{"title":"术后辅助经动脉化疗栓塞延长甲胎蛋白阴性肝癌合并胆管肿瘤血栓形成患者的总生存期：一项长期回顾性队列研究。","authors":"Xin-Wei Yang, Jun Chen, Mu-Qing Yang, Rong-Zheng Ran, Hai-Yan Gu, Hua Wang, Tian-Geng You, Biao Duan, Qing-De Wang, Feng Shen, Wei-Feng Tan","doi":"10.1186/s12957-025-03917-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) is a rare clinical condition with rapid disease progression and poor prognosis. This study aimed to evaluate the prognostic value of postoperative adjuvant transarterial chemoembolization (PA-TACE) among HCC-BDTT patients after radical resection (R0).</p><p><strong>Methods: </strong>Between January 2002 and December 2010, 93 HCC-BDTT patients who underwent R0 resection were enrolled for a retrospective study, including 46 patients with PA-TACE and 47 patients without PA-TACE within two months postoperatively. The correlation between PA-TACE and the long-term prognosis of patients was analysed. Independent risk factors were identified by univariate and multivariate analysis.</p><p><strong>Results: </strong>Overall, PA-TACE did not significantly improve disease-free survival (DFS) or overall survival (OS) in the entire cohort (median OS: 25 vs. 16 months, P = 0.106). However, alpha fetoprotein (AFP)-negative patients receiving PA-TACE demonstrated significantly prolonged DFS (5-year: 50.8% vs. 11.6%, P = 0.030) and OS (5-year: 64.0% vs. 26.3%, P = 0.005). AFP (HR = 3.79, 95% CI 2.06-6.98, P < 0.001) and ALP (HR = 2.12, 95% CI 1.11-4.06, P = 0.023) were independent risk factors for OS. PA-TACE showed no benefit in AFP-positive patients (5-year OS: 0% vs. 9.4%, P = 0.859). Elevated ALP (≥ 130 U/L) correlated with worse DFS (5-year: 3.1% vs. 19.6%, P = 0.027) and OS (5-year: 8.8% vs. 22.3%, P = 0.020).</p><p><strong>Conclusion: </strong>Preoperative serum AFP and alkaline phosphatase were independent risk factors for evaluating the prognosis of HCC-BDTT. Postoperative prophylactic TACE can significantly prolong overall survival of HCC-BDTT in AFP-negative patients but not in AFP-positive cases, highlighting the need for tailored adjuvant therapies.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":"23 1","pages":"260"},"PeriodicalIF":2.5000,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219712/pdf/","citationCount":"0","resultStr":"{\"title\":\"Postoperative adjuvant transarterial chemoembolization prolongs overall survival in alpha-fetoprotein-negative hepatocellular carcinoma with bile duct tumor thrombosis: a long-term retrospective cohort study.\",\"authors\":\"Xin-Wei Yang, Jun Chen, Mu-Qing Yang, Rong-Zheng Ran, Hai-Yan Gu, Hua Wang, Tian-Geng You, Biao Duan, Qing-De Wang, Feng Shen, Wei-Feng Tan\",\"doi\":\"10.1186/s12957-025-03917-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) is a rare clinical condition with rapid disease progression and poor prognosis. This study aimed to evaluate the prognostic value of postoperative adjuvant transarterial chemoembolization (PA-TACE) among HCC-BDTT patients after radical resection (R0).</p><p><strong>Methods: </strong>Between January 2002 and December 2010, 93 HCC-BDTT patients who underwent R0 resection were enrolled for a retrospective study, including 46 patients with PA-TACE and 47 patients without PA-TACE within two months postoperatively. The correlation between PA-TACE and the long-term prognosis of patients was analysed. Independent risk factors were identified by univariate and multivariate analysis.</p><p><strong>Results: </strong>Overall, PA-TACE did not significantly improve disease-free survival (DFS) or overall survival (OS) in the entire cohort (median OS: 25 vs. 16 months, P = 0.106). However, alpha fetoprotein (AFP)-negative patients receiving PA-TACE demonstrated significantly prolonged DFS (5-year: 50.8% vs. 11.6%, P = 0.030) and OS (5-year: 64.0% vs. 26.3%, P = 0.005). AFP (HR = 3.79, 95% CI 2.06-6.98, P < 0.001) and ALP (HR = 2.12, 95% CI 1.11-4.06, P = 0.023) were independent risk factors for OS. PA-TACE showed no benefit in AFP-positive patients (5-year OS: 0% vs. 9.4%, P = 0.859). Elevated ALP (≥ 130 U/L) correlated with worse DFS (5-year: 3.1% vs. 19.6%, P = 0.027) and OS (5-year: 8.8% vs. 22.3%, P = 0.020).</p><p><strong>Conclusion: </strong>Preoperative serum AFP and alkaline phosphatase were independent risk factors for evaluating the prognosis of HCC-BDTT. Postoperative prophylactic TACE can significantly prolong overall survival of HCC-BDTT in AFP-negative patients but not in AFP-positive cases, highlighting the need for tailored adjuvant therapies.</p>\",\"PeriodicalId\":23856,\"journal\":{\"name\":\"World Journal of Surgical Oncology\",\"volume\":\"23 1\",\"pages\":\"260\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219712/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12957-025-03917-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12957-025-03917-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：肝细胞癌（HCC）合并胆管肿瘤血栓形成（BDTT）是一种罕见的临床疾病，疾病进展迅速，预后差。本研究旨在评价HCC-BDTT根治性切除（R0）后辅助经动脉化疗栓塞（PA-TACE）对预后的价值。方法：对2002年1月至2010年12月93例行R0切除术的HCC-BDTT患者进行回顾性研究，其中46例术后2个月内行PA-TACE， 47例术后未行PA-TACE。分析PA-TACE与患者长期预后的相关性。通过单因素和多因素分析确定独立危险因素。结果：总体而言，PA-TACE没有显著改善整个队列的无病生存期（DFS）或总生存期（OS）（中位OS: 25个月vs. 16个月，P = 0.106）。然而，接受PA-TACE的甲胎蛋白（AFP）阴性患者的DFS（5年：50.8% vs. 11.6%, P = 0.030）和OS（5年：64.0% vs. 26.3%, P = 0.005）显著延长。结论：术前血清AFP和碱性磷酸酶是评价HCC-BDTT预后的独立危险因素。术后预防性TACE可以显著延长afp阴性患者HCC-BDTT的总生存期，但在afp阳性患者中却不能，这突出了定制辅助治疗的必要性。
Postoperative adjuvant transarterial chemoembolization prolongs overall survival in alpha-fetoprotein-negative hepatocellular carcinoma with bile duct tumor thrombosis: a long-term retrospective cohort study.
Background: Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) is a rare clinical condition with rapid disease progression and poor prognosis. This study aimed to evaluate the prognostic value of postoperative adjuvant transarterial chemoembolization (PA-TACE) among HCC-BDTT patients after radical resection (R0).
Methods: Between January 2002 and December 2010, 93 HCC-BDTT patients who underwent R0 resection were enrolled for a retrospective study, including 46 patients with PA-TACE and 47 patients without PA-TACE within two months postoperatively. The correlation between PA-TACE and the long-term prognosis of patients was analysed. Independent risk factors were identified by univariate and multivariate analysis.
Results: Overall, PA-TACE did not significantly improve disease-free survival (DFS) or overall survival (OS) in the entire cohort (median OS: 25 vs. 16 months, P = 0.106). However, alpha fetoprotein (AFP)-negative patients receiving PA-TACE demonstrated significantly prolonged DFS (5-year: 50.8% vs. 11.6%, P = 0.030) and OS (5-year: 64.0% vs. 26.3%, P = 0.005). AFP (HR = 3.79, 95% CI 2.06-6.98, P < 0.001) and ALP (HR = 2.12, 95% CI 1.11-4.06, P = 0.023) were independent risk factors for OS. PA-TACE showed no benefit in AFP-positive patients (5-year OS: 0% vs. 9.4%, P = 0.859). Elevated ALP (≥ 130 U/L) correlated with worse DFS (5-year: 3.1% vs. 19.6%, P = 0.027) and OS (5-year: 8.8% vs. 22.3%, P = 0.020).
Conclusion: Preoperative serum AFP and alkaline phosphatase were independent risk factors for evaluating the prognosis of HCC-BDTT. Postoperative prophylactic TACE can significantly prolong overall survival of HCC-BDTT in AFP-negative patients but not in AFP-positive cases, highlighting the need for tailored adjuvant therapies.
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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