不能切除肝癌缩小后二期切除疗效及影响预后因素

Sequential resection after cytoreduction of unresectable hepatocellular carcinoma and factors influencing survival of patients

目的探讨不能切除肝细胞癌(HCC)经皮穿刺肝动脉化疗栓塞(TACE)缩小后切除的疗效及影响预后的因素。方法 12例二期切除 HCC 病人 TACE 前因肿瘤巨大或肿瘤虽不大但紧贴肝门或下腔静脉的大血管,无法达到根治性切除而行 TACE 治疗。共行 TACE 1～7次(平均2.4±1.2次)。肿瘤缩小后予以切除。选择7个可能对 HCC 二期切除后预后产生影响的临床因素通过单因素、多因素 Cox 模型进行分析。结果随访至2000年12月,TACE 后1,3,5,7年生存率分别为94.1%,64.7%,51.2%和40.8%;肿瘤切除后1,3,5,7年生存率分别为88.0%,59.6%,49.0%和37.1%。肝硬化程度、缩小后肿瘤有无包膜及肿瘤坏死程度是影响预后的主要因素(P<0.05)。结论不能切除的 HCC 经 TACE 缩小后应行二期切除,并可获得满意疗效。而肝硬化程度及肿瘤坏死程度是影响肝癌二期切除预后的主要因素。

Objective To study the therapeutic effects of hepatic resection on shrunk hepatocel- lular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE)and investigate factors influencing the survival of patients with unresectable HCC.Methods A total of 112 patients with un- resectable HCC received TACE for 1～7 courses(mean=2.4±1.2 courses).Then the shrunk tumors were surgically removed by two-stage operation in all the patients.Seven possible factors influ- encing the outcome of sequential resection of HCC were studied by univariate and Cox multivariate a nalysis.All patients were followed up until December 2000.Results After resection of the shrunk tumors,the 1-,3-,5- and 7-year survival rates were 94.1%,64.7%,51.2% and 40.8%,respec- tively.No matter whether the capsule of the shrunk tumor was complete or not,the extent of cirrhotic liver and percentages of tumor necrosis were of prognostic significance.Conclusions Sequential resec- tion should be performed after cytoreduction of the tumor in patients with unresectable HCC because it can improve survival of the patients.No matter whether the capsule of the shrunk tumor was complete or not,the extent of cirrhotic liver and percentages of tumor necrosis are the major factors influencing the survival of patients after two-stage operation.