术前化疗栓塞对不同大小肝细胞癌预后的影响

The effect of preoperative transcatheter arterial chemoembolization on prognosis of patients with hepatocellular carcinoma in different sizes

目的 从整体、细胞和基因分子水平研究经导管动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)对不同大小肝细胞癌 (hepatocellularcarcinoma ,HCC)预后的影响。方法 经手术病理证实的肝细胞癌 110例 ,TACE后Ⅱ期手术切除 5 3例 (A组 ) ,单纯手术 5 7例 (B组 ) ,肿瘤直径≤ 8cm者被分为A1组 (18例 )和B1组 (30例 ) ;>8cm者被分为A2组 (35例 )和B2组 (2 7例 )。用流式细胞术检测凋亡率 (apoptoticrate ,AR)、S期细胞比率 (S phasefraction ,SPF)和增殖指数(proliferativeindex,PI) ,用免疫组化检测各标本ras癌基因的表达蛋白p2 1、P 糖蛋白 (P glycoprotein ,Pgp)、上皮型钙黏蛋白 (epithelialcadherin ,ECD)和nm2 3癌基因的表达蛋白二磷酸核苷激酶 (nucleosidediphosphatekinase ,ndpk)。回顾分析各组这些标志物改变、肿瘤坏死、包膜形成情况 ,并统计肿瘤体积、转移率及累计生存率。结果 肿瘤直径≤ 8cm和 >8cm者 ,术前TACE均可引起肿瘤坏死、诱导凋亡、肿瘤包膜形成、体积缩小、转移潜能下降 ,1、2、3年累计生存率 ,A1组分别为 94 4 %、6 6 7%和44 4 %,B1组分别为 90 0 %、6 3 3%和 40 0 %(P >0 0 5 ) ;A2组分别为 88 6 %、6 0 0 %和 5 1 4 %,B2组分别为 5 9 3%、48 1%和 2 5

Objective To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on prognosis of patients with hepatocellular carcinoma (HCC) in different sizes. Methods One hundred and ten patients with histologically-proven HCC were divided into two groups: 53 patients undergoing TACE before operation (group A) and 57 patients without previous treatment (group B). Patients with tumors ≤8 cm were assigned to group A1 (n=18) and B1 (n=30), and those with tumors > 8 cm were assigned to group A2 (n=35) and B2 (n=27). ndpk, p21, ECD, and Pgp were measured by immunohistochemistry, and AR, PI, and SPF by flow cytometry. Changes of these markers, tumor necrosis, encapsulation, volume, metastatic rate and cumulative survival in each group were retrospectively analyzed. Results More tumor necrosis, apoptosis, encapsulation and volume-lessening, less metastasis were seen in group A1 and B1.The cumulative 1-, 2-, and 3-year survival rates were 94.4%, 66.7%, and 44.4% for patients in group A1, and 90.0%, 63.3%, and 40.0% for those in group B1, respectively (P>0.05); 88.6%, 60.0%, and 51.4% for those in group A2, and 59.3%, 48.1%, and 25.9% for those in group B2, respectively (P<0.05). Conclusion The preoperative TACE is safe and might benefit all patients especially those with tumors > 8 cm.