术前肝动脉化疗栓塞对肝细胞癌术后无瘤生存的影响

The effect of preoperative transcatheter hepatic arterial chemoembolization on disease free survival after hepatectomy for hepatocellular carcinoma

目的 分析术前肝动脉化疗栓塞（ＴＡＣＥ） 对提高肝癌术后无瘤生存率的作用，评价对可切除肝癌术前行ＴＡＣＥ的意义。方法 对１ ７２５ 例行根治或相对根治切除的原发性肝细胞癌患者进行回顾性随访，回访１ ４５７ 例，其中１２０ 例术前行ＴＡＣＥ。采用Ｃｏｘ 模型对一些临床病理因素做单、多因素分析，用ＫａｐｌａｎＭｅｉｅｒ 法分析术后无瘤生存情况。结果 Ｃｏｘ 模型分析结果显示，术前ＴＡＣＥ次数和疗效等因素对无瘤生存有显著影响。术前行两次以上ＴＡＣＥ，其无瘤生存率明显高于一次者，更高于未行者。行两次以上ＴＡＣＥ 组、一次组和未行组的５ 年无瘤生存率分别为５１ ．０ ％ 、３５ ．５ ％ 和２１ ．４ ％ ，中位无瘤生存期分别为６６．４ 个月、２５ ．５ 个月和１２ ．５ 个月。结论 术前ＴＡＣＥ是目前临床可行的提高肝癌术后无瘤生存率的有效方法之一。

Objective To analyse the effect of preoperative transcatheter hepatic arterial chemoembolization(TACE) on disease free survival rate after surgical excision for hepatocellular carcinoma(HCC), in order to evaluate its therapeutic significance.Methods The history of 1 457 cases of HCC with long term follow up who received curative or relatively curative tumor resection was reviewed. Among these patients, 120 received preoperative TACE. Factors of prognostic significance were analysed using Cox proportional hazards survival mode, and the disease free survival was analysed by Kaplan Meier estimation.Results Multivariate analysis revealed that the factors of prognostic significance were number and size of tumor mass and its gross type, number and efficacy of TACE treatment, presence of tumor thrombus, satellite nodules, vascular invasion, and postoperative AFP level. The 5 year disease free survival rate following surgery of patients who received TACE twice or more was 51.0%, while that of patients who received TACE once and none was 35.5% and 21.4%, respectively. The mean disease free suvival time in these 3 groups of patients was 66.4, 22.5 and 12.5 months, respectively. For patients whose TACE treatment was effective, the 5 year disease free survival rate was 56.8%, with a mean disease free suvival time of 90.1 months.Conclusion Preoperative TACE is so far the most feasible approach to improve disease free survival of HCC patients.