■尽管手术切除是治疗肝癌的最有效方法之一,其治疗中央肝细胞癌(HCC)的疗效和安全性仍然难以捉摸。因此,找到综合治疗模式非常重要,如根治性切除联合新辅助放疗(neoRT)。
■纳入2015年7月至2021年4月接受根治性切除术的位于中央的HCC患者。根据新RT是否实施,这些患者被分为新辅助放疗联合肝切除(neoRT+LR)组和单纯肝切除(LR)组.研究方法采用倾向得分分析和Cox比例风险回归模型。我们生成了一个E值,以评估对未测量的混杂因素的敏感性。这项研究是一个真实的世界,基于II期临床试验的回顾性研究。
■共纳入168名患者,包括38例接受neoRT+LR治疗的患者和130例LR患者。1-,3-,5年无病生存率(DFS)为74%,新RT+LR组中的55%和39%,44%,28%,LR组中有24%,分别。新辅助放疗是术后复发的独立预后因素([HR]0.42,95%CI[0.25,0.69])。neoRT+LR与更长的无病生存期(Match,[HR]0.43,95%CI[0.24,0.76];GenMatch,[HR]0.32,95%CI[0.23,0.43];调整倾向评分,[HR]0.41,95%CI[0.23,0.73];逆概率加权,[HR]0.38,95%CI[0.22,0.65],分别)。匹配分析前后两组DFS差异有统计学意义(p值=0.005,p值=0.0024)。新辅助放疗可显著降低术后早期复发(p值<0.05)。E值分析表明对不可测量的混杂因素具有鲁棒性。
■肝切除联合新辅助放疗治疗中央型肝癌是安全有效的。改善了患者的预后,降低了早期复发的发生率。
UNASSIGNED: Although surgical resection is one of the most effective way to treat liver cancer, its efficacy and safety in treatment of centrally located hepatocellular carcinoma (HCC) remains elusive. Therefore, it is very important to find a comprehensive treatment mode, such as radical resection combined with neoadjuvant radiotherapy (neoRT).
UNASSIGNED: The centrally located HCC patients who underwent radical resection from July 2015 to April 2021 were enrolled. According to whether the neoRT was implemented or not, these patients were allocated into neoadjuvant radiotherapy combined with liver resection (neoRT+LR) and liver resection alone (LR) group. The research method used propensity-score analysis and Cox proportional-hazards regression models. We generated an E-value to assess the sensitivity to unmeasured confounding. This study is a real-world, retrospective study based on phase II clinical trial.
UNASSIGNED: A total of 168 patients were enrolled, including 38 patients treating with neoRT+LR and 130 patients with LR. The 1-, 3-, 5-year disease free survival (DFS) rates were 74%, 55% and 39% in the neoRT+LR group, and 44%, 28%, and 24% in the LR group, respectively. Neoadjuvant radiotherapy was an independent prognostic factor for postoperative recurrence ([HR]0.42, 95% CI [0.25, 0.69]). There was significant association between neoRT+LR and longer disease-free survival (Match, [HR] 0.43, 95% CI [0.24, 0.76]; GenMatch, [HR] 0.32, 95% CI [0.23, 0.43]; Adjusted for propensity score, [HR] 0.41, 95% CI [0.23, 0.73]; Inverse probability weighting, [HR] 0.38, 95% CI [0.22, 0.65], respectively). DFS before and after matching analysis was statistically different in two groups (p-value=0.005, p-value=0.0024, respectively). Neoadjuvant radiotherapy can significantly reduce the postoperative early recurrence (p-value <0.05). E-value analysis suggested robustness to unmeasured confounding.
UNASSIGNED: Liver resection combined with neoadjuvant radiotherapy was effective and safe for treatment of centrally located HCC patients, which improved the prognosis of patients and reduced the incidence of early recurrence.