以手术为主治疗108例ⅢA期肝细胞癌的疗效分析

Efficacy of hepatectomy-predominant treatment on stage ⅢA hepatocellular carcinoma:a report of 108 cases

背景与目的:目前ⅢA期肝癌的治疗选择尚未统一。本研究分析以手术为主的综合方法治疗108例ⅢA期肝癌的疗效。方法:从2002年1月到2003年12月,108例ⅢA期肝癌患者在我院接受以手术为主的综合治疗。入组患者随机分成单纯手术组和综合治疗组,单纯手术组仅行肝切除术,综合治疗组行肝切除术联合肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)。以无瘤生存率和生存率作为评价指标分析疗效。结果:全组患者中位无瘤生存期5.0(2.0～69.0)个月,1、3、5年无瘤生存率分别为25.0%、8.3%和6.5%;中位生存期21.0(4.0～69.0)个月,1、3、5年生存率分别为72.2%、25.9%和19.4%。其中综合治疗组的中位无瘤生存期7.0个月,1、3、5年无瘤生存率分别为40.0%、16.0%和12.0%,单纯手术组中位无瘤生存期4.0个月,1、3、5年无瘤生存率分别为15.5%、1.7%和1.7%(log-rank16.01,P<0.01)。综合治疗组中位生存期24.5个月,1、3、5年生存率分别为86.0%、36.0%和24.0%;单纯手术组中位生存期15.5个月,1、3、5年生存率分别为60.3%、17.2%和13.8%(log-rank6.17,P=0.013)。结论:手术并术后辅助性肝动脉栓塞化疗治疗ⅢA期肝癌的疗效确切,可提高ⅢA期肝癌的治疗效果。

Background and Objective. At present, there are controversies in the treatment for stage Ⅲ A hepatocellular carcinoma （HCC）. This study was to explore the efficacy of hepatectomy-predominant treatment on stage Ⅲ A HCC. Methods： From January 2002 till December 2003, 108 stage Ⅲ A HCC patients were randomized into two groups： 58 underwent hepatectomy （hepatectomy alone group） and 50 underwent hepatectomy with adjuvant transcatheter arterial chemoembolization （TACE）（combination group）. The overall survival and tumor-free survival were observed. Results： The median tumor-free survival for all the patients was 5.0 months （2.0-69.0 months）. The 1-, 3- and 5-year tumor-free survival rates were 25.0%, 8.3% and 6.5%, respectively. The median survival for all the patients was 21.0 months （4.0-69.0 months）. The 1-, 3- and 5-year overall survival rates were 72.2%, 25.9% and 19.4%, respectively. The median tumor-free survival and 1-, 3- and 5-year tumor-free survival rates for combination group were 7.0 months, 40.0%, 16.0% and 12.0%, respectively; correspondingly, for hepatectomy alone group were 4.0 months, 15.5%, 1.7% and 1.7%, respectively （log-rank=16.01, P 〈 0.01）. The median overall survival, 1-, 3- and 5-year overall survival rates for combination group were 24.5 months, 86.0%, 36.0% and 24.0%, respectively ; correspondingly, for hepatectomy alone group were 15.5 months, 60.3%, 17.2% and 13.8%, respectively （log-rank =6.17, P=0.013）. Conclusions： Hepatectomy-predominant treatment has certain effect on stage Ⅲ A HCC. Hepatectomy plus adjuvant TACE could improve the survival of stage Ⅲ A HCC patients.