术前多次肝动脉介入栓塞治疗对肝癌肝移植预后的影响

Impact of multiple sessions of transarterial chemoembolization for hepatocellular carcinoma patients awaiting liver transplantation

目的探讨术前多次TACE治疗后对于肝癌患者的肿瘤坏死、肝移植后肿瘤复发及患者生存的影响。方法回顾性分析中国人民解放军第九七〇医院2003年1月至2012年12月间收治的84例移植前接受过TACE治疗的肝癌患者的相关临床资料及其治疗效果。中位随访时间为76个月(0~146个月)。结果84例患者中9例(10.7%)肝移植后复发,复发率与肝癌的诊断和肝移植之间的短期间隔(≤6个月)具有显著的相关性(P=0.029,OR=19.2)。肿瘤的坏死与复发没有显著的相关性。平均总体存活时间为102.8个月(95%可信区间:94.9~110.8月)。1年,3年,5年的存活率分别为91.7%,88.1%,82.1%。等待时间≤6个月、肿瘤的病理学特征、微血管侵犯与患者的生存期有统计学联系(P<0.05)。TACE治疗的次数与肿瘤的坏死及患者的预后无关。结论TACE治疗的次数与肝癌患者肝移植后的复发及生存期无关。肿瘤的病理学特征、微血管侵犯、移植前等待时间缩短与HCC行肝移植后复发的风险增高及生存期缩短有关。

Objective To assess the impact of multiple sessions of transarterial chemoembolization(TACE)on tumor necrosis,tumor recurrence and survival in patients awaiting liver transplantation(LT).Methods From January 2003 to December 2012,retrospective analysis was performed for 84 LT patients receiving TACE for HCC.The median follow-up period was 76(0-146)months.Results Among them,9/84 LT patients(10.7%)developed recurrent HCC.Recurrence had a significant relationship with a short interval between the diagnosis of HCC and LT(<6 months)[P=0.029,odds ratio(OR)=19.2].No significant relationship existed between tumor necrosis in explant and recurrence.The mean overall survival was 102.8 months(95%confidence interval 594.9-110.8 months)and the 1/3/5-year survival rates were 91.7%,88.1%and 82.1%respectively.Waiting time<6 months,microvascular invasion and tumor characteristics were statistically associated with shorter survival.The session number of TACE was not associated with tumor necrosis or survival.Conclusions Multiple sessions of TACE are not associated with a higher risk of recurrence or shorter survival.A shorter waiting time before LT is correlated with an elevated risk of recurrence and lowered survival after LT for HCC.