肝动脉化疗栓塞在可切除性肝癌治疗中的地位

Transcatheter arterial chemoembolization for the treatement of resectable hepatocellular carcinoma

目的评价肝动脉化疗栓塞（transcatheter arterial chemoembolization TACE）在可切除性肝癌治疗中的有效性及其临床地位。方法回顾性分析我院1992年6月至2002年12月肝癌患者的临床资料,具有随访资料的可切除性肝癌有465例,根据治疗方式不同分成手术组、TACE组和保守治疗组,比较3个组的累积生存率,Cox逐步回归分析影响预后的相关因素。结果手术组328例（70.5%）,TACE组93例（20%）,保守治疗组44例（9.5%）,患者1、3、5、7年的累积生存率,手术组分别是87.5%、63.2%、45.1%、32.7%;TACE组分别是74.2%、38.4%、18.5%、8.1%;保守治疗组分别是47.7%、12.6%、3.1%、0。3个组在总体、TNMⅠ/Ⅱ期和TNMⅢ期的累积生存曲线比较,结果均为手术组最佳、TACE组次之,保守治疗组最差。Cox回归分析结果提示手术、TACE、TNM分期、静脉浸润、肿瘤大小及数目均是影响预后的重要因素,手术和TACE的危险比（hazard ratio HR）分别是2.14和1.58。结论治疗可切除性肝癌,首选手术;若患者拒绝手术,TACE能有效地改善其预后。

Objective To evaluate the efficacy and role of transcatheter arterial chemoembolization （TACE） for resectable hepatocellular carcinoma （HCC）. Methods From June 1992 to December 2002, there were 465 patients with potentially resectable HCC admitted receiving according the patient＇s own choice respectively surgery, TACE or conservative therapy. The survivals among the three groups were compared. The factors associated with prognosis were analyzed in Cox regression model. Result Among 465 patients, 328 （ 71% ） underwent resection, 93 （ 20% ） received TACE, and 44 （ 9. 5% ） received only supportive treatment. The 1-, 3-, 5-, 7-year cumulative survival rates was 87.5%, 63.2% , 45.1% , and 32.7% respectively in group with surgery treatment, while 74. 2% , 38. 4% , 18. 5%, and 8. 1% respectively in group with TACE treatment, 47.7%, 12. 6%, 3.1%, and 0% respectively in group with supportive treatment. Comparison of survivals among three groups as a whole or based on TNM Ⅰ / Ⅱ and TNM Ⅲ stage separately indicated that surgery provided the best result, TACE also prolonged survival as compared with supportive treatment. With Cox stepwise regression analysis, surgery, TACE, TNM stage, venous invasion, tumor size and number were significant predictors of survival. Conclusion For patients with potentially resectable HCC, surgery is the optimal choice. Patients who refuse surgery also benefit by TACE.