辅助性肝动脉化疗栓塞治疗肝细胞癌微血管浸润的疗效

The Curative Effect of Auxiliary Hepatic Arterial Chemoembolization in the Treatment of Microvascular Invasion of Hepatocellular Carcinoma

目的研究辅助性肝动脉化疗栓塞治疗肝细胞癌微血管浸润(MVI)后的复发率等,探讨治疗的有效性与安全性.方法收集2010年1月至2016年12月间在西安交通大学第一附属医院肝胆外科的临床分期早中期肝细胞癌患者590例,进行肝切除术治疗并进行随访,采用回顾性分析的方法进行研究.采用单变量和多变量分析方法,患者均分4组.用Kaplan-Meier方法比较4组术后RFS和OS的发生率,并采用Log-rank分析方法确定显著差异.结果肝细胞癌患者中,经TACE和无TACE 2组间性别、乙肝病毒表面抗原、总胆红素、凝血酶原时间、AFP、HBV-DNA、最大肿瘤直径、包膜、手术类型、肝门阻断、Child-Pugh分级等比较,差异无统计学意义(P>0.05);而年龄、肝硬化结节、肿瘤细胞异型性、BCLC等在无微血管浸润组中比较,差异有统计学意义(P<0.05).脾功能亢进、复发率等在微血管浸润组中比较,差异有统计学意义(P<0.05).单因素与多因素分析,AFP(>400 ng/m L)、肿瘤直径、包膜完整性、MVI、肝大部分切除等与总体生存率有相关(P<0.05),AFP(>400ng/m L)、Child-Pugh分级B、肿瘤直径、肝细胞癌异型程度、包膜完整性、MVI等与无瘤生存率有相关(P<0.05).多个逻辑回归确定血清AFP水平>400 ng/L,肿瘤大小>5 cm,和不完整的肿瘤包膜是独立的相关因子(P<0.05).在存在微血管浸润的肝细胞癌患者中,辅助性肝动脉化疗栓塞的总体生存率和无瘤生存率相较于未进行辅助性肝动脉化疗栓塞有明显的改善(P<0.05),而不存在微血管浸润的肝细胞癌患者中无显著影响(P>0.05).结论微血管浸润与肝细胞癌复发率和生存率存在一定相关性,利用辅助性肝动脉化疗栓塞的方法有助于降低复发率延长生存期.

Objective To investigate the recurrence rate, the efficacy and safety of auxiliary hepatic arterial chemoembolization after the treatment of microvascular invasion（MIV） of hepatocellular carcinoma. Methods A total of 104 patients with hepatocellular carcinoma clinical staging of early metaphase were collected from the First Affiliated Hospital of Xi＇an Jiaotong University in Jan.2010 to Dec.2016, all treated with liver resection and follow-ups. Adopting the method of retrospective analysis,univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival（RFS）and overall survival（OS）. Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE. Results In HCC patients,the gender HBs Ag,total bilirubin,and prothrombin time,AFP,HBV-DNA, the size of largest tumor, capsule, operation type, hepatic door block, Child-Pugh grade,classification comparison differences had no statistical significance between the two groups of with or without TACE（P〉0.05）; Age, nodules, tumor cell resection, and BCLC were statistically significant in the non-MIV infiltration group（P〉0.05）.Hypersplenism and recurrence rate were statistically significant in MIV group（P〉0.05）.Univariate and multivariate analyses demonstrated that AFP（ 400 ng/m L）, tumor diameter, membrane integrity, MVI, and most liver resection were significantly associated with overall survival rates（P〉0.05）, the AFP（400 ng/m L）, Child-Pugh, grade B, tumor diameter, hepatocellular carcinoma（HCC） and other abnormal degree, membrane integrity, MVI have significant correlation with disease-free survival rate（P〉0.05）. Multiple logistic regression identified serum AFP level 400 ng/L, tumor size 5 cm, and incomplete tumor envelope was independent correlation factor（P〉0.05）. In the HCC patients with MIV, both OS and DFS were significantly improved in patients who received PA-TACE as compared to those who underwent liver resection alone（P 0.05）, but no significant effect in HCC patients wieh no MIV invasion（P〉 0.05）.Conclusions There is a certain correlation between microvascular infiltration and the recurrence rate and survival rate of hepatocellular carcinoma, and the method of using adjuvant hepatic arterial chemoembolization is helpful to reduce the recurrence rate and prolong the survival period.