肝脏残留癌的动脉化疗栓塞及预后因素分析

Transcather arterial chemoembolization for postoperative residual tumor of hepatocellular carcinoma

目的 研究肝动脉化疗栓塞 (transcatherarterialchemoembolization ,TACE)治疗原发性肝癌切除术后残癌的疗效 ,并分析影响疗效的因素。方法 原发性肝癌患者于术后 2个月行B超和肝动脉造影检查 ,部分患者还行增强CT检查 ,证实残癌后行TACE。采用Kaplan Meier方法分析TACE患者术后的生存期 ,以Cox比例风险模型分析影响TACE疗效的因素。结果 74例术后残癌患者经TACE术后 ,1,2 ,3年生存率分别为 78.0 %、5 7.6 %和 37.0 % ,中位生存期为 33个月。单因素分析显示 ,原发癌体积 >5cm、有血管侵犯、TNM分期较晚为疗效差的影响因素 ;而合用其他局部治疗 ,如瘤内无水乙醇注射 (PEI)或放射治疗则为疗效好的影响因素。但多因素分析显示 ,原发癌血管侵犯和合用其他局部治疗为独立的影响因素。结论 肝动脉化疗栓塞治疗术后残癌可取得较好疗效 ,如能合用PEI或放射治疗 ,还可进一步提高疗效。

Objective To understand and analyze the survival and prognostic factors of postoperative residual tumor of hepatocellular carcinoma treated by transcatheter arterial chemoembolization. Methods Transcatheter arterial chemoembolization was performed in 74 patients who were identified as having residual lesions by ultrasonography, hepatic arterial angiography or enhanced computed tomography about two months after resection of hepatocellular carcinoma. Kaplan Meier method was used for survival and Cox regression model for prognostic factors. Results The 1 , 2 and 3 year survival rates were 78.0%、57.6%、37.0%, with a median survival of 33 months. Univariate analysis indicated that a primary tumor over >5 cm in diameter, vascular involvement by the primary tumor and TNM extent of the residual lesion were important factors indicating a bad prognosis, where as the combination of other treatment methods such as percutaneous ethanol injection (PEI), and/or radiotherapy indicated a better prognosis. However,multivariate analysis showed that vascular involvent by the primary tumor and the other combined local treatments were independent factors of prognosis. Conclusion Transcatheter arterial chemoembolization is effective in treating the postoperative residual tumor of hepatocellualr carcinoma. Further improvement is observed if combined with other local therapies such as percutaneous ethanol injection or radiotherapy.