Analysis of survival prognosis and influencing factors in patients with primary liver cancer after D-TACE: a retrospective cohort study.
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BACKGROUND AND OBJECTIVE: Transarterial chemoembolization (TACE) has become the standard treatment for moderately advanced hepatocellular carcinoma (HCC), but there are significant differences in postoperative survival rates, and the key factors influencing prognosis remain unclear. This article focuses on exploring the prognostic factors that affect the progression-free survival (PFS) and overall survival (OS) of patients with primary hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (D-TACE). METHODS: A retrospective cohort study design was adopted. A total of 114 HCC patients who received their first D-TACE treatment at our hospital from January 2021 to December 2023 and were followed up (with a follow-up period of 6 to 36 months) were included. Baseline data were collected, and survival rates were calculated using the Kaplan-Meier method and survival curves were plotted. Log-rank test was used for inter-group comparison. Multivariate analysis was conducted using methods such as Cox proportional hazards regression analysis to screen independent prognostic factors. RESULTS: The patients were divided into the survival group and the death group based on their survival status after 36 months. We found that there were significant differences in baseline characteristics such as the maximum tumor diameter, portal vein invasion, extrahepatic metastasis, CNLC stage, BCLC stage, ECOG score, liver function classification (Child-pugh score), multiple tumor foci, BMI, and several serum indicators between the survival group (46 cases) and the death group (68 cases) (P < 0.05). The KM survival analysis showed that the differences in PFS and OS between the two groups were statistically significant (Log-rank P < 0.001). Multivariate Cox analysis indicated that the maximum tumor diameter of the lesion (HR = 1.08, 95% CI: 1.01-1.18, P = 0.049) and portal vein invasion (HR = 1.99, 95% CI: 1.09-3.64, P = 0.025), ECOG score (HR = 1.91, 95% CI: 1.05-3.50, P = 0.035) were independent risk factors for PFS. Portal vein invasion (HR = 3.22, 95% CI: 1.66-6.26, P < 0.001) and HB (HR = 0.99, 95% CI: 0.97-0.99, P = 0.044), NLR (HR = 1.25, 95% CI: 1.02-1.53, P = 0.035) were independent risk factors for OS. CONCLUSIONS: This study found that the maximum diameter of the tumor, invasion of the portal vein, and ECOG score were independent predictors of disease progression in HCC patients after D-TACE surgery. Meanwhile, invasion of the portal vein and HB, NLR were key factors affecting the overall survival of patients. In clinical practice, these indicators should be comprehensively evaluated. For high-risk patients, enhanced follow-up management and active consideration of combined systemic treatment and other comprehensive strategies should be adopted to improve their prognosis.