Effect Of Surgery Combined With Postoperative Adjuvant Radiotherapy On Postoperative Recurrence Of Patients With Centrally Located Hepatocellular Carcinoma

Objective:Radical liver resection is one of the most effective methods in the treatment of hepatocellular carcinoma,but its efficacy and safety remain unclear.Therefore,it is very important to explore a comprehensive treatment mode,such as radical liver resection combined with postoperative adjuvant radiotherapy,to improve the prognosis of patients with centrally located hepatocellular carcinoma.Methods:Patients with centrally located hepatocellular carcinoma who received surgical treatment in our department from June 2015 to June 2020 were included according to inclusion and exclusion criteria.Patients were divided into liver resection combined with adjuvant radiotherapy group(LR+RT)and liver resection alone group(LR)according to whether postoperative radiotherapy was performed.Standardized mean difference was used to compare the characteristics of all patients.The research methods were based on propensity score matching and Cox proportional hazard regression model.Subgroup analysis was conducted to discuss the differences in DFS between the two groups of patients with early recurrence and those without early recurrence.An E value was generated to assess the effect of unmeasured confounding factors.This is a real-world study to explore the effect of liver resection combined with postoperative adjuvant radiotherapy on postoperative recurrence.Results:A total of 193 patients were included in this study,of which 88 patients received LR+RT therapy and 105 patients received LR therapy alone.The DFS rates at 1,3 and 5 years were 98%,85%and 74%in LR+RT group and 76%,55%and 44%in LR group,respectively.According to univariate and multivariate COX analysis,adjuvant radiotherapy was an independent prognostic factor for postoperative recurrence(HR 0.67,95%CI[0.45,0.98];HR 0.60,95%CI[0.40,0.88]).In the propensity score matching,LR+RT group was significantly associated with longer disease-free survival(HR 0.6,95%CI[0.38,0.94]).Before and after matching analysis by Kaplan-Meier method and Log-rank test,there was a statistically significant difference in DFS between the two groups(p-value=0.034,p-value=0.022,respectively).Adjuvant radiotherapy significantly reduced the early postoperative recurrence rate(p-value<0.05).Operation was successful in both groups without serious complications.The E value analysis suggested that the study results were robust for unmeasured confounding factors.Conclusion:Liver resection combined with postoperative adjuvant radiotherapy is safe and effective in the treatment of centrally located hepatocellular carcinoma,improving the prognosis of patients,and reducing the incidence of early postoperative recurrence.