Disease-Free Survival Benefit of Radiotherapy Following Narrow-Margin Hepatectomy in Patients with Hepatocellular Carcinoma

Abstract

To evaluate the effect of postoperative radiotherapy on the prognosis and recurrent patterns of hepatocellular carcinoma (HCC) patients with narrow-margin hepatectomy. From July 2007 to October 2016, a total of 234 patients with narrow-margin (<1.0 cm) hepatectomy were recruited in this study. Of which, 76 patients (Group A) eligible for inclusion in Phase II study were received postoperative radiotherapy, and the rest 158 patients were assigned to Group B. Kaplan-Meier survival analysis was performed to identify the association between postoperative radiotherapy and clinical outcomes of HCC patients with narrow-margin hepatectomy. Propensity score-matched (PSM) analysis was used to balance the differences in the basic clinical characteristics between Groups. Before PSM, the overall survival (OS) between Group A and Group B was not significantly different (P=0.2062), and the 1-year, 3-year and 5-year OS rate for the Group A and Group B were 98.6%, 89.0% and 72.6% versus 92.5%, 80.5% and 72.7%, respectively. While the disease-free survival (DFS) was significantly higher in Group A than in Group B (P=0.0337), and the 1-year, 3-year and 5-year DFS rate for the Group A and Group B were 88.0%, 71.3% and 60.2% versus 77.9%, 62.3% and 48.8%, respectively. After PSM, the OS between Group A and Group B were marginally different (P=0.0739), and the 1-year, 3-year and 5-year OS rate were 98.6%, 89.0% and 72.6% versus 88.0%, 76.8% and 66.9%, respectively. The DFS values were still significantly higher in Group A than in Group B (P=0.0076), and the 1-year, 3-year and 5-year DFS rate were 88.0%, 71.3% and 60.2% versus 73.4%, 55.6% and 43.2%, respectively. Before PSM, the surgical margin recurrence, single recurrence beyond the margin, and diffuse recurrence rates in Group A were 0% (0), 23.4% (18) and 5.3% (4) versus 5.1% (8), 12% (19), 13.9% (22) in Group B (P=0.009), respectively. There were no significant difference in extrahepatic recurrence rates (P=0.826), the early recurrence (less than 18 months after surgery) and late recurrence (more than 18 months after surgery) rates (P=0.104)．After PSM, regarding the patterns of margin recurrence, single recurrence beyond the margin or diffuse recurrence, the patients who had undergone postoperative IMRT still showed a significantly lower intrahepatic recurrence than those who did not undergo treatment (P=0.009). Postoperative radiotherapy has a significant DFS benefit for patients with narrow-margin hepatectomy. Long-term follow up and prospective studies with larger patient cohorts are needed to confirm OS benefit.