肝细胞癌根治性切除术后辅助性经导管肝动脉化疗栓塞价值的前瞻性研究

Postoperative adjuvant transcatheter arterial chemoembolization for hepatocellular carcinoma: a prospective study

目的通过前瞻性队列研究进一步探讨根治性肝切除术后辅助性肝动脉化疗栓塞(transcatheter arterial chemo-embolization,TACE)的应用价值。方法 2008年1月至2008年12月共220例肝细胞癌患者在本院接受肝切除术,有104例符合条件的患者纳入本研究。其中治疗组56例,术后1个月接受了辅助性TACE治疗;对照组48例,术后不接受任何辅助性治疗。患者接受定期随访,统计分析术后无瘤生存及总生存情况。结果治疗组中位无瘤生存时间较对照组缩短[11(2～38)个月vs 13(2～59)个月,P=0.005]。术后1、2、3年复发率,治疗组与对照组分别为50%、85.7%、89.3%和46.8%、58.3%、62.5%(P=0.005)。COX回归多因素分析提示:术后辅助性TACE、AFP、完整包膜、肝硬化、合并肉眼血管侵犯及肿瘤Edmondson-Steiner分级是影响术后肿瘤复发的危险因素(P<0.05)。治疗组中位生存时间与对照组比较差异无统计学意义[29(4～41)个月vs 24(5～59)个月,P=0.789]。术后1、2、3年生存率,治疗组与对照组分别为85.6%、59.5%、36.5%和75%、50%、41.7%(P=0.789)。COX回归多因素分析提示:AFP、完整包膜及肿瘤Edmondson-Steiner分级是影响术后生存的危险因素(P<0.05)。结论根治性肝切除术后辅助性TACE并不能显著改善肝细胞癌患者的无瘤生存及总生存,甚至可能会弊大于利,因此在治疗方案的选择上应慎重考虑。

Objective To evaluate the clinical value of postoperative adjuvant transcatheter arterial chemoembolization（TACE） on the prognosis of hepatocellular carcinoma（HCC） patients after radical hepatectomy using a prospective cohort study.Methods A total of 220 HCC patients underwent radical hepatectomy from Jan.2008 to Dec.2008 and 104 were recruited in the present study.Fifty-six patients（TACE group） received adjuvant TACE one month after hepatectomy,and 48（control group） did not receive any adjuvant therapies.Follow-up was done regularly.The disease-free survival（DFS） time and total survival（TS） were statistically analyzed.Results The median DFS time in TACE group was significantly shorter than that in the control group（11 months vs 13 months,P=0.005）.The 1-year,2-year and 3-year recurrence rates were 50%,85.7%,and 89.3% in TACE group and 46.8%,58.3%,and 62.5% in the control group（P=0.005）,respectively.Multivariate COX regression analysis indicated that TACE,AFP,intact tumor peplos,liver cirrhosis,vascular invasion and tumor Edmondson-Steiner grade were the risk factors for recurrence（P〈0.05）.The median TS time periods in TACE group and control group were 29（4-41） months and 24（5-59） months（P=0.789）,respectively.The 1-year,2-year and 3-year survival rates were 85.6%,59.5%,and 36.5% in TACE group and 75%,50%,and 41.7% in the control group（P=0.789）,respectively.Multivariate COX regression analysis indicated that AFP,intact tumor peplos and tumor Edmondson-Steiner grade were correlated with the total survival of patients（P〈0.05）.Conclusion Adjuvant TACE can not improve DFS and TS of HCC patients after radical hepatectomy,and it may even contribute to a poor prognosis.Therefore more attention should be paid in choosing treatment strategy.