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Background <p>Hypohepatia limits the feasibility of therapeutic options for hepatocellular carcinoma (HCC), negatively affecting patient prognosis. Established guidelines for the treatment strategies of HCC patients with hypohepatia are lacking. This study was performed to evaluate therapeutic benefits between liver resection (LR) and interventional treatments using ablation or transarterial chemoembolization (TACE) in such population.</p> Methods <p>Survival analyses were performed using the Kaplan–Meier method and log-rank test. The Cox proportional hazards regression models were used to analyze potential risk factors associated with prognosis. Multivariate&#xa0;regression and&#xa0;propensity score regression adjustment analyses&#xa0;were applied to adjust for baseline confounding variables. Restricted cubic spline curves were used to assess the association between prognostic index and risk of death or progression on a continuous scale.</p> Results <p>Of the enrolled 5774 HCC patients with hypohepatia, 506 (8.8%), 2326 (40.3%) and 2942 (51.0%) underwent ablation, LR and TACE, respectively. A tentative analysis&#xa0;of the overall cohort demonstrated that&#xa0;a&#xa0;high&#xa0;degree of heterogeneity existed in this population, while LR rendered a&#xa0;possible&#xa0;tendency&#xa0;to survival&#xa0;benefit over ablation and TACE through adjustment for baseline confounding variables. After categorizing the patients according to the indication of ablation treatment, the indisputable superiority of LR over ablation and TACE in terms of OS and DFS before and after adjustments were evident and the survival advantages of LR were consistent&#xa0;across&#xa0;all&#xa0;pre-specified&#xa0;subgroups. Individualized treatment decision analyses based on restricted cubic spline curves demonstrated that LR group presented the lowest&#xa0;risk&#xa0;of&#xa0;death and disease&#xa0;progression.</p> Conclusions <p>HCC patients with hypohepatia could obtain survival benefits through surgical and non-surgical&#xa0;treatment approaches. LR appears to confer a significant survival&#xa0;benefit compared with interventional treatments using ablation or TACE, even for selected intermediate and advanced populations.</p> Graphical abstract <p></p>

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Liver resection versus interventional treatments for hepatocellular carcinoma patients with hypohepatia: a multicenter study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月16日

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  • Shoujie Zhao,
  • Yejing Zhu,
  • Jinming Zhu,
  • Bo Wang,
  • Enxin Wang,
  • Jun Zhu,
  • Liangzhi Wen,
  • Yan Zhao,
  • Man Yang,
  • Luo Zuo,
  • Jiahao Fan,
  • Jia Jia,
  • Wenbing Wu,
  • Weirong Ren,
  • Xing Chen,
  • Jing Li,
  • Xingshun Qi,
  • Xilin Du,
  • Lei Liu

摘要

Background

Hypohepatia limits the feasibility of therapeutic options for hepatocellular carcinoma (HCC), negatively affecting patient prognosis. Established guidelines for the treatment strategies of HCC patients with hypohepatia are lacking. This study was performed to evaluate therapeutic benefits between liver resection (LR) and interventional treatments using ablation or transarterial chemoembolization (TACE) in such population.

Methods

Survival analyses were performed using the Kaplan–Meier method and log-rank test. The Cox proportional hazards regression models were used to analyze potential risk factors associated with prognosis. Multivariate regression and propensity score regression adjustment analyses were applied to adjust for baseline confounding variables. Restricted cubic spline curves were used to assess the association between prognostic index and risk of death or progression on a continuous scale.

Results

Of the enrolled 5774 HCC patients with hypohepatia, 506 (8.8%), 2326 (40.3%) and 2942 (51.0%) underwent ablation, LR and TACE, respectively. A tentative analysis of the overall cohort demonstrated that a high degree of heterogeneity existed in this population, while LR rendered a possible tendency to survival benefit over ablation and TACE through adjustment for baseline confounding variables. After categorizing the patients according to the indication of ablation treatment, the indisputable superiority of LR over ablation and TACE in terms of OS and DFS before and after adjustments were evident and the survival advantages of LR were consistent across all pre-specified subgroups. Individualized treatment decision analyses based on restricted cubic spline curves demonstrated that LR group presented the lowest risk of death and disease progression.

Conclusions

HCC patients with hypohepatia could obtain survival benefits through surgical and non-surgical treatment approaches. LR appears to confer a significant survival benefit compared with interventional treatments using ablation or TACE, even for selected intermediate and advanced populations.

Graphical abstract