术前肝动脉化疗栓塞对肝细胞癌切除术疗效影响的探讨

Effectsofpreoperativetranscatheterhepaticarterialchemoembolization(TAE)ontheprognosisofpa┐tientswithhepaticcarcinomaundergoingtumorresection

为了探讨术前肝动脉栓塞（ＴＡＥ）能否改善肝癌切除术预后，作者分析了肿瘤直径３ｃｍ以上，无门静脉癌栓的７７例患者，术前是否行肝动脉化疗栓塞对肝癌切除术后疗效影响。７７例患者按术前是否接受ＴＡＥ分为栓塞组（Ａ组，ｎ＝２６）和非栓塞组（Ｂ组，ｎ＝５１），每组按肿瘤直径再分Ａ１、Ｂ１（３～８ｃｍ），Ａ２、Ｂ２（＞８．０ｃｍ）两个亚组。结果术后１、２、３年无瘤存活率各组分别为：Ａ１组（ｎ＝１４）为５０．０％、３３．３％、１６．６％；Ｂ１组（ｎ＝３３）为７２．７％、５４．２％、３９．７％；Ａ２组（ｎ＝１２）为７５．０％、５６．２％、４５．０％；Ｂ２组（ｎ＝１８）为３８．９％、３２．４％、１０．８％。术后１、３、５年存活率各组分别为：Ａ１组为８５．７％、３１．２％、０；Ｂ１组为８４．８％、５８．７％、２７．９％；Ａ２组为９１．６％、８２．５％、５３．０％；Ｂ２组为７７．８％、３０．１％、０。术后１、２、３年无瘤存活率和１、３、５年存活率Ａ１组与Ｂ１组差异无显著意义，Ａ２组与Ｂ２组差异有显著意义（Ｐ＜０．０５）。此外，同为术前ＴＡＥ组，Ａ１组术后无瘤存活率和５年存活率均低于Ａ２组。结果表明对８．０ｃｍ以下可切除肝癌术前不宜?

Thisstudyconsistsof77hepatocelularcarcinomapatients.Twenty-six(GroupA)re-ceivedpreoperativeTAEand51didnot(GroupB).GroupAandBwerefutherdividedintotwosub-groupsaccordingtotheirtumorsizei.e.GroupA1andB1(tumorsize3～8cm);GroupA2andB2(tu-morsize>8cm).The1-,2-,3-yeardiseasefreesurvivalrateswere50.0%,33.3%,16.6%forGroupA1and72.7%,54.2%,39.7%forGroupB1;75.0%,56.2%,45.0%forGroupA2and38.9%,32.4%,10.8%forGroupB2respectively.The1-,3-,5-yearssurvivalrateswere85.7%,31.2%,0forGroupA1and84.8%,58.7%,27.9%forGroupB1;91.6%,82.5%,53.0%forGroupA2and77.8%,30.1%,0forGroupB2respectively.ThereweresignificantdiferencesbetweenGroupA2andB2bothindeseasefreesurvivalrateand5-yearsurvivalrate(P<0.05).TheresultsalsodemonstratedthatthepreoperativeTAEdidworsentheprognosisofpatientswithtumorsizebetween3～8cm(GroupA1)withdiseasefreesurvivalrateand5-yearsurvivalrateshorterthanthatofGroupA2.