术前辅助性肝动脉化疗栓塞对巨块型肝癌预后的影响

Effect of preoperative assisted transcatheter hepatic arterial chemoembolization on the prognosis of massive liver cancer

目的评价术前辅助性肝动脉化疗栓塞(transcatheter hepatic arterial chemoemb-olization,TACE)对巨块型肝癌预后的影响。方法收集2010年1月~2015年3月收入院手术治疗的31例巨块型肝癌患者,均为经术后病理确诊肝细胞性肝癌的病例,对该患者的资料进行回顾性分析,根据手术前是否行TACE术分组为一期手术组(n=21)与术前辅助性TACE术联合降期手术组(n=10),两组均行巨块型肝癌切除手术,比较两组的总体生存率与无瘤生存率。结果一期手术组和术前辅助性TACE术联合降期手术组1、3年总体生存率分别为70.70%(7/10)、20.00%(1/5)和100.00%(10/10)、71.40%(5/7),平均生存时间分别为(45.429±5.122)个月和(26.399±4.658)个月,两组术后生存率的差异有统计学意义(P=0.041)。两组1年的无瘤生存率分别是26.67%(4/15)和75.00%(6/8),两组术后无瘤生存率有统计学差异(P=0.031)。结论术前辅助性TACE术能使巨块型肝癌的肿块减小,增加手术切除机会,减少明显的肝功能损害,降低手术难度,对术后恢复影响小,对提高巨块型肝癌的术后总生存率及无瘤生存率有帮助。

Objective To evaluate the effect of preoperative assisted transcatheter hepatic arterial chemoembolization (TACE) on the prognosis of massive liver cancer. Methods Thirty-one patients with massive liver cancer who underwent surgical treatment from January 2010 to March 2015 were collected. All of these patients were diagnosed with hepatocellular carcinoma by postoperative pathology. The patients' data were retrospectively analyzed. According to whether TACE was performed before surgery, the patients were divided into one-stage operation group(n=21) and preoperative auxiliary TACE combined with descending-stage operation group(n=10). Massive liver cancer resection was performed in all patients, and the overall survival rate and tumor-free survival rate were compared between the two groups. Results The 1-and 3-year overall survival rates of the two groups were 70.00%(7/10), 20.00%(1/5), and 100.00%(10/10), 71.40%(5/7), and the average survival time was (45.429±5.122) months and (26.399±4.658) months. There were statistically significant differences in postoperative survival rates between the two groups (P=0.041). The 1-year tumor-free survival rates of the two groups were 26.67%(4/15) and 75.00%(6/8), respectively, and the difference was statistically significant(P=0.031). Conclusion Preoperative assisted TACE can reduce the mass of massive liver cancer, increase the chance of surgical resection, reduce obvious liver function damage, reduce the difficulty of surgery, with little effect on postoperative recovery, and can improve the postoperative total survival rate and tumor-free survival rate in patients with massive liver cancer.