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Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion

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World Journal of Gastroenterology 2017年第41期23卷 7415-7424页

作者： Jia-Zhou Ye Jun-Ze Chen Zi-Hui Li Tao Bai Jie Chen Shao-Liang Zhu Le-Qun Li Fei-Xiang Wu Department of Hepatobiliary Surgery Affiliated Tumor Hospital of Guangxi Medical University Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor Ministry of Education Department of General Surgery The Ninth Affiliated Hospital of Guangxi Medical University

AIM To investigate the efficacy and safety of postoperative adjuvant transcatheter arterial chemoembolization(PA-TACE) in preventing tumor recurrence and improving survival in Barcelona Clinic Liver Cancer(BCLC) early(A) and intermediate(B) stage hepatocellular carcinoma(HCC) patients with microvascular invasion(MVI).METHODS A total of 519 BCLC A or B HCC patients treated by liver resection alone or followed by PA-TACE between January 2012 and December 2015 were studied retrospectively. Univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival(RFS) and overall survival(OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE. RESULTS Univariate and multivariate analyses demonstrated that serum AFP level > 400 ng/m L, tumor size > 5 cm, tumor capsule invasion, MVI, and major hepatectomy were risk factors for poor OS. Tumor capsule invasion, MVI, tumor size > 5 cm, HBV-DNA copies > 1 x 104 IU/m L, and multinodularity were risk factors for poor RFS. Multiple logistic regression identified serum AFP level > 400 ng/m L, tumor size > 5 cm, and tumor capsule invasion as independent predictors of MVI. Both OS and DFS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent liver resection alone. Patients without MVI did not show a significant difference in OS and RFS between those treated by liver resection alone or followed by *** PA-TACE is a safe adjuvant intervention and can efficiently prevent tumor recurrence and improve the survival of BCLC early-and intermediate-stage HCC patients with MVI.

关键词： Hepatocellular carcinoma Microvascular invasion postoperative adjuvant transcatheter arterial chemoembolization Recurrence-free survival Overall survival

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Prognostic factors and predictors of postoperative adjuvant transcatheter arterial chemoembolization benefit in patients with resected hepatocellular carcinoma

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World Journal of Gastroenterology 2020年第10期26卷 1042-1055页

作者： Ming-Yu Chen Sarun Juengpanich Jia-Hao Hu Win Topatana Jia-Sheng Cao Chen-Hao Tong Jian Lin Xiu-Jun Cai Department of General Surgery Sir Run-Run Shaw HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina School of Medicine Zhejiang UniversityHangzhou 310016Zhejiang ProvinceChina Engineering Research Center of Cognitive Healthcare of Zhejiang Province Hangzhou 310000Zhejiang ProvinceChina Department of General Surgery Shaoxing People’s HospitalZhejiang UniversityShaoxing 312000Zhejiang ProvinceChina Department of General Surgery Longyou People’s HospitalQuzhou 314400Zhejiang ProvinceChina

BACKGROUND postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain *** To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected *** Univariate and multivariate analyses were performed to identify the potential prognostic factors for *** order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression *** A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching *** to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both *** (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone *** addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for ***,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.

关键词： postoperative adjuvant transcatheter arterial chemoembolization Hepatocellular carcinoma Prognostic factors Predictive factors Overall survival

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Prognostic predictors for hepatocellular carcinoma patients receiving postoperative transcatheter arterial chemoembolization

Prognostic predictors for hepatocellular carcinoma patients ...

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2018年中国肿瘤标志物学术大会暨第十二届肿瘤标志物青年科学家论坛

作者：顾静娴张兴崔瑞霞张佳王志鑫贾一凡苗润晨董妍妍马小华樊海宁王海久任利黎一鸣牛文泉曲凯刘昌 Department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiaotong University Department of Hepatopancreatobiliary Surgery The Affiliated Hospital of Qinghai University Department of Hepatobiliary Surgery The Second Affiliated Hospital of Xi’an Jiaotong University Institute of Clinical Medical Sciences China-Japan Friendship Hospital

Background & Aims: We aimed to confirm the clinical effectiveness of PA-TACE in HCC patients after liver resection, and further identify the patients who could benefit most from ***: Propensity score matching(PSM) 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(OS) and recurrence-free survival(RFS) between two groups, univariate COX regression and stratified analysis were performed to screen and identify survival predictors for PA-TACE patients. The identified predictive markers were validated in an external ***: 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 [CI]: 0.420-0.855) and 0.623(95%CI: 0.449-0.866) respectively for OS and RFS. The identified prognostic predictors for PA-TACE included TNM stage, tumor size and number, hepatitis B infection, spleen diameter, preoperative serum alpha-fetoprotein(AFP), alkaline phosphatase(ALP), γ-glutamyl transpeptidase(GGT) and monocyte(MONO), and three risk signatures(aspartate aminotransferase-to-alanine aminotransferase ratio[AAR], neutrophil-to-lymphocyte ratio [NLR] and systemic immune-inflammation index[SII]).Conclusions: The treatment effectiveness of adjuvant TACE for HCC patients 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 AFP, ALP, GGT and monocytes.

关键词： hepatocellular carcinoma postoperative adjuvant transcatheter arterial chemoembolization prognostic predictor propensity score matching

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