iLIVER · 2026
Comparison of surgical treatment versus transcatheter arterial chemoembolization combined with systemic treatment for spontaneously ruptured hepatocellular carcinoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Jianwei, Pan Xiaorong, Bai Shilei, Lu Caixia, Li Chunmei, Liu Liu, Zhai Jian, Xue Hui, Xia Yong, Wang Kui
Аннотация
BACKGROUND AND AIMS: This study aimed to evaluate the efficacy of hepatectomy versus transcatheter arterial chemoembolization (TACE), both combined with targeted therapy and immunotherapy, in patients with spontaneously ruptured hepatocellular carcinoma (HCC).
METHODS: We retrospectively reviewed the data of 78 patients with spontaneously ruptured HCC. Patients received targeted therapy and immunotherapy and were stratified into the hepatectomy group (n = 43) or TACE group (n = 35) based on the local treatment modality. Postoperative complications and long-term prognosis were compared.
RESULTS: Multivariable analysis identified TACE (hazard ratio [HR]: 3.394, 95% confidence interval [CI]: 1.777-6.483 for overall survival [OS]; HR: 4.763, 95% CI: 2.601-8.723 for event-free survival [EFS] and vascular invasion (VI) (HR: 3.141, 95% CI: 1.554-6.346 for OS; HR: 3.277, 95% CI: 1.713-6.269 for EFS) as independent risk factors for OS and EFS. An AFP level > 400 ng/mL (HR: 1.944, 95% CI: 1.075-3.518) was identified as an independent risk factor for EFS. The 1-, 3-, and 5-year OS rates for the hepatectomy and TACE groups were 88.4%, 53.9%, and 31.8% and 71.4%, 22.9%, and NA (p = 0.001), respectively, and the 1-, 3-, and 5-year EFS rates were 72.1%, 26.3%, and 23.0% and 45.7%, 0%, and 0% (p < 0.001). Multivariable analysis following propensity score matching showed that TACE, VI, and AFP > 400 ng/mL remained independent risk factors for OS and EFS. The incidence of complications associated with hepatectomy was significantly lower than that associated with TACE (p = 0.031). There were no significant differences between the groups regarding Grade III/IV complications related to hepatectomy or TACE or any grade or Grade III/IV complications related to targeted therapy and immunotherapy (p > 0.05).
CONCLUSIONS: Compared with TACE combined with targeted therapy and immunotherapy, hepatectomy combined with targeted therapy and immunotherapy is a safe and effective treatment for patients with spontaneously ruptured HCC. It does not increase the incidence of complications and offers improved long-term prognosis.
METHODS: We retrospectively reviewed the data of 78 patients with spontaneously ruptured HCC. Patients received targeted therapy and immunotherapy and were stratified into the hepatectomy group (n = 43) or TACE group (n = 35) based on the local treatment modality. Postoperative complications and long-term prognosis were compared.
RESULTS: Multivariable analysis identified TACE (hazard ratio [HR]: 3.394, 95% confidence interval [CI]: 1.777-6.483 for overall survival [OS]; HR: 4.763, 95% CI: 2.601-8.723 for event-free survival [EFS] and vascular invasion (VI) (HR: 3.141, 95% CI: 1.554-6.346 for OS; HR: 3.277, 95% CI: 1.713-6.269 for EFS) as independent risk factors for OS and EFS. An AFP level > 400 ng/mL (HR: 1.944, 95% CI: 1.075-3.518) was identified as an independent risk factor for EFS. The 1-, 3-, and 5-year OS rates for the hepatectomy and TACE groups were 88.4%, 53.9%, and 31.8% and 71.4%, 22.9%, and NA (p = 0.001), respectively, and the 1-, 3-, and 5-year EFS rates were 72.1%, 26.3%, and 23.0% and 45.7%, 0%, and 0% (p < 0.001). Multivariable analysis following propensity score matching showed that TACE, VI, and AFP > 400 ng/mL remained independent risk factors for OS and EFS. The incidence of complications associated with hepatectomy was significantly lower than that associated with TACE (p = 0.031). There were no significant differences between the groups regarding Grade III/IV complications related to hepatectomy or TACE or any grade or Grade III/IV complications related to targeted therapy and immunotherapy (p > 0.05).
CONCLUSIONS: Compared with TACE combined with targeted therapy and immunotherapy, hepatectomy combined with targeted therapy and immunotherapy is a safe and effective treatment for patients with spontaneously ruptured HCC. It does not increase the incidence of complications and offers improved long-term prognosis.