中国肝癌分期Ⅲa期巨大肝癌术后辅助免疫治疗的疗效分析

Postoperative adjuvant immunotherapy for huge hepatocellular carcinoma in China liver cancer stagingⅢa

目的 探讨术后辅助免疫治疗对预防CNLCⅢa期巨大肝癌早期复发的疗效。方法 2017年6月~2022年6月本中心行手术治疗的CNLCⅢa期巨大肝癌病人48例,按是否采用术后辅助免疫治疗分为两组,实验组20例,术后辅助免疫治疗。对照组28例,术后不行辅助免疫治疗。比较两组病人无复发生存期(RFS)和总生存期(OS),应用Cox风险回归模型分析RFS和OS的影响因素。结果 实验组中位RFS 6.8个月,与对照组2.8个月比较,差异有统计学意义(P<0.05);实验组中位OS 17.2个月,与对照组7.2个月比较,差异有统计学意义(P<0.05)。实验组1年、2年RFS分别为35.0%、25.0%,与对照组比较(7.1%、0),差异有统计学意义(P<0.05);1年、2年OS实验组为65.0%、30.0%,与对照组的42.9%、14.3%比较,差异有统计学意义(P<0.05)。多因素分析显示,术前门冬氨酸氨基转移酶>40 U/L、多个肿瘤、术后辅助免疫治疗是RFS的独立影响因素;术后辅助免疫治疗、术中输血是OS的独立影响因素。结论 术后辅助免疫治疗能有效降低CNLCⅢa期巨大肝癌病人复发风险,延长病人的RFS和OS。

Objective The purpose of the study was to explore the clinical value of postoperative adjuvant immunotherapy for huge hepatocellular carcinoma(HCC)in China liver cancer staging(CNLC)Ⅲa.Methods Data of patients diagnosed as huge HCC in CNLCⅢa treated by liver resection at our center during June 2017 and July 2022 was retrospectively collected and divided into the treatment group and the control group according to whether underwent postoperative adjuvant treatment.48 cases included 20 cases in the treatment group while 28 cases in the control group were enrolled in this study.The endpoints of the study were recurrence-free survival(RFS)and overall survival(OS).Independent prognostic risk factors for OS and RFS were confirmed by Cox regression analysis.Results The median RFS in the treatment group compared to the control group was 6.8 vs.2.8 months(P<0.05)and median OS was 17.2 vs.7.2 months(P<0.05).The 1-year and 2-year RFS in the treatment group were 35.0%and 25.0%respectively while in the control group were 7.1%and 0.0%(P<0.05).The 1-year and 2-year OS in the treatment group were 65.0%and 30.0%respectively while in the control group were 42.9%and 14.3%(P<0.05).Multivariable analysis showed that preoperative aspartate transaminase(AST)>40 U/L,multiple tumors and postoperative adjuvant immunotherapy were significant prognostic factors related to RFS while postoperative adjuvant immunotherapy and intraoperative blood transfusion were significant prognostic factors related to RFS.Conclusions Postoperative adjuvant immunotherapy can effectively improve the RFS and OS of huge HCC patients in CNLCⅢa.