术后预防性肝动脉化疗栓塞对合并微血管侵犯肝细胞癌患者早期复发的影响

Postoperative prophylactic transcatheter arterial chemoembolization on early recurrence in patients with hepatocellular carcinoma with microvascular invasion

目的比较术后预防性肝动脉化疗栓塞（TACE）对合并微血管癌栓肝癌患者早期复发的影响。方法回顾性分析2012年1月至2013年12月广西医科大学附属肿瘤医院收治的接受根治性肝切除治疗的肝细胞癌患者资料，其中合并微血管侵犯且符合入组条件的患者127例。根据术后是否行预防性TACE把患者分为两组，单纯手术组（I组）86例和手术联合预防性TACE组（Ⅱ组）41例。结果经PSM法均衡组问协变量后，共有39对匹配成功，I组和Ⅱ组患者4、8、12个月累积无复发生存率分别为68．3％、57．8％、41．4％和89．7％、76．1％、62．8％，组问比较差异有统计学意义（X2=4．247，P〈0．05）。结论对于合并微血管侵犯的肝癌患者，在根治性切除术后予以预防性TACE可有效延缓早期复发。

Objective To study the effects of postoperative prophylactic transcatheter arterial che- moembolization （TACE） on early recurrence （ ≤1 year） in patients with hepatocellular carcinoma （HCC） with microvascular invasion. Methods We collected the clinical data of HCC patients treated with radical hepateetomy from Cancer Hospital of Guangxi Medical University between January 2012 and December 2013, and 127 eligible cases with microvascular invasion were reviewed. According to the treatment with or without TACE, the patients were divided into hepateetomy alone group （group Ⅰ , n = 86） and combined with TACE group （group Ⅱ , n = 41 ）. The PSM （Propensity Score Matching） of SPSS software was used to reduce con- founding bias between the two groups, and the disease free survival rates were compared between the matched data. Results Thirty-nine pairs were matched with PSM for balancing eovariates in the two groups. The relapse-free survival rates of 4, 8 and 12-month were all significantly higher in the group Ⅱ （89. 7% , 76. 1% , 62.8% ） than that in group I （68.3%, 57.8% , 41.4% ）. There were significantly statistical differences （ X2 =4.247, P 〈0.05）. Cox regression analysis revealed serum AST level was an inde- pendent prognostic factor associated with poor early recurrence. Conclusion Prophylactic TACE after radical resection might have benefits in delaying early-onset recurrence for HCC patients with microvascular invasion.