巨块型肝内胆管癌术后经肝动脉化疗栓塞的有效性

Effectiveness of postoperative transarterial chemoembolization for huge intrahepatic cholangiocarcinoma

目的:探讨巨块型肝内胆管癌术后经肝动脉化疗栓塞(transarterial chemoembolization,TACE)治疗的有效性。方法:回顾性分析2009年1月至2013年12月手术治疗125例巨块型肝内胆管癌(最大径≥10 cm)病人的临床病理资料。35例术后TACE,90例无术后TACE,分别为TACE组和非TACE组。采用Kaplan-Meier法估计病人术后复发率和生存率。采用Log-Rank检验比较组间差异。应用Cox回归探索影响病人术后复发和生存的独立危险因素。采用倾向评分匹配减少组间差异。根据肝内胆管癌第8版TNM分期进行亚组分析,探索术后TACE治疗的获益病人。结果:TACE组和非TACE组具有相似的复发率和生存率(5年复发率:85.7%比84.4%,P=0.487;5年生存率:22.9%比20.0%,P=0.426)。1∶1倾向评分配对后,两组各33例病人,术后复发率(P=0.114)和生存率(P=0.197)差异无统计学意义。TNM分期亚组分析,61例TNMⅠ期,64例TNMⅡ期。分期分析显示Ⅰ期病人TACE组和非TACE组的复发率和生存率差异无统计学意义。Ⅱ期病人TACE组5年复发率较低(91.7%比97.5%,P=0.022),5年生存率较高(12.5%比2.5%,P=0.002)。在矫正肿瘤多发、血管侵犯和癌胚抗原≥5μg/L后,TACE仍是显著影响Ⅱ期病人肿瘤复发(风险比:0.564,95%CI:0.327~0.974)和生存(风险比:0.449,95%CI:0.259~0.777)的危险因素。结论:术后TACE有可能改善巨块型肝内胆管癌TNMⅡ期病人的预后。

Objective To investigate the effect of postoperative transarterial chemoembolization(TACE)for huge intrahepatic cholangiocarcinoma(ICC).Methods Data of 125 huge ICC(diameter≥10 cm)patients with surgical treatment treated with or without TACE(TACE group 35 cases,and non-TACE group 90 cases)between January 2009 and December 2013 were analyzed retrospectively.Both recurrence rate and overall survival(OS)rate were analyzed using the Ka-plan-Meier method and the difference using Log-Rank test.Cox regression analysis was used to explore the independent risk factors of postoperative recurrence and OS.Propensity score matching was used to reduce the difference between groups.Subgroup analysis was done for benefited patients from TACE based on the 8 th TNM staging of ICC.Results TACE group had similar recurrence and OS with non-TACE group.5-year recurrence rate and OS rate were 85.7%vs.84.4%,P=0.487;22.9%vs.20.0%,P=0.426,respectively.After 1∶1 propensity score matching with 33 cases each group,there was no significant difference between two groups(P=0.114 for recurrence,P=0.197 for OS).According to TNM staging,there were 61 cases in stageⅠand 64 cases in stageⅡ.Staging analysis showed that TACE group and non-TACE groups yielded similar recurrence and OS in patients with stageⅠ.However,for patients in stageⅡ,TACE group had lower recurrence rate(91.7%vs.97.5%,P=0.022)and higher OS rate(12.5%vs.2.5%,P=0.002).After adjustment for multiple tumors,vascular invasion,and CEA≥5μg/L,TACE was independent risk factor of recurrence(hazard ratio:0.564,95%CI:0.327-0.974)and OS(hazard ratio:0.449,95%CI:0.259-0.777)in patients with stageⅡ.Conclusions For patients with huge ICC,postoperative TACE may improve the prognosis of patients with TNM stageⅡ.