经肝动脉化疗栓塞术与肝切除术治疗巴塞罗那B期多发性肝细胞癌的近远期效果比较

Short-and long-term efficacy of transarterial chemoembolization versus liver resection in treatment of patients with Barcelona stage B multiple hepatocellular carcinoma

目的对比研究经肝动脉化疗栓塞术(TACE)与肝切除术治疗巴塞罗那临床肝癌(BCLC)分期B期的多发性肝细胞癌(HCC)的近远期疗效。方法回顾性分析2010年6月-2011年6月在武汉市中心医院接受治疗的80例BCLC B期多发性HCC患者的临床资料,其中,49例行肝切除术(LR组),31例行TACE(TACE组)。比较2组患者术后并发症、肝功能变化、生存时间及生存率。计量资料2组间比较采用t检验;计数资料2组间比较采用χ~2检验。采用Kaplan-Meier曲线进行生存分析,进一步比较采用log-rank检验。结果术后1周,LR组和TACE组的TBil、ALT、AST均较术前显著升高(LR组:t值分别为3.181、2.181、2.955,P值分别为0.002、0.032、0.004;TACE组:t值分别为3.109、3.965、4.519,P值分别为0.003、<0.001、<0.001),且术后LR组的AST及ALT显著低于TACE组(t值分别为2.094、2.111,P值分别为0.040、0.038)。LR组的1、3、5年生存率分别为75.51%、51.02%、40.82%,显著高于TACE组的61.29%、22.58%、9.68%(P值均<0.05);LR组的中位生存时间为36.3个月,明显长于TACE组的26.5个月(P<0.05)。LR组的复发率显著低于TACE组(30.61%vs 67.74%,χ~2=10.576,P=0.001)。结论肝切除术治疗BCLC期多发性HCC的疗效优于TACE,可提高患者总生存率并延长生存时间。

Objective To investigate the short-and long-term efficacy of transarterial chemoembolization（TACE） versus liver resection in the treatment of patients with Barcelona Clinic Liver Cancer（BCLC） stage B multiple hepatocellular carcinoma（HCC）.Methods A retrospective analysis was performed for the clinical data of 80 patients with BCLC stage B multiple HCC who were treated from June 2010 to June 2011,and among these patients,49 underwent liver resection（LR group） and 31 underwent TACE（TACE group）.The postoperative complications,changes in liver function parameters,survival time,and 1-,3-,and 5-year survival rates were compared between the two groups.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier curve was used for survival analysis,The log-rank test was used for conparison between two groups.Results At 1 week after surgery,the LR group and the TACE group had significant increases in total bilirubin,alanine aminotransferase（ALT）,and aspartate aminotransferase（AST）（LR group：t=3.181,2.181,and 2.955,P=0.002,0.032,and 0.004;TACE group：t=3.109,3.965,and 4.519,P=0.003,P〈0.001,and P〈0.001）,and after surgery,the LR group had significantly lower levels of AST and ALT than the TACE group（t=2.094 and 2.111,P=0.040 and 0.038）.Compared with the TACE group,the LR group had significantly higher 1-,3-,and 5-year survival rates（75.51%/51.02%/40.82% vs 61.29%/22.58%/9.68%,all P〈0.05） and significantly longer median survival time（36.3 months vs 26.5 months,P〈0.05）.The LR group had a significantly lower recurrence rate than the TACE group（30.61% vs 67.74%,χ^2=10.576,P=0.001）.Conclusion Liver resection has a better effect in the treatment of patients with BCLC stage B multiple HCC than TACE and can improve overall survival and prolong survival time.