术后辅助性TACE对肝细胞癌患者预后的作用

Role of postoperative adjuvant transarterial chemoembolization on the prognosis of patients with hepatocellular carcinoma

目的探究术后辅助性动脉化疗栓塞(TACE)对肝细胞癌(Hepatocellular carcinoma,HCC)患者预后的影响。方法回顾性分析本院2005年12月至2009年12月收治的243例行肝癌切除术的原发性肝癌患者的临床病理资料,根据术后是否接受辅助性TACE治疗分为TACE组(129例)和非TACE组(114例),用Kaplan-Meier法描绘两组的生存曲线,Cox回归模型分析影响HCC患者预后的危险因素。根据巴塞罗纳(BCLC)分期对243例HCC患者进行分层分析,分别探究术后辅助性TACE对0/A期和B期患者的作用。结果 TACE组和非TACE组的1、3、5年的总体生存率分别为84.9%、52.4%、41.1%和84.1%、51.4%和38.9%,差异无统计学意义(P=0.052);1、3、5年的肿瘤复发率分别为28.2%、47.0%、55.5%和34.4%、60.6%、71.1%,差异具有统计学意义(P=0.038)。多因素分析结果显示:丙氨酸氨基转移酶、凝血酶原时间、糖类抗原19-9水平、肿瘤直径、多发肿瘤是影响患者总体生存的独立危险因素;BCLC分期B期、肿瘤直径、微血管侵犯、淋巴结转移是肿瘤复发的独立危险因素,而术后辅助性TACE则具有抗复发作用。分层分析显示103例B期患者中,术后辅助性TACE可以提高患者总体生存率(P=0.016),降低肿瘤复发率(P=0.002);而在0/A期的患者中,术后辅助性TACE对OS和肿瘤复发都无影响。结论术后辅助性TACE能够降低肿瘤复发风险,BCLC分期B期患者应建议其术后接受辅助性TACE治疗。

Objective To explore the clinical effect of postoperative adjuvant transarterial chemoembolization （TACE） on the prognosis of hepatocellular carcinoma （HCC） patients underwent liver resection. Methods From December 2005 to December 2009, clinical and pathological data of 243 consecutive HCC patients in our hospital were retrospectively analysed, according to whether they accept postoperative adjuvant TACE, they were divided into two groups, namely TACE group （129 cases） and non-TACE group （114 cases）. Kaplan-Meier curves of two groups were described, and Cox regression model was used to analyze the prognostic factors of HCC. 243 HCC patients were stratified according to the Barcelona Clinic Liver Cancer （BCLC） staging system to explore the role of adjuvant TACE on the prognosis in different stage. Results The 1-,3-,5-years overall survival rates of TACE group and non-TACE group were 84. 9% , 52. 4% , 41.1% and 84. 1% , 51.4% , 38. 9% , respectively （P =0. 052）. The 1-,3-,5-years recurrence rates among the two groups were 28.2% , 47% , 55.5% and 34. 4% , 60. 6% , 71.1% , respectively （P =0. 038）. COX regression analy- sis showed that alanine aminotransferase, prothrombin time, carbohydrate antigen 19-9 level, tumor diameter, multiple tumors were in- dependent risk factors of overall survival （OS） ; BCLC B stage, tumor size, vascular invasion, lymph node metastasis were the inde- pendent risk factors of tumor recurrence, and postoperative adjuvant TACE could decrease the tumor recurrence rate. Stratified analysis showed that postoperative adjuvant TACE therapy was a protective factor of OS （P = 0. 016） for the patients of BCLC B stage, and could decrease the tumor recurrence rate （P = 0. 002） ; while for patients of BCLC 0/A stage, postoperative adjuvant TACE had no effect on OS and tumor recurrence. Conclusions Postoperative adjuvant TACE could reduce recurrence risk in HCC patients, BCLC stage B patients should be recommended to receive postoperative adjuvant TACE.