经导管肝动脉栓塞化疗联合抗病毒治疗对乙肝相关肝癌患者复发的影响

The impact of combined postoperative antiviral therapy with adjuvant transarterial chemoembolization in hepatitis B-related hepatocellular carcinoma patients with high risks of recurrence

目的探讨经导管肝动脉栓塞化疗（TACE）联合抗病毒治疗对具有复发危险因素的肝细胞癌（HCC）患者术后复发的影响。方法前瞻性分析2014年1月至2015年2月南京医科大学附属淮安第一医院53例HCC患者资料。所有入选者均推荐TACE联合抗病毒治疗。将未行TACE或抗病毒治疗患者归人对照组（21例），行TACE联合抗病毒治疗归人试验组（32例）。患者入组后每3个月随访1次，定期随诊患者存活以及复发情况。对比两组患者术后无瘤生存率和总体生存率。结果两组患者一般临床资料比较，差异无统计学意义（P〉0．05）。术后无瘤生存时间试验组（20．1±1．8）个月，对照组（18．7±2．4）个月，差异无统计学意义（P〉0．05）。试验组和对照组术后1、2、3年无瘤生存率分别为65．6％比57．1％、31．3％比28．6％和15．6％比14．3％，差异无统计学意义（P〉0．05）。术后总体生存时间试验组（26．8±1．7）个月，对照组（21．1±2．2）个月，差异有统计学意义（P〈0．05）。试验组和对照组患者术后1、2、3年总体生存率分别为87．5％比66．7％、59．4％比38．1％和43．8％比19．0％，试验组高于对照组，差异有统计学意义（P〈0．05）。结论TACE联合抗病毒治疗虽然不能降低具有复发危险因素HCC患者术后复发率，但可明显提高总体生存时间。

Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization （TACE） with antiviral therapy in hepatitis B-related hepatocellular carcinoma （HBV- HCC） patients with high risks of recurrence. Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled. These patients were assigned to either the adjuvant antiviral therapy combined with TACE group （n = 32）, the treatment group or the no adjuvant treatment group （n= 21, the control group）. The recurrence-free survival （RFS） and overall survival （OS） were analyzed. Results There was no significant difference between the two groups in clinical characteristics （P〉0.05）. The recurrence-free survival （RFS） （mean＋S.D.） was （20.1±1.8） months in the treatment group and （18.7±2.4） months in the control group （P=0.752）. The 1-, 2- and 3-year RFS rates of the treatment group and the control group were 65.6% vs. 57.1%, 31.3% vs. 28.6% and 15.6% vs. 14.3%, respectively （ P〉0.05 ）. The overall survival （OS） （ mean＋ S. D. ） was （ 26.8±1.7 ） months in the treatment group and （21.1±2.2） months in the control group （P=0.037）. The 1-, 2- and 3-year RFS rates were 65.6% vs. 57.1%, 31.3% vs. 28.6% and 15.6% vs. 14.3% in the treatment group and the control group, respectively. The 1-, 2-, and 3-year OS rates were 87.5% vs. 66.7%, 59.4% vs. 38.1% and 43.8% vs. 19.0% in the treatment group and the control group, respectively. Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate, but it improved the OS rate in HCC patients with high risks of recurrence.