单发小肝细胞癌根治术后行预防性TACE的生存及早期复发影响因素分析

Analysis of survival and early recurrence factors of preventive TACE after radical resection of single small hepatocellular carcinoma

目的探讨预防性经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)对单发小肝细胞癌(small hepatocellular carcinoma,SHCC)病人术后的生存影响,并分析影响单发SHCC术后早期复发和总体生存的危险因素。方法选取内江市第二人民医院2014年2月至2016年3月经术前影像学及多学科诊断为可切除的单发SHCC病人95例,按治疗方式分为预防组(37例)和对照组(58例),预防组先行肝切除术再行预防性TACE治疗,比较两组间的复发及生存差异。对术后2年内的复发和未复发病人进行比较,并对影响早期复发和总体生存的临床病理资料进行单因素分析,将单因素分析后有显著性差异的指标纳入多因素生存分析。结果预防组1、3、5年生存率和中位生存期分别为94.6%、72.3%、51.5%和52.0个月,对照组分别为96.6%、75.5%、49.2%和52.3个月;预防组1、3、5年无复发生存率和中位无复发生存期分别为91.9%、54.1%、40.5%和42.0个月,对照组分别为84.5%、56.9%、37.9%和39.1个月;两组中位生存期和中位无复发生存期差异均无统计学意义(P>0.05)。单因素分析显示,甲胎蛋白(alpha fetoprotein,AFP)>400μg/L、微血管侵犯(microvascular invasion,MVI)、分化程度较低、切缘≤1 cm、无完整包膜是单发SHCC早期复发的危险因素,AFP>400μg/L、MVI、非解剖性肝切除、分化程度较低、切缘≤1 cm、无完整包膜、早期复发是影响单发SHCC总体生存情况的危险因素(P<0.05)。多因素生存分析显示,AFP>400μg/L、MVI是单发SHCC早期复发的独立危险因素(OR值分别为4.451、11.309,均P<0.05),MVI、分化程度较低、切缘≤1 cm、无完整包膜、早期复发是单发SHCC总体生存情况的独立危险因素(HR分别为0.366、8.362、3.532、6.688、0.261,均P<0.05)。结论应避免对单发SHCC病人不加选择地行预防性TACE,但对于AFP>400μg/L、MVI的单发SHCC,可考虑行预防性TACE联合免疫及靶向治疗来预防其早期复发。

Objective To explored the effect of preventive transcatheter arterial chemoem-bolization(TACE)on the survival of patients with single small hepatocellular carcinoma(SHCC)after surgery and analyzed the risk factors of early recurrence.Methods From February 2014 to March 2016,a total of 95 patients with resectable solitary small hepatocellular carcinoma were diagnosed by preoperative imaging and multidisciplinary diagnosis and divided into two groups of prevention(n=37)and control(n=58).Prevention group underwent hepatectomy and subsequent adjuvant TACE treatment.The inter-group differences in recurrence and survival were compared.The patients recurrent within 2 years post-operation were compared and clinicopathological data affecting early recurrence and overall survival examined by univariate analysis.The parameters with significant differences after univariate analysis were included for multivariate survival analysis.Results The 1/3/5-year survival rates and median survival of prevention group were 94.6%,72.3%,51.5%and 52.0 months and control group 96.6%,75.5%,49.2%and 52.3 months respectively;The 1/3/5-year recurrence-free survival rates and median recurrence-free survival rates were 91.9%,54.1%,40.5%and 42.0 months while 84.5%,56.9%,37.9%and 39.1 months in control group respectively;no significant inter-group difference existed in median survival time or median recurrence-free survival time(P>0.05).Univariate analysis showed that alpha fetoprotein(AFP)>400μg/L,microvascular invasion(MVI),low differentiation,margin≤1 cm and incomplete envelope were risk factors for early recurrence of SHCC.AFP>400μg/L,MVI,non-dissecting hepatectomy,low differentiation,margin≤1 cm,incomplete envelope,high-risk factors for early recurrence of SHCC.Early recurrence was a risk factor for overall survival of single SHCC(P<0.05).Multivariate survival analysis indicated that AFP>400μg/L and MVI were independent risk factors for early recurrence of SHCC(OR=4.451,11.309,P<0.05).MVI,low degree of differentiation,margin≤1 cm,incomplete capsule and early recurrence were independent risk factors for overall survival of SHCC(HR=0.366,8.362,3.532,6.688,0.261,P<0.05).Conclusion Prophylactic TACE should be avoided for single SHCC.However,for single SHCC with AFP>400μg/L and MVI,prophylactic TACE plus immunotherapy and targeted therapy are indicated for preventing early recurrence.