肝癌术后TACE的抗复发作用

The effect and utilization of TACE on intrahepatic recurrence after hepatic resection for hepatocellular carcinoma

目的:从临床角度发现影响肝癌术后复发的原因,预防性TACE在延缓肝癌手术后复发中的作用。方法:从1999年2月到2006年2月,连续性收治326例肝癌患者,所有患者均接受了肝癌切除术。将可能影响原发性肝癌术后复发的观察指标包括性别、年龄、术前AFP、有无癌栓、手术切缘、手术前肿瘤是否破裂、肿瘤大小、肿瘤有无子灶、肿瘤包膜情况、手术后有无行预防性TACE等,用Cox模型分析各因素与复发时间之间的关系。结果:年龄小、有癌栓、手术前肿瘤有破裂、肿瘤体积大和肿瘤周围有子灶等因素使肝癌手术后复发时间提前,保证较大手术切缘距离和手术后行预防性TACE可延缓肝癌手术后复发。结论:对于存在术后复发高危倾向的患者,在术前、术中及术后采取相应措施,可有效提高术后无瘤生存率、延长生存时间。术后施行TACE,可能对具有早期复发倾向的肝癌患者具有作用。

Objective：To evaluate prognostic factors that could affect disease-free survival and recurrence and evaluate effect of post-operative TACE in inhibiting recurrence for patients after liver resection for hepatocellular carcinoma（HCC）.Methods：A total of consecutive 326 patients with hepatocellular carcinoma from Feb.1999 to Feb.2006 were included in this study.All patients underwent hepatic resection.Variables might related with recurrence including sex,age,preoperative AFP level,vascular invasion,resection margin,tumor rapture,tumor size,number of nodule,tumor capsule and post-operative TACE were used in the multivariate analysis using the Cox proportional hazard model to analyze factors affecting intrahepatic recurrence.Results：On multivariate analysis by Cox proportional hazard model,younger HCC patients,presence of vascular invasion,presence of tumor rupture,larger in tumor diameter,presence of multiple nodules were significantly related to a higher incidence of tumor recurrence.Wider clearance resection margin and post-operative TACE were signiticantlv related to a lower incidence of tumor recurrence.Conclusion：Appropriate measures adopted pre-,during and post-operative may improve disease-free survival and survival time especially in patients who possess high risk factors for recurrence.Post-operative TACE might be effective for the patients who had HCC expressing early recurrence characteristic.