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Title: Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience.
Author: Zhang Y, Huang G, Wang Y, Liang L, Peng B, Fan W, Yang J, Huang Y, Yao W, Li J.
Journal: Oncologist; 2016 Dec; 21(12):1442-1449. PubMed ID: 27486202.
Abstract:
INTRODUCTION: This study evaluated long-term outcomes of salvage surgery as additional therapy following downstaging of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) in patients with initially unresectable HCC. METHODS: A retrospective analysis was performed of 831 consecutive patients with unresectable HCC who underwent TACE as initial treatment between June 2004 and December 2014. Of these, 82 patients with downstaged resectable HCC were enrolled in this study: 43 received salvage surgery (S group) and the remaining 39, who refused salvage resection, were the control group (T group). The primary endpoint was overall survival (OS). RESULTS: The median OS in the S and T groups was 49 and 31 months, respectively (p = .027). The 2-, 4-, and 5-year survival rates were 93%, 47%, and 26% in the S group and 74%, 18%, and 10% in the T group, respectively (p = .019). Treatment modality (hazard ratio [HR], 0.337; 95% confidential interval [CI], 0.184-0.616; p < .001) and response to TACE (complete vs. partial; HR, 3.154; 95% CI, 1.709-5.822; p < .001) were independent prognostic factors for survival. The median OS for patients in the complete response and partial response (PR) subgroups was 50 and 49 months, respectively, in the S group and 54 and 24 months, respectively, in the T group (p = .699 and p < .001, respectively). The median OS for HCC patients with macroscopic vascular invasion (MVI) was 58 and 30 months in the S and T groups, respectively (p = .024). CONCLUSION: Salvage surgery after downstaging of unresectable HCC had a survival benefit only for patients with MVI or a PR to TACE. IMPLICATIONS FOR PRACTICE: The results of this study suggest that salvage liver resection after downstaging of unresectable hepatocellular carcinoma in patients with a complete response to transarterial chemoembolization (TACE) has a comparable long-term outcome in this good-prognosis group. Salvage liver resection may provide a better long-term outcome compared with TACE alone, but only in patients with macroscopic vascular invasion or those with a partial response to TACE. 摘要 引言. 本研究评价了挽救性手术作为最初不可手术的肝细胞癌 (HCC) 患者在经动脉化疗栓塞 (TACE) 治疗降期后的额外治疗的远期转归。 方法. 对2004年6月至2014年12月间, 831例接受TACE作为初始治疗的不可手术HCC患者进行了回顾性分析。其中82例降期为可手术HCC的患者纳入本研究: 43例接受了挽救性手术 (S组) , 其余39例拒绝挽救性手术的患者作为对照组 (T组) 。主要终点为总生存 (OS) 。 结果. S组和T组的中位OS分别为49个月和31个月 (P=0.027) 。S组的2年、4年和5年生存率分别为93%、47%和26%, 而T组分别为74%、18%和10% (P=0.019) 。治疗形式[风险比 (HR) : 0.337, 95%置信区间 (CI) : 0.184∼0.616, P<0.001]和TACE治疗反应 (完全缓解 (CR) vs部分缓解 (PR) HR: 3.154, 95%CI: 1.709∼5.822, P<0.001) 是生存的独立预后因素。S组的CR和PR亚组患者的中位OS分别为50和49个月, T组分别为54和24个月 (P=0.699和P<0.001) 。S组和T组有肉眼血管浸润 (MVI) 的HCC患者的中位OS分别为58和30个月 (P=0.024) 。 结论. 不可手术HCC患者在降期后进行挽救性手术的生存获益仅见于MVI或TACE后达到PR者。The Oncologist 2016;21:1442–1449 对临床实践的提示: 本研究结果提示, 对于不可手术切除的肝细胞癌患者, 在经动脉化疗栓塞 (TACE) 治疗后达到完全缓解这一预后良好的患者组中, 降期后行挽救性手术的长期转归与仅行TACE相似。与仅行TACE相比, 再行挽救性肝切除术可能有更好的长期转归, 但仅限于肉眼血管浸润或TACE治疗达到部分缓解的患者。

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