中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (09): 1055-1061.DOI: 10.19538/j.cjps.issn1005-2208.2024.09.15

• 论著 • 上一篇    下一篇

免疫治疗对早中期肝细胞癌局部治疗后5年生存率的影响研究：基于安徽省肝胆外科联盟肝癌临床-生物样本库

王永帅，张    峰，张珅瑜，宋瑞鹏，蔡  伟，张树庚，王嘉倍，尹大龙，刘连新，王继洲   

  1. 中国科学技术大学附属第一医院肝胆外科 安徽省肝胆胰外科重点实验室 安徽省肝胆疾病临床研究中心，安徽合肥230001
  • 出版日期:2024-09-01 发布日期:2024-09-20

  • Online:2024-09-01 Published:2024-09-20

摘要： 目的    探讨免疫治疗对进行局部治疗的早中期肝细胞癌病人5年生存率的影响。方法    回顾性分析安徽省肝胆外科联盟肝癌临床-生物样本库中22家中心2010年2月至2024年2月收治的2609例接受局部治疗的早中期肝细胞癌病人的临床资料，采用倾向性评分匹配（PSM）按1∶1最近邻匹配法匹配，匹配后免疫治疗组和未免疫治疗组各236例。比较两组病人的总生存期（OS），用Cox回归模型分析影响病人OS的危险因素。结果    （1）PSM前，与未免疫治疗组相比，免疫治疗组病人的OS更长（P＜0.001）；PSM后，免疫治疗组病人的总体生存期仍更长（P＜0.001）。（2）PSM后，单因素分析结果显示，肝硬化（HR=0.45，95%CI 0.31~0.65，P＜0.001）、根治性手术切除（HR=0.23，95%CI 0.16~0.34，P＜0.001）、复发后免疫治疗（HR=0.59，95%CI 0.40~0.89，P=0.011）是影响病人OS的保护性因素，而肝功能Child-Pugh分级B级（HR=2.43，95%CI 1.48~3.98，P＜0.001）、肿瘤最大直径≥5 cm（HR=1.92，95%CI 1.32~2.82，P＜0.001）、甲胎蛋白≥400 μg/L（HR=1.52，95%CI 1.06~2.17，P=0.023）是影响病人OS的危险因素。多因素分析结果显示，抗病毒治疗（HR=0.62，95%CI 0.39~0.99，P=0.044）、根治性手术切除（HR=0.33，95%CI 0.21~0.51，P＜0.001）、复发后免疫治疗（HR=0.64，95%CI 0.42~0.96，P=0.031）、复发后免疫治疗（无围手术期免疫治疗）（HR=0.22，95%CI 0.08~0.62，P=0.004）是影响病人OS的独立保护性因素。结论    与仅局部治疗相比，免疫治疗可为接受局部治疗的早中期肝细胞癌病人带来一定的生存获益，延长病人OS。

关键词: 免疫治疗, 肝细胞癌, 预后, 数据库

Abstract: To investigate the effect of immunotherapy on the 5-year survival in locally treated early and middle-stage hepatocellular carcinoma undergoing local treatment. Methods    Clinical data of 2609 patients with early and middle-stage hepatocellular carcinoma treated with local therapy admitted to 22 centers from the Liver Cancer Clin-Bio Databank of Anhui Hepatobiliary Surgery Union (LCCBD_AHSU) from October 2010 to February 2024 were retrospectively analyzed. Propensity score matching (PSM) was used according to 1∶1 nearest neighbor matching method, and there were 236 patients in each group of immunotherapy and non-immunotherapy after matching. Overall survival (OS) was compared between the two groups, and the risk factors of OS were analyzed by the Cox regression model. Results     (1) Before PSM, OS was longer in the immunotherapy group compared with the non-immunotherapy group (P<0.001); after matching the PSM, the OS of patients in the immunotherapy group was still longer (P<0.001). (2) After matching the PSM, the results of the univariate analysis showed that cirrhosis (HR=0.45, 95%CI 0.31-0.65, P<0.001), radical surgical resection (HR=0.23, 95%CI 0.16-0.34, P<0.001), immunotherapy after recurrence (HR=0.59, 95%CI 0.40-0.89, P=0.011) were the protective factors for the OS of patients, while Child-Pugh class B (HR=2.43, 95%CI 1.48-3.98, P<0.001), the maximum tumor diameter ≥5 cm (HR=1.92, 95%CI 1.32-2.82, P<0.001) and alpha-fetoprotein (AFP)≥400 μg/L (HR=1.52, 95%CI 1.06-2.17, P=0.023) were the risk factors for the OS of patients. The results of the multivariate analysis showed that antiviral therapy (HR=0.62, 95%CI 0.39-0.99, P=0.044), radical surgical resection (HR=0.33, 95%CI 0.21-0.51, P<0.001) and immunotherapy after recurrence (HR=0.64, 95%CI 0.42-0.96, P=0.031), immunotherapy after recurrence (without perioperative immunotherapy) (HR=0.22, 95%CI 0.08-0.62, P=0.004) were the independent protective factors affecting the OS of patients. Conclusion    Compared with local therapy alone, immunotherapy may provide survival benefits and prolong the OS of patients with early and middle-stage hepatocellular carcinoma undergoing local treatment.

Key words: immunotherapy, hepatocellular carcinoma, prognosis, databank