背景:尽管术中放疗(IORT)在恶性肿瘤治疗中的疗效和安全性,比如乳腺癌,已经被记录在案,目前尚不清楚这种治疗对伴有微血管侵犯(MVI)的中央肝细胞癌(HCC)是否有效.
目的:本研究旨在探讨IORT治疗合并MVI的中央HCC的疗效和安全性。
结果:位于中央的HCC患者,在2016年1月至2020年1月期间接受手术的患者被纳入.然后将患者队列分为两组:接受IORT联合肝切除术(IORT+LR)或单独LR(LR)的患者。进行倾向评分匹配和Cox比例风险回归分析。Kaplan-Meier方法用于估计无复发生存率(RFS),采用对数秩检验确定各组间RFS是否存在差异.进行亚组分析以评估不同MVI分级患者的RFS和早期复发率的差异。生成E值以测量对未测量的混杂因素的敏感性。总的来说,97名患者入选,其中27人接受了IORT+LR,70人单独接受了LR。1-,3-,IORT+LR组的5年RFS率为66%,50%,32%,分别,而LR组为54%,37%,26%,分别。经过匹配分析,23例患者成功匹配,发现RFS在两组之间存在显着差异(p=0.04)。IORT是RFS的独立预后因素(风险比0.46[95%置信区间0.21-0.99])。在亚组分析中,在MVI(M1级)患者中,IORTLR和LR组之间的RFS存在显着差异(p=.0067)。术后早期复发率显著降低(p<0.05)。手术后两组均无严重并发症。基于E值,结果对于未测量的混杂因素似乎是稳健的.
结论:IORT+LR提供了安全的,MVI位于中央的HCC患者的可行治疗,随着预后的改善和早期复发率的降低。
Although the efficacy and safety of intraoperative radiotherapy (IORT) in the treatment of malignant tumours, such as breast cancer, have been documented, it remains unclear whether this treatment is effective for centrally located hepatocellular carcinoma (HCC) with microvascular invasion (MVI).
This study aimed to explore the efficacy and safety of IORT in the treatment of centrally located HCC with MVI.
Patients with centrally located HCC, who underwent surgery between January 2016 and January 2020, were enrolled. The patient cohort was then allocated to two groups: those who underwent IORT combined with liver resection (IORT+LR); or LR alone (LR). Propensity score matching and Cox proportional hazards regression analyses were performed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and the log-rank test was used to determine whether RFS differed between the groups. Subgroup analysis was performed to evaluate differences in RFS and early recurrence rates in patients with different MVI grades. E-values were generated to measure the sensitivity to unmeasured confounding factors. In total, 97 patients were enrolled, 27 of whom underwent IORT+LR and 70 underwent LR alone. The 1-, 3-, and 5-year RFS rates in the IORT+LR group were 66%, 50%, and 32%, respectively, whereas those in the LR group were 54%, 37%, and 26%, respectively. After matching analysis, 23 patients were successfully matched, and RFS was found to be significantly different between the two groups (p = .04). IORT was an independent prognostic factor for RFS (hazard ratio 0.46 [95% confidence interval 0.21-0.99]). In subgroup analysis, RFS between the IORT+LR and LR groups was significantly different in patients with MVI (M1 grade) (p = .0067). The postoperative early recurrence rate was significantly reduced with IORT (p < .05). No serious complications were reported in either group following surgery. Based on E-values, the results appeared to be robust against unmeasured confounding factors.
IORT+LR provided safe, feasible treatment for patients with centrally located HCC with MVI, along with an improvement in prognosis and lower early recurrence rates.