Prognostic predictors for patients with hepatocellular carcinoma receiving adjuvant transcatheter arterial chemoembolization

医学 经导管动脉化疗栓塞 肝细胞癌 危险系数 内科学 胃肠病学 置信区间 比例危险模型 单变量分析 倾向得分匹配 多元分析
作者
Jingxian Gu,Shouxin Zhang,Ruixia Cui,Jia Zhang,Zhixin Wang,Yifan Jia,Runchen Miao,Yanyan Dong,Xiaohua Ma,Haining Fan,Haijiu Wang,Li Ren,Yiming Li,Wenquan Niu,Jingyao Zhang,Kai Qu,Haibo Liu
出处
期刊:European Journal of Gastroenterology & Hepatology [Ovid Technologies (Wolters Kluwer)]
卷期号:31 (7): 836-844 被引量:12
标识
DOI:10.1097/meg.0000000000001346
摘要

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.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.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 α-fetoprotein, alkaline phosphatase, γ-glutamyl transpeptidase and monocyte, and three risk signatures (aspartate aminotransferase-to-alanine aminotransferase ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index).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 α-fetoprotein, alkaline phosphatase, γ-glutamyl transpeptidase, and monocytes.
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