术前放疗降低中央型肝细胞癌患者肝切除术后复发风险的临床研究  

Clinical study on preoperative radiotherapy before hepatectomy for reducing postoperative recurrence risk in patients with central hepatocellular carcinoma

作　　者：陶常诚 荣维淇 吴凡 王黎明 吴健雄 Tao Changcheng;Rong Weiqi;Wu Fan;Wang Liming;Wu Jianxiong(Department of Hepatobiliary Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京100021

出　　处：《肿瘤研究与临床》2024年第2期81-87,共7页Cancer Research and Clinic

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2020L05)。

摘　　要：目的探讨术前放疗对肝切除术治疗的中央型肝细胞癌患者术后复发的影响。方法回顾性队列研究。回顾性收集2016年1月至2019年1月中国医学科学院北京协和医学院肿瘤医院接受手术治疗的142例中央型肝细胞癌患者临床病理资料。根据术前是否接受放疗,将患者分为术前放疗组(30例)和单纯手术组(112例)。主要观察指标为无复发生存(RFS)及术中出血量、手术时间和术后并发症发生情况。采用Kaplan-Meier法进行生存分析,组间比较采用log-rank检验;通过标准化均数差(SMD)评价各因素两组间是否存在差异;采用Cox比例风险模型分析行肝切除术的中央型肝细胞癌患者RFS的影响因素;采用倾向得分匹配(PSM)、回归模型调整倾向得分(CAPS)以及逆概率加权(IPTW)方法研究暴露因素及混杂变量与RFS的关系;敏感性分析采用E值评估未测量混杂因素对结果的潜在影响。结果术前放疗组和单纯手术组中男性分别占96.7%(29/30)、87.5%(98/112),年龄分别为(55±10)岁和(54±12)岁。PSM法匹配前,两组间性别、丙型肝炎患者比例、丙氨酸氨基转移酶、血清清蛋白、甲胎蛋白、术后病理卫星结节、肿瘤数量均存在差异(均SMD>0.1)。共26对患者匹配成功,术前放疗组和单纯手术组匹配后基线特征均无差异(均SMD<0.1)。单因素Cox回归分析示术前放疗、肿瘤数量、肿瘤长径以及术后病理卫星结节是RFS的影响因素(均P<0.05);多因素Cox回归分析示术前放疗是行肝切除术的中央型肝细胞癌患者RFS的独立保护因素(HR=0.55,95%CI:0.31~0.97,P=0.038),肿瘤长径(HR=1.08,95%CI:1.02~1.15,P=0.008)、有术后病理卫星结节(HR=1.97,95%CI:1.21~3.19,P=0.006)为RFS的独立危险因素。术前放疗与中央型肝细胞癌患者较优的RFS相关(PSM,HR=0.41,95%CI:0.20~0.86,P=0.018;CAPS,HR=0.42,95%CI:0.20~0.87,P=0.019;IPTW,HR=0.41,95%CI:0.22~0.76,P=0.005)。匹配前,术前放疗组术后1、3、5年RFS率分别为7Objective To investigate the effect of preoperative radiotherapy on postoperative recurrence in central hepatocellular carcinoma patients treated by hepatectomy.Methods A retrospective cohort study was conducted.Clinicopathological data of 142 patients with central hepatocellular carcinoma who underwent surgical treatment at the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016 to January 2019 were retrospectively collected.According to whether they received preoperative radiotherapy or not,the patients were divided into preoperative radiotherapy group(30 cases)and surgery-only group(112 cases).The main observation indexes were recurrence-free survival(RFS),intraoperative bleeding amount,operation time and the occurrence of postoperative complications.Kaplan-Meier method was used for survival analysis,and log-rank test was used for intergroup comparisons;the differences between the two groups for each factor were evaluated by standardized mean difference(SMD);Cox proportional hazards model was used to analyze the influencing factors of RFS in central hepatocellular carcinoma patients with hepatectomy.Propensity score matching(PSM),regression model-adjusted propensity score(CAPS)and inverse probability of treatment weighting(IPTW)methods were used to investigate the relationship between exposure factors and confounding variables and RFS.Sensitivity analysis was performed using E-value to assess the potential impact of unmeasured confounders on outcomes.Results Men comprised 96.7%(29/30)and 87.5%(98/112)of the preoperative radiotherapy and surgery-only groups,with ages of(55±10)years old and(54±12)years old,respectively.Before matching by the PSM method,there were differences in gender,proportion of patients with hepatitis C,alanine aminotransferase,serum albumin,alpha-fetoprotein,satellite nodules by postoperative pathology,and number of tumors between the two groups(all SMD>0.1).A total of 26 pairs of patients were successfully matched,and there was no dif

关 键 词：癌 肝细胞 肝切除术 放射疗法 复发 

分 类 号：R735.7[医药卫生—肿瘤]