术前介入对合并门脉侵犯肝癌术后生存影响的前瞻性研究

Effect of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: A prospective non-random study

目的前瞻性对合并门脉侵犯可切除肝癌患者术前行肝动脉栓塞化疗(TACE),研究探讨该方法的有效性及安全性。方法术前影像学及多学科诊断为可切除肝癌合并门脉侵犯患者219例,按初始治疗分为一期手术切除的手术组(132例)和TACE组(87例),TACE组患者先行TACE治疗后再行手术切除。分层分析两组间的生存差异。结果手术组和TACE组1、3、5年生存率和中位生存时间分别为52.4%、19.1%、13.1%、13.87个月和57.1%、27.2%、21.1%、16.13个月(P=0.037)。亚组分析中,段叶级癌栓手术组和TACE组1、3、5年生存率分别为61.0%、32.1%、20.1%和92.9%、55.7%、47.8%(P=0.012)。主分支癌栓中两组生存率差异无统计学意义(P=0.272)。两组术后死亡率及并发症发生率差异无统计学意义。结论伴有门脉侵犯可切除肝癌术前行肝动脉栓塞化疗安全有效,尤其可以显著延长伴有段叶级侵犯肝癌患者的生存。

Objective To explore the efficacy and safety of preoperative transarterial chemoembolization（TACE） for resectable hepatocellular carcinoma（HCC） with portal vein invasion. Methods Two hundred and nineteen patients,diagnosed as rescetable HCC and portal vein tumor thrombus（PVTT） via preoperative imaging and multidisciplinary consultation,were prospectively enrolled and allocated into two groups. In the immediate resection group（132 cases）,patients received immediate surgical resection. In the preoperative TACE group（87 cases）,patients underwent TACE before surgical resection. Stratal analysis was carried out of the survival difference between the two groups. Results The 1-,3-,5-year overall survival rates and the median survival time were 52.4%,19.1%,13.1%,and 13.87 months for the immediate resection group; 57.1%,27.2%,21.1%,and 16.13 months for the preoperative TACE group（P=0.037）. On the strata analysis of segmental PVTT group,the overall survival rates of the immediate resection group and preoperative TACE group were 61.0% and 92.9% at 1-year,32.1% and 55.7% at 3-year,20.1% and 47.8% at 5-year,respectively（P=0.012）. However,comparing the 1-,3-,5-year overall survival rates between the two groups respectively,no significant difference was found of major PVTT group（P=0.272）. No significant difference was found between the 2 groups in postoperative complications and hospital mortality. Conclusion The preoperative TACE is a safe and effective procedure for patients diagnosed as HCC with portal vein tumor thrombi,and will not increase the incidence of complications,especially for resectable HCC with segmental PVTT.