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Abstract
Despite that surgical resection is widely regarded as the most effective approach to the treatment of liver cancer, its safety and efficacy upon centrally located hepatocellular carcinoma (HCC) remain unsatisfactory. In consequence, seeking an integrated treatment, like combined with adjuvant radiotherapy, to enhance the prognosis of patients is of critical importance. By recruiting patients undergoing surgical resection for centrally located HCC ranging from June 2015 to 2020, they were divided into liver resection combined with adjuvant radiotherapy (LR + RT) and mere liver resection (LR) groups. The calculation of propensity score and model of Cox proportional hazards regression were utilized. 193 patients were recruited in aggregation, containing 88 ones undergoing LR + RT, while 105 handled with LR. RT was verified to be an independent factor of prognosis for relapse (HR 0.60). In propensity-score analyses, significant association existed between adjuvant radiotherapy and better disease-free survival (DFS) (Matched, HR 0.60; Adjustment of propensity score, HR 0.60; Inverse probability weighting, HR 0.63). The difference of DFS was apparent within two groups (p value = 0.022), and RT significantly down-regulated early relapse (p value < 0.05) in subgroup analysis. The calculation of E-value revealed robustness of unmeasured confounding. The combination of liver surgical resection with RT is safe and effective towards patients with centrally located HCC, which would notably enhance the prognosis and decrease the early relapse of HCC.
Highlights
Despite that surgical resection is widely regarded as the most effective approach to the treatment of liver cancer, its safety and efficacy upon centrally located hepatocellular carcinoma (HCC) remain unsatisfactory
As the globally fourth-leading factor of cancer-associated death, hepatocellular carcinoma (HCC) takes up almost 90% of primary liver cancer (PLC)[1], which is a fatal illness accompanied by severe morbidity, negative prognosis, along with a series of clinical c omplications[2]
We explored the effect of adjuvant radiotherapy accompanied by surgical resection in order to solve the problem above
Summary
Despite that surgical resection is widely regarded as the most effective approach to the treatment of liver cancer, its safety and efficacy upon centrally located hepatocellular carcinoma (HCC) remain unsatisfactory. Abbreviations HCC Hepatocellular carcinoma RT Adjuvant radiotherapy LR Liver resection SMD Standardized mean difference PLC Primary liver cancer TACE Transcatheter arterial chemoembolization RT Radiotherapy SDRVO Selective and dynamic region-specific vascular occlusion OS Overall survival DFS Disease-free survival PSM Propensity-score match. The probability of relapse would significantly escalate when margins of resection are narrower (< 1 cm) or even null, facilitating the diffusion of microscopic residual lesions via intrahepatic vessels[8] Under this condition, it has been a critical and topical issue to conduct researches over combined therapies on the basis of surgical resection. It has been accessible for patients to receive accurate radiotherapy thanks to technical advances, like the appearance of intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and three-dimensional conformal radiotherapy (3D-CRT)[9–11] In this way, we explored the effect of adjuvant radiotherapy accompanied by surgical resection in order to solve the problem above
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