三级淋巴结构对肝细胞癌患者术后辅助经导管肝动脉化疗栓塞术疗效的影响

孟繁盛; 杨皓康; 杨毕伟

doi:10.12025/j.issn.1008-6358.2025.20250435

三级淋巴结构对肝细胞癌患者术后辅助经导管肝动脉化疗栓塞术疗效的影响

The impact of tertiary lymphoid structure on the efficacy of postoperative adjuvant transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

摘要

摘要:
目的探讨三级淋巴结构（tertiary lymphoid structure, TLS）对肝细胞癌（hepatocellular carcinoma，HCC）患者根治性切除术后经导管肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）辅助治疗疗效的影响。
方法回顾性纳入2011年1月至2015年12月在复旦大学附属中山医院肝肿瘤外科诊治的根治性切除接受术后辅助TACE治疗的HCC患者200例及未接受辅助TACE治疗的HCC患者145例，对肿瘤组织切片进行苏木精-伊红（hematoxylin-eosin，HE）染色评估TLS。将200例接受TACE治疗的患者分为TLS阳性组和TLS阴性组，采用倾向评分匹配（propensity score matching, PSM）减少混杂因素。采用Kaplan-Meier生存曲线、log-rank检验以及Cox比例风险模型，分析TLS对接受术后辅助TACE治疗患者预后的影响。
结果 PSM前，TLS阳性组（n＝101）早期无复发生存期（recurrent-free survival, RFS）及总生存期（overall survival, OS）较TLS阴性组（n＝99）延长（P＜0.001）。PSM后，TLS阳性组和TLS阴性组各69例，两组基线资料差异无统计学意义。TLS阳性组早期RFS（P＜0.001）及OS（P＝0.002）仍显著延长。Cox比例风险模型结果显示，肿瘤组织存在TLS是接受术后辅助TACE治疗患者早期RFS（HR＝0.240，P＜0.001）及OS（HR＝0.282，P＜0.001）的独立保护因素。345例患者亚组分析显示，在肿瘤组织存在TLS的患者中，接受辅助TACE的患者早期RFS（P＝0.034）和OS（P＝0.018）优于未接受辅助TACE的患者，而辅助TACE疗效在不存在TLS的患者中不显著。
结论 TLS是影响术后辅助TACE疗效及患者预后的重要指标。

Abstract:
Objective To explore the impact of tertiary lymphoid structure (TLS) on the efficacy of adjuvant transcatheter arterial chemoembolization (TACE) following curative resection in patients with hepatocellular carcinoma (HCC).
Methods A retrospective study enrolled 200 patients receiving adjuvant TACE and 145 non-TACE controls who underwent curative resection for HCC at the Department of Hepatobiliary Surgery, Zhongshan Hospital, Fudan University from January 2011 to December 2015. Tumor tissue sections were evaluated for TLS through hematoxylin-eosin (HE) staining. Two hundred patients receiving TACE treatment were divided into the TLS positive group and the TLS negative group. Propensity score matching (PSM) was used to reduce confounding factors. Kaplan-Meier survival curves, log-rank tests and Cox proportional hazards model were employed to assess the impact of TLS on prognosis of patients receiving postoperative adjuvant TACE.
Results Before PSM, the TLS positive group (n＝101) had significantly longer early recurrence-free survival (RFS) and overall survival (OS) compared to TLS negative group (n＝99, P＜0.001). After PSM, there were 69 cases in both the TLS positive and TLS negative groups, with no statistically significant differences in baseline data between the two groups. The TLS positive group still showed significantly longer early RFS (P＜0.001) and OS (P＝0.002). The results of the Cox proportional hazards model indicated that the presence of TLS in tumor tissue was an independent protective factor for early RFS (HR＝0.240, P＜0.001) and OS (HR＝0.282, P＜0.001) in patients undergoing postoperative adjuvant TACE treatment. Subgroup analysis of 345 patients showed that among patients with TLS present in tumor tissue, those receiving adjuvant TACE had longer early RFS (P＝0.034) and OS (P＝0.018) compared to those who did not receive adjuvant TACE, while the efficacy of adjuvant TACE was not significant in patients without TLS.
Conclusions TLS is an important indicator affecting the efficacy of postoperative adjuvant TACE and patient prognosis.

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