摘要
目的评价术后辅助肝动脉化疗栓塞术（TACE）对预防、监测、治疗肝癌复发的效果。方法纳入166例肝癌手术后辅助TACE和190例单纯肝癌手术患者，采用多因素分析评估复发的危险因素。根据复发危险因素做亚组分析，比较患者术后复发率及复发患者的总生存率。通过比较复发患者CT／MRI结果评估术后TACE增强CT／MRI检测复发肿瘤的敏感性。结果多因素分析结果表明，包膜侵犯、肝内血管侵犯、多结节是早期复发危险因素（均P〈0．05），复发高峰期均为术后4～6个月；HBsAg是晚期复发危险因素。手术＋TACE患者与单纯手术患者第6、12、18、24个月复发率在包膜侵犯亚组中分别为23．2％比59．4％、68．4％比72．5％、83．1％比89．2％、90．1％比91．3％；肝内大血管侵犯亚组分别为26．3％比64．5％、69．8％比78．4％、87．4％比97．2％、88．6％比98．1％；多结节亚组分别为12．5％比31．2％、36．4％比47．4％、50．3％比60．1％、56．8％比65．3％。单纯手术组患者仅第6和12个月复发率减少，两组差异有统计学意义（P〈0．05）。两组患者平均生存期分别为25．3和20．5个月，第1、2和3年总生存率分别为68．5％比50．3％、49．3％比31．2％、27．6％比20．3％（均P〈0．05）。术后TACE可增加CT／MRI检测直径〈1cm复发灶的敏感性。结论术后TACE不但可降低肝癌患者早期复发率，还可用于监测和治疗术后复发病灶。
Objective To investigate the efficacy of transarterial chemoemblozaition （TACE） in preventing, detecting and treating recurrence of hepatocellular carcinoma （HCC） in patients after liver re- section. Methods 166 patients who underwent liver resection followed by adjuvant TACE and 190 patients with liver resection alone were retrospectively studied. Multivariate analyses and subgroup analyses were per- formed to investigate the risk factors of recurrence. The recurrence and survival rates were calculated. The role of postoperative adjuvant TACE in enhancing sensitivity of CT/MRI to detect recurrence was also ana- lyzed. Results Multivariate analyses revealed tumor capsule invasion, vascular invasion and multiple no- dules were risk factors of early recurrence （ all P 〈 O. 05 ）. HBsAg positivity was closely related to late recur- rence. The 6-, 12-, 18-, and 24-month recurrence rates between patients who underwent liver resection ＋ TACE and liver resection alone were 23.2% vs 59.4% ,68.4% vs 72. 5% ,83.1% vs 89. 2% and 90. 1% vs 91.3% in the tumor capsule invasion subgroup; 26. 3% vs 64. 5%, 69. 8% vs 78. 4%, 87.4% vs 97.2% and 88.6% vs 98.1% in the vascular invasion subgroup; and 12. 5% vs 31.2%, 36. 4% vs 47.4% ,50. 3% vs 60. 1% and 56. 8% vs 65.3% in the multiple nodules subgroup, respectively. The re- currence rates only significantly decreased at 6 months and 12 months in the group of patients after liver re- section ＋ adjuvant TACE （ P 〈 0. 05）. Among the patients who developed recurrence, the mean survival inthese two groups was 25.3 vs 20.5 months, and the 1-, 2- and 3-year overall survival rates were 68.5% vs 50.3% , 49.3% vs 31.2% and 27.6% vs 20.3% , respectively all P 〈0.05. Furthermore, postoperative adjuvant TACE was effective in enhancing sensitivity of CT/MRI to deteet 〈 1 em recurrent lesions. Conclu- sion Postoperative adjuvant ＇FACE was effective in preventing, deteeting and treating early recurrent HCC ~ after liver resection.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2016年第4期217-222,共6页
Chinese Journal of Hepatobiliary Surgery
基金
广西科技攻关计划（桂科攻14124003-4）
关键词
肝癌
根治性手术
辅助性TACE
术后
早期复发
Liver cancer
Curative resection
Adjuvant TACE, postoperative
Early recur-
