辅助性经肝动脉化疗栓塞对肝内胆管癌患者根治术后预后的影响

Influence of postoperative adjuvant transarterial chemoembolization on the prognosis and recurrence in patients with intrahepatic cholangiocarcinoma

目的评估肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)根治性切除术后行辅助性经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗对患者生存及肿瘤复发的影响。方法本研究收集2010年1月—2015年12月在东方肝胆外科医院完成根治性切除术的ICC患者,按是否接受术后辅助性TACE,分为TACE组(术后接受辅助TACE)和非TACE组(术后未接受辅助TACE)。根据美国癌症联合委员会(AJCC)第8版肿瘤TNM分期系统进行分期。单因素及多因素分析用于评估独立的预后因素。Kaplan-Meier方法比较无复发生存率(RFS)和总生存率(OS)。结果共有599例ICC患者纳入本研究,TACE组115例,非TACE组484例,中位随访时间为23个月。TACE组和非TACE组的1、3、5年OS生存率分别为67.0%、51.8%、36.6%和67.2%、48.5%、35.9%,两组患者生存时间比较,差异无统计学意义(P=0.5929);TACE组的中位RFS时间要明显短于非TACE组(6个月vs 11个月),TACE组和非TACE组的1、3、5年RFS生存率分别为32.3%、24.0%、18.8%,和46.1%、33.4%、25.8%,两组比较,差异具有统计学意义(P=0.0036)。Cox回归模型显示,TACE组与非TACE组ICC患者无复发生存率存在统计学差异(HR=1.51,95%CI:1.151.96;P=0.0026)。结论ICC患者根治性切除术后辅助性TACE不能延长ICC患者的总生存率,而且可能有增加ICC术后患者肿瘤复发的风险。

Objective To evaluate the effects of adjuvant transarterial chemoembolization(TACE)on survival and recurrence of patients with intrahepatic cholangiocarcinoma(ICC)afer radical liver surgery.Methods A total of 599 patients who underwent hepatectomy for ICC at the Eastern Hepatobiliary Surgery Hospital between January 2008 and December 2011,including 115 patients with adjuvant TACE and 484 patients without TACE.Univariate and multivariate analysis were used to evaluate independent prognostic factors.The recurrence-free survival(RFS)and overall survival(OS)rates were compared between two groups using the Kaplan-Meier method.Results Patients were followed up for a median of 23 months.The 1-,3-and 5-year OS rates in the TACE group and non-TACE group were 67.0%,51.8%,36.6%,and 67.2%,48.5%,and 35.9%respectively(P=0.5929).The 1-,3-and 5-year RFS rates in the TACE group were 32.3%,24.0%,and 18.8%,respectively,which was significant lower than those in non-TACE group(46.1%,33.4%,and 25.8%;P=0.0036).Cox regression model shows that the risk of ICC recurrence in TACE group was significantly higher than that in non-TACE group(HR=1.51,95%CI:1.15-1.96;P=0.0026).Conclusion The results indicate that adjuvant TACE after radical surgery may not prolong the OS for patients with ICC,and it might increase the risk of disease recurrence for ICC patients.