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ejgh:肝细胞癌患者接受辅助经动脉化疗栓塞治疗的预后预测因素-ag捕鱼平台

文字: 2019-12-17    浏览次数:438    


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. 

目的

确定肝细胞癌肝切除术后辅助经动脉化疗栓塞(pa-tace)的临床疗效,并进一步明确哪些患者最能从pa-tace中获益。

 

pantients 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. 

患者和方法

在接受和未接受pa-tace的肝切除术患者中,按照12的比例进行倾向性评分匹配。采用kaplan-meier分析法比较两组患者的总生存和无复发生存。采用单变量cox回归和分层分析筛选并识别pa-tace患者的生存预测因素。在外部队列中对已识别的预测标记进行验证。

 

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 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). 

结果

倾向分析将pa-tace组的116例患者与对照组的232例患者进行了匹配。一系列的配对生存曲线(对数秩p=0.0090.008)示出pa-tace明显的保护作用,总生存期和无复发生存期的危险比分别为0.599(95%ci:0.420-0.855)0.623(95%ci:0.449-0.866)。所确定的pa-tace预后预测因素包括tnm分期,肿瘤大小和数量,乙型肝炎感染,脾脏直径,术前血清α-甲胎蛋白,碱性磷酸酶,γ-谷氨酰转肽酶和单核细胞,以及三个风险特征(天冬氨酸转氨酶与丙氨酸转氨酶比值,中性粒细胞与淋巴细胞比值和全身免疫炎症指数)。

 

conclusions

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.

结论

本研究证实了辅助经动脉化疗栓塞对肝细胞癌术后患者的治疗效果,并确定了pa-tace的最佳获益患者群,包括晚期肿瘤患者、门静脉高压症患者,以及术前血清α-甲胎蛋白、碱性磷酸酶、γ-谷氨酰转肽酶水平和单核细胞偏高的患者。