透明细胞型肝癌术后复发的治疗及预后分析

Prognosis and management of recurrent primary clear cell carcinoma of liver

目的探讨透明细胞型肝癌（PCCCL）术后复发的治疗措施及预后。方法对1996年1月至2006年3月采用根治性手术切除治疗的214例PCCCL患者的临床及随访资料进行回顾性分析。术后1年及1年以内复发者定义为早期复发，术后1年以上复发者定义为晚期复发。结果99例PCCCL患者术后复发，其中早期复发者28例，晚期复发者71例。复发患者手术切除33例，酒精注射治疗7例，射频消融治疗10例，动脉化疗栓塞治疗27例，全身化疗和中医治疗各1例，未行治疗20例。晚期复发患者再次手术切除率显著高于早期复发患者（P=0．04）。复发患者接受根治性治疗后1年、3年及5年的总生存率分别为100％、86．0％、63．5％，与未复发患者比较（分别为85．2％、72．2％、64．3％），无显著差异（P=0．71）。手术切除、射频消融及酒精注射治疗对复发患者生存率的影响无显著差异（P=0．68），均显著优于动脉化疗栓塞（P=0．03）。复发患者接受动脉化疗栓塞术后1年、3年及5年的总生存率（分别为100％、66．7％、44．4％）显著优于未栓塞治疗的复发患者（分别为80．0％、25．0％、10．0％，P〈O．01）。结论手术切除、射频消融及酒精注射治疗是PCCCL术后复发最佳治疗手段。动脉化疗栓塞对于不能手术切除的复发患者仍能有效延长生存时间。

Objective To evaluate the prognosis and management of recurrent primary clear cell carcinoma of liver （PCCCL）. Methods 214 patients with PCCCL treated by curative resection from January 1996 to March 2006 were retrospectively studied. Tumour recurrences were classified into early （41 year） and late （〉1 year） recurrences. Results Of 99 patients who developed recurrences, 28 developed early recurrence while 71 developed late recurrence. The patients with recurrences were treated with re resection （n=33）, percutaneous ethanol injection （PEI, n= 7）, radiofrequeney ablation （RFA, n： 10）, transcatheter arterial chemoembolization （TACE, n= 27）, systemic chemotherapy （n= 1）, Chinese medicine （n=1）, and conservative management （n=20）. The re resection rate was higher in the late than in the early recurrence group （P=0.04）. In this study, reresection, PEI, and RFA were considered as curative therapies. There was no significant difference in the overall sur viral （OS） for patients who received these different curative therapeutic procedures （P=0.68）. The 1-, 3 , and 5-year OS of patients with recurrences who were treated with curative treatment were comparable to those patients who did not develop recurrences （100%, 86.0%, 63.5% vs 85.2%, 72.2%, 64.3%, P=0.71）. The 1 , 3-, and 5-year OS of patients who received TACE for recurrences were 100%0, 66.7%, and 44.4% respectively. The results were poorer than patients who received curative treatment for recurrences （P=0.03）, but were better than those who received conservative management after recurrences （80.0%, 25.0%, and 10.0%, P〈0.01）. Conclusions Reresection, PEI and RFA are optimal curative methods for recurrent PCCCL. TACE plays an important role in the management of patients with recurrent PCCCL who cannot be treated with curative methods.