术后预防TACE延缓微血管癌栓肝癌患者的抗复发作用

THE EFFECT OF POSTOPERATIVE PROPHYLACTIC TACE ON DELAYING RECURRENCE IN HCC PATIENTS WITH MICROVASCULAR INVASION

目的探讨术后预防性TACE对存在微血管癌栓肝癌患者的抗复发作用。方法166例患者进入本研究,根据患者术后病理结果有无肿瘤微血管癌栓以及术后两个月内有无接受预防性TACE分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四组。比较各组患者逐年肿瘤复发率及总体无瘤生存率。结果:共有85例患者存在肿瘤微血管癌栓,其中43例曾接受预防性TACE治疗(Ⅰ组),42例未接受预防性TACE治疗(Ⅱ组);有81例患者不存在肿瘤微血管癌栓,其中29例曾接受预防性TACE治疗(Ⅲ组),52例未接受预防性TACE治疗(Ⅳ组);Ⅰ、Ⅱ两组间及Ⅲ、Ⅳ两组间在肿瘤直径、切缘距离、AFP水平等三项因素方面不存在显著差异(P>0.05)。Ⅰ、Ⅱ组患者之间总体无瘤生存率存在显著性差异(P<0.05),Ⅲ、Ⅳ组患者之间无瘤生存率无显著性差异(P>0.05);Ⅰ、Ⅱ组患者之间仅第1年肝癌复发率存在显著性差异(34.9%vs73.8%,P=0.048),第2、3、4年的肝癌复发率差异无显著性(P>0.05);Ⅲ、Ⅳ组患者之间各年度的肝癌复发率均无显著性差异(P>0.05)。结论:术后预防性TACE对于合并肿瘤微血管癌栓的肝癌患者,可以降低早期复发(1年内)的发生率,但对于1年以上较远期的肝癌复发无显著影响。肝癌根治性切除术后复发高峰在第一年内,因此预防性TACE也应在术后早期(1～2个月)内实施。

Objective To investigate the effect of postoperative prophylactic TACE on delaying recurrence in HCC patients with microvascular invasion. Methods 166 HCC patients after curative resection were entered into this study. 85 patients were confinned with microvascular invasion by pathological results and 43 of them accepted postoperative prophylactic TACE （ Group 1 ） while 42 did not accept TACE （ Group 2）. 81 patients were confirmed without microvascular invasion by pathological results and 29 of them accepted postoperative prophylactic TACE （ Group 3 ） while 52 did not accept TACE （ Group 4）. Results There was significant difference in tumor free survival between Group 1 and Group 2 （P 〈 0. 05 ）. But the difference between Group 3 and Group 4 was not significant （P 〉 0. 05 ）. For Group 1 and Group 2, TACE only decreased the tumor recurrence in the 1 st year after operation significantly（34. 9% vs 73.8% ,P =0. 048）. The difference in tumor recurrence rate in the 2nd, 3rd and 4th year between Group 1 and Group 2 were not significant（P 〉 0. 05 ）. The difference in tumor recurrence rate by year between Group 3 and Group 4 was also not significant（ P 〉 0. 05 ）. Conclusions： For HCC patients with microvascular invasion, postoperative prophylactic TACE can decrease the early recurrence（ER） rate after curative operation and improve the tumor-free survival. But it did not show significant influence on late recurrence.Postoperative prophylactic TACE performed at early stage （ 1 - 2 months） was safe and effective.