期刊
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
卷 31, 期 7, 页码 836-844出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEG.0000000000001346
关键词
hepatocellular carcinoma; postoperative adjuvant transcatheter arterial chemoembolization; prognostic predictor; propensity score matching
资金
- National Science Foundation of China [81773128, 81472247]
- Natural Science Basic Research Plan in Shaanxi Province of China [2017JM8039]
- Fundamental Research Fund for the Central Universities [2016qngz05]
- Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University [XJTU1AF-CRF-2015-003, XJTU1AF-CRF-2015-011]
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.
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