Transarterial chemoembolization as an adjuvant therapy in patients with hepatocellular carcinoma treated with hepatectomy

目的 评价动脉化疗栓塞(transarterial chemoembolization,TACE)对可切除肝癌患者生存期的影响.方法 回顾性分析386例因肝癌行部分肝切除术患者的临床资料.全部病例经术后病理证实.根据是否辅以TACE治疗分为TACE组(230例)和非TACE组(156例).TACE组再根据手术与TACE的先后关系分3个亚组:仅术前行TACE者71例为术前TACE组,仅术后行TACE者86例为术后TACE组,术前术后均行TACE者73例为联合TACE组.为比较TACE对肿瘤坏死的影响,术前未行TACE者242例归为A组(非TACE组+术后TACE组),术前行TACE者144例归为B组(术前TACE组+联合TACE组).应用寿命表计算累积生存率,以Kaplan-Meier生存曲线进行生存分析.采用X2检验比较A、B两组肿瘤的坏死率.结果 B组(18/144)较A组(0/242)有较高的肿瘤完全坏死率(P＜0.01).肿瘤完全坏死患者的累积生存率优于不完全坏死者(P＜0.01).患者1、3、5、10年累积生存率:联合TACE组分别为90.4%(66/73)、72.9%(42/73)、51.9%(22/73)和25.4%(2/73),术前TACE组分别为74.0%(50/71)、46.2%(28/71)、27.3%(5/71)和0(0/71),术后TACE组分别为88.0%(73/86)、59.6%(39/86)、36.7%(11/86)和0(0/86),非TACE组分别为75.8%(110/156)、63.4%(48/156)、31.0%(13/156)和23.9%(10/156).联合TACE组疗效最好,优于非TACE组及单纯术前TACE组和术后TACE组(P值均＜0.05).术前或术后TACE组累积生存率与非TACE组比较差异无统计学意义(P值均＞0.05).结论 术前联合术后TACE辅助手术部分肝切除可提高肝癌患者的累积生存率,仅单一术前或术后TACE对患者的远期生存无显著影响.Objective To evaluate the role of transarterial chemoembolization (TACE) as an adjuvant therapy in patients with hepatocellular carcinoma (HCC) treated with hepatectomy. Methods Clinical data of 386 consecutive patients who underwent hepatectomy for HCC were analyzed retrospectively.Of the 386 patients, 156 patients did not undergo TACE served as controls (non-TACE group), the remaining 230 patients underwent TACE (TACE group) preoperatively (n=71), postoperatively (n=86), or both (n =73). For the purpose of comparison, patients who did not undergo preoperative TACE were assigned to group A (n=242), and those patients who underwent preoperative TACE were assigned to group B (n =144). Patients cumulative survival rates were calculated by survival table and analyzed using Kaplan-Meier survival curves. Results There were significantly higher complete necrosis rates in group B (18/144) than those in group A (0/242) ( P ＜ 0.01). The difference between the survival rate of patients with complete necrosis and those with incomplete necrosis was statistically significant (P＜0.01).The 1-,3-,5-and 10-year survival rates were 90.4%(66/73),72.9%(42/73),51.9%(22/73) and 25.4%(2/73) in combined TACE group, 74.0% (50/71) ,46.2%(28/71) ,27.3%(5/71) and 0(0/71) in preoperative TACE group, 88. 0% (73/86) ,59. 6% (39/86) ,36. 7% (11/86) and 0(0/86) in postoperative TACE group, and 75. 8% (110/156), 63.4% (48/156), 31.0% (13/156) and 23.9% (10/156) in non-TACE group,respectively. Combined TACE group got a significantly higher survival rate compared with non-TACE group or preoperative TACE group or postoperative TACE group (P＜0.05). The survival rates in either preoperative or postoperative TACE group were not significantly better than those in non-TACE group (P＞0.05).Conclusions As an adjuvant treatment, combined pre-and post-operative TACE can increase survival rate in patients with surgically resectable HCC. No significant benefit for patient's long term survival when either preoperative or postoperative TACE was performed in addition to surgery.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)08847-8514