考克斯分析证实，随着PVTT的扩大，PA-TACE的保护作用显著更大（I型，OR 0.66; II型，OR 0.33; III型，OR 0.33，相互作用p= 0.011）。在原始队列中，也有证据表明PVTT类型会改变治疗效果（Ⅰ型OR 0.60; Ⅱ型OR 0.32;和III型，OR分别为0.32，相互作用p= 0.011）。结论在HCC和PVTT患者中，PA-TACE与较低的死亡风险相关，特别是在累及右/左或门静脉主干的PVTT患者中，排除术后1个月不适合该手术的患者后。
BackgroundIt remains uncertain whether patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) benefit from postoperative adjuvant trans-arterial chemoembolization (PA-TACE).MethodsWe retrospectively identified 540 patients to form the crude cohort and adopted propensity score matching analysis to assemble another cohort of 464 patients with similar baseline characteristics. Univariate and multivariate Cox analyses were performed in exploratory subgroups to identify the independent effect of PA-TACE on overall survival (OS).ResultsIn the overall study population, univariate analysis showed PA-TACE was associated with longer OS [odds ratio (OR) = 0.55,p= 0.001], and stratified analyses indicated an interaction between PVTT types and PA-TACE on OS (p= 0.057 for interaction). After matching, all of the characteristics were well balanced between the PA-TACE and control groups (allp> 0.05). Multivariate Cox analysis validated that the protective role of PA-TACE was significant greater with the expansion of PVTT (type I, OR 0.66; type II, OR 0.33; and type III, OR 0.33, respectively,p= 0.011 for interaction). There also was evidence of treatment effect modification by PVTT type in the crude cohort (type I, OR 0.60; type II, OR 0.32; and type III, OR 0.32, respectively,p= 0.011 for interaction).ConclusionsIn patients with HCC and PVTT, PA-TACE was associated with a lower risk of death, particularly, among those with PVTT involving right/left or main portal vein, after excluding patients who were unsuitable for this procedure at 1 month after surgery.