索拉非尼和预防性TACE对合并微血管侵犯的肝癌患者术后预防复发的影响

Effect of sorafenib and prophylactic TACE for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion

目的研究根治性肝癌切除术后应用索拉非尼和预防性肝动脉化疗栓塞术(TACE)对合并微血管侵犯(MVI)的肝癌患者复发的影响。方法回顾性分析2015年8月至2018年1月郑州大学第一附属医院137例行根治性肝癌切除术,且术后病理诊断为有MVI的肝癌患者的临床资料。其中A组单纯手术,B组术后应用索拉非尼,C组术后行预防性TACE,分析3组患者的一般资料;用Kaplan-Meier计算无瘤生存率,采用COX比例风险模型分析肝癌合并MVI术后复发的独立危险因素,计数资料组间比较采用χ2检验、无瘤生存率组间比较采用log-rank检验。结果A、B、C三组病例数分别为49、36、52,三组患者的一般临床病理资料比较,差异无统计学意义。A、B、C三组患者术后1、2、3年无瘤生存率分别为71.4%、51.0%、38.8%,86.1%、75.0%、66.7%和82.7%、75.0%、59.6%,A组和B组比较(χ2=9.105,P=0.003)、A组和C组比较(χ2=5.958,P=0.015),1、2、3年无瘤生存率差异均有统计学意义,B组和C组患者无瘤生存率明显提高;B组和C组1、2、3年无瘤生存率差异无统计学意义(χ2=1.227,P=0.268)。经COX比例风险模型多因素分析发现,患者年龄(HR=0.622,P=0.046)、肿瘤最大直径(HR=1.661,P=0.033)、是否行预防性TACE(HR=0.544,P=0.019)、术后是否应用索拉非尼(HR=0.419,P=0.007)是影响肝癌伴MVI术后复发的独立危险因素。在复发类型上,B组以肝内单发为主,A组和C组以肝内多发为主。结论对于行根治性手术治疗合并MVI的肝癌患者,应用索拉非尼或预防性TACE可显著降低患者术后3年内的复发率。

Objective To study the effect of sorafenib and prophylactic transarterial chemoembolization(TACE)for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion(MVI)after using radical hepatectomy.Methods A retrospective analysis was performed on 137 cases that underwent radical hepatectomy at the First Affiliated Hospital of Zhengzhou University from August 2015 to January 2018.Clinical data of liver cancer patients with MVI were diagnosed by postoperative pathology.General data of the three groups were analyzed.Kaplan-Meier was used to calculate the tumor-free survival rate.COX proportional hazards-model was used to analyze the independent risk factors for postoperative recurrence of liver cancer with MVI recurrence.Counting data was compared by x2 test between groups,and log-rank test was used to compare the tumor-free survival rates.Results A,B,and C groups had 49,36,and 52 cases,respectively.General clinicopathological data of the three groups were not statistically significant.The postoperative tumor-free survival rates at 1-,2-,and 3-years were 71.4%,51.0%,38.8%,86.1%,75.0%,66.7%,and 82.7%,75.0%,and 59.6%respectively in A,B,and C groups.Multivariate Cox proportional-hazards regression model showed that patients'age(HR=0.622,P=0.046),maximum tumor diameter(HR=1.661,P=0.033),prophylactic TACE(HR=0.544,P=0.019),and postoperative use of sorafenib(HR=0.419,0.222,0.791,P=0.007)were independent risk factors for postoperative recurrence of liver cancer with MVI.Conclusion Sorafenib or prophylactic TACE use can significantly reduce the recurrence rate within 3 years after radical surgery in patients with liver cancer who were confirmed to have MVI by postoperative pathology.