Effect of postoperative prophylactic TACE on prognosis of patients with intrahepatic cholangiocarcinoma

doi:10.3877/cma.j.issn.2095-3232.2022.03.011

Abstract

Abstract:

Objective

To evaluate the effect of postoperative prophylactic TACE on the prognosis of patients with intrahepatic cholangiocarcinoma (ICC).

Methods

Clinical data of 309 patients with ICC who underwent surgery in Shanghai Eastern Hepatobiliary Surgery Hospital from January 2013 to December 2016 were retrospectively analyzed. Among them, 208 patients were male and 101 female, aged from 27 to 78 years,with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the surgery group (n=218) and surgery + TACE group (n=91) according to whether they received prophylactic TACE treatment after surgery. The risk factors of the survival and recurrence of ICC patients were identified by Cox proportional hazards regression model. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Results

Postoperative TACE was an independent protective factor of the overall survival (OS) (HR=0.628, 95%CI: 0.420-0.939; P<0.05) and recurrence-free survival (RFS) (HR=0.663, 95%CI: 0.464-0.947; P<0.05) of ICC patients. In the surgery + TACE group, the 1-, 3- and 5-year OS were 78.5%, 59.0%, 49.4%, and were 63.9%, 39.5%, 37.5% in the surgery group, where significant differences were observed (χ²=7.438, P<0.05). In the surgery +TACE group, the 1-, 3- and 5-year RFS were 62.5%, 50.6%, 37.1%, and were 48.4%, 30.5%, 26.8% in the surgery group, where significant differences were observed (χ²=6.521, P<0.05). Sub-group analysis revealed that OS and RFS of patients with TNM stage Ⅲ-Ⅳ ICC in the surgery + TACE group were significantly better than those in the surgery group (χ²=5.954, 5.451; P<0.05).

Conclusions

For ICC patients, especially those with TNM stage Ⅲ or Ⅳ ICC, postoperative prophylactic TACE can effectively prolong the survival time and reduce the tumor recurrence rate.

Key words: Liver neoplasms, Chemoembolization, therapeutic, Hepatectomy, Prognosis, Impact factors

Wenfeng Lu, Yong Fu, Kai Yan, Jianyong Yuan, Peiqin Chen, Haibin Zhang. Effect of postoperative prophylactic TACE on prognosis of patients with intrahepatic cholangiocarcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(03): 268-272.

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Figures/Tables 4

References 23

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指标		手术组	手术+TACE组
性别（例，男/女）		133/85	75/16
年龄（岁，±s）		55±11	52±11
肝内胆管结石（例）		15	04
肝血吸虫病（例）		02	00
HBsAg阳性（例）		1100	51
肝硬化（例）		44	26
AFP[μg/L，M（Q_R）]		3.9（5.5）	05.3（22.8）
CEA[μg/L，M（Q_R）]		2.6（3.1）	2.3（2.0）
CA19-9[kU/L，M（Q_R）]		041（273）	036（110）
TB [μmol/L，M（Q_R）]		13.4（7.6）	12.9（7.1）0
ALB（g/L，±s）		42±6	43±3
ALT[U/L，M（Q_R）]		29（30）	30（20）
AST[U/L，M（Q_R）]		30（20）	30（17）
GGT[U/L，M（Q_R）]		076（118）	78（84）
PT（s，±s）		12.1±1.2	12.0±1.3
WBC[×10⁹/L，M（Q_R）]		6.2（3.1）	5.9（2.5）
Hb[g/L，M（Q_R）]		135（23）	142（20）0
Plt[×10⁹/L，M（Q_R）]		165（81）	168（81）0
Child-Pugh分级（例）
	A级	2150	90
	B级	03	01
解剖性肝切除（例）		89	35
术中输血（例）		34	14
淋巴结转移（例）		75	37
邻近组织侵犯（例）		27	4
门静脉癌栓（例）		22	12
微血管侵犯（例）		25	9
肿瘤直径[cm，M（Q_R）]		5.3（4.5）	6.0（4.0）
多发肿瘤（例）		75	33
TNM分期（例）
	Ⅰ~Ⅱ期	1260	61
	Ⅲ~Ⅳ期	92	30

指标		手术组	手术+TACE组
性别（例，男/女）		133/85	75/16
年龄（岁，±s）		55±11	52±11
肝内胆管结石（例）		15	04
肝血吸虫病（例）		02	00
HBsAg阳性（例）		1100	51
肝硬化（例）		44	26
AFP[μg/L，M（Q_R）]		3.9（5.5）	05.3（22.8）
CEA[μg/L，M（Q_R）]		2.6（3.1）	2.3（2.0）
CA19-9[kU/L，M（Q_R）]		041（273）	036（110）
TB [μmol/L，M（Q_R）]		13.4（7.6）	12.9（7.1）0
ALB（g/L，±s）		42±6	43±3
ALT[U/L，M（Q_R）]		29（30）	30（20）
AST[U/L，M（Q_R）]		30（20）	30（17）
GGT[U/L，M（Q_R）]		076（118）	78（84）
PT（s，±s）		12.1±1.2	12.0±1.3
WBC[×10⁹/L，M（Q_R）]		6.2（3.1）	5.9（2.5）
Hb[g/L，M（Q_R）]		135（23）	142（20）0
Plt[×10⁹/L，M（Q_R）]		165（81）	168（81）0
Child-Pugh分级（例）
	A级	2150	90
	B级	03	01
解剖性肝切除（例）		89	35
术中输血（例）		34	14
淋巴结转移（例）		75	37
邻近组织侵犯（例）		27	4
门静脉癌栓（例）		22	12
微血管侵犯（例）		25	9
肿瘤直径[cm，M（Q_R）]		5.3（4.5）	6.0（4.0）
多发肿瘤（例）		75	33
TNM分期（例）
	Ⅰ~Ⅱ期	1260	61
	Ⅲ~Ⅳ期	92	30

变量	单因素分析			多因素分析
变量	HR	95%CI	P值	HR	95%CI	P值
CA19-9	1.001	1.001~1.002	<0.001	1.001	1.000~1.001	0.002
ALB	0.956	0.932~0.981	<0.002	0.965	0.935~0.996	0.029
GGT	1.001	1.001~1.002	<0.001	1.001	1.000~1.002	0.039
邻近组织侵犯	2.359	1.478~3.767	<0.001	1.844	1.125~3.022	0.015
多发肿瘤	1.845	1.318~2.582	<0.001	1.488	1.036~2.136	0.031
术后TACE	0.589	0.400~0.865	<0.006	0.628	0.420~0.939	0.023

变量	单因素分析			多因素分析
变量	HR	95%CI	P值	HR	95%CI	P值
CA19-9	1.001	1.001~1.002	<0.001	1.001	1.000~1.001	0.002
ALB	0.956	0.932~0.981	<0.002	0.965	0.935~0.996	0.029
GGT	1.001	1.001~1.002	<0.001	1.001	1.000~1.002	0.039
邻近组织侵犯	2.359	1.478~3.767	<0.001	1.844	1.125~3.022	0.015
多发肿瘤	1.845	1.318~2.582	<0.001	1.488	1.036~2.136	0.031
术后TACE	0.589	0.400~0.865	<0.006	0.628	0.420~0.939	0.023

变量	单因素分析			多因素分析
变量	HR	95%CI	P值	HR	95%CI	P值
CA19-9	1.001	1.001~1.002	<0.001	1.001	1.000~1.001	<0.001
ALB	0.957	0.936~0.977	<0.001	0.961	0.936~0.986	00.003
微血管侵犯	2.127	1.380~3.278	<0.001	1.759	1.075~2.878	00.024
多发肿瘤	1.783	1.317~2.412	<0.001	1.543	1.122~2.124	00.008
术后TACE	0.644	0.458~0.905	<0.011	0.663	0.464~0.947	00.024

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