肝细胞肝癌伴脉管癌栓单纯手术切除与切除术后联合介入治疗预后对比

Prognosis of surgical excision combined with interventional therapy in treatment of hepatocellular carcinoma with microvascular invasion

目的分析手术切除后联合介入治疗肝细胞肝癌（HCC）伴微血管癌栓（MVI）患者的预后。方法选取我院2009年1月至2015年9月收治的296例手术切除后病理确诊为肝细胞肝癌伴微血管癌栓的连续病例作为研究对象,根据其术后是否联合应用介入治疗,分为单纯切除组（n=159）和切除术后联合介入组（n=137）,分析2组患者的一般资料,对单因素分析后有显著性差异的指标进行Cox回归分析,并分别计算2组患者的长期生存率（OS）及无瘤生存率（DFS）。结果切除术后联合介入组在长期生存率及无肿瘤复发率方面均优于单纯切除组（OS：18%vs.8%,P=0.001;TRF：15%vs.8%,P=0.008）。多因素分析结果显示,慢性乙肝感染（HR 1.596,P=0.002,95%CI 1.194~2.131）,肿瘤大于5 cm（HR 0.729,P=0.042,95%CI 0.539~0.989）以及多个肿瘤（HR 1.480,P=0.049,95%CI 1.002~2.186）是影响患者长期生存的不利因素。结论 HCC伴MVI患者切除术后联合介入治疗可改善预后。

Objective The aim of this study is to analyze the long-time outcome of hepatocellular carcinoma（ HCC） patients with microvascular invasion underwent liver resection combined with transarterial chemoembolization（ TACE）. Methods Our database of surgical resection from January 2009 to September 2015 was retrospectively analyzed. This study was conducted on 296 HCC patients with MVI. Patients were divided into two groups：one group underwent liver resection（ n = 159） and another for liver resection combined with TACE（ n = 137）.The 5-year overall survival rate（ OS） and disease free survival（ DFR） were compared. A multivariate Cox proportional hazards regression analysis was performed to assess the prognostic risk factors associated with overall survival rate. Results The 5- year OS and 5- year DFR see significant difference（ OS：18% vs. 8%,P = 0. 001;TRF：15% vs. 8%,P = 0. 008）. Multivariate analysis revealed that HBsA g（ HR 1. 596,P = 0. 002,95% CI 1. 194 ~ 2. 131）,tumor size 5 cm（ HR 0. 729,P = 0. 042,95% CI 0. 539 ~ 0. 989） as well as multiple tumors（ HR1. 480,P = 0. 049,95% CI 1. 002 ~ 2. 186） were correlated to poor overall survival rate. Conclusion Surgical resection combined TACE for HCC patients with MVI realized a better prognosis than patients merely underwent therapy of resection.