基于倾向性匹配肝切除术后联合经动脉化疗栓塞临床疗效研究

Analysis of prognostic predictors affecting hepatectomy combined with postoperative adjuvant TACE in patients with hepatocellular carcinoma:A double-centered propensity-score matching study

目的探讨肝切除术后联合经动脉化疗栓塞术(TACE)对肝细胞癌(HCC)病人治疗的有效性。方法回顾性分析2005年1月至2016年12月西安交通大学第一附属医院和2011年1月至2017年6月青海大学附属医院收治的行肝切除术的593例HCC病人的临床资料,根据术后是否联合TACE治疗分为联合组和手术组,并按临床信息进行倾向性得分匹配(PSM)后纳入348例,绘制Kaplan-Meier曲线比较两组病人预后,利用Cox单因素回归和分层分析筛选和确定预后预测指标。结果 Log-rank检验结果显示,联合组病人总生存期和无病生存期均长于手术组,差异有统计学意义(P<0.05)。单因素Cox回归分析及分层分析筛选出的肝切除术后辅助性TACE的预后预测指标包括:乙型肝炎患病情况、术前甲胎蛋白(AFP)水平、肿瘤TNM分期、肿瘤最大直径和HCC病灶数目。结论肝切除术后联合TACE能显著改善HCC病人预后,尤其适合应用于合并乙型肝炎、门静脉高压、术前AFP水平较高、分期偏晚的HCC病人。

Objective To confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization（TACE） in HCC patients after liver resection, and further identify the patients who could benefit most from postoperative adjuvant TACE. Methods The clinical data of 593 consecutive patients were retrospectively collected from the First Affiliated Hospital of Xi＇ an Jiaotong University from January 2005 to December 2016 and the Affiliated Hospital of Qinghai University between January 2011 and June 2017. Propensity score matching （PSM） was used between hepatectomy patients with and without receiving postoperative adjuvant TACE and finally a total of 348 patients were matched. Kaplan-Meier analysis was performed to compare overall survival （OS） and recurrence-free survival （RFS） between the two groups, univariate COX regression and stratified survival analysis were performed to screen and identify survival predictors for postoperative adjuvant TACE patients. Results The Log-rank tests showed both OS and RFS of the patients in postoperative adjuvant TACE group were significantly longer than those in the control group （P〈0.05）. The identified prognostic predictors by Cox regression and stratified survival analysis included hepatitisB infection, spleen diameter, preoperative serum alpha-fetoprotein （AFP）, TNM stage, tumor size, tumor number. Conclusion Postoperative adjuvant TACE could improve prognosis markedly in HCC patients, particularly in late-stage ones with hepatitis B, portal hypertension, or higher level of preoperative AFP.