门静脉灌注化疗对于延缓Ⅱ期肝癌患者术后肝内复发的意义  

The Value of Portal Vein Chemotherapy after Radical Resection in Delaying Intrahepatic Recurrence of Stage Ⅱ Primary Hepatocellular Carcinoma

作　　者：张国庆[1] 葛磊[1] 丁伟[1] 李海军[1] 

机构地区：[1]新疆医科大学附属肿瘤医院肝胆胰外科,新疆乌鲁木齐830011

出　　处：《癌症》2008年第12期1297-1301,共5页Chinese Journal of Cancer

摘　　要：背景与目的:肝切除术目前被认为是治疗肝癌最有效的方法。影响肝癌切除术后疗效的主要因素是术后复发。目前国内外学者对于预防肝癌术后复发的治疗措施的选择存在许多争议。本研究目的在于了解术后门静脉灌注化疗在延缓临床Ⅱ期肝癌患者手术后复发方面的作用以及影响术后复发的危险因素。方法:选择2003年2月至2007年2月在新疆医科大学附属肿瘤医院行手术治疗的51例经病理检查证实为肝细胞性肝癌(hepatocellular carcinoma)的患者,随机分为试验组(手术切除+术后门静脉化疗)和对照组(单纯手术),两组均行根治性手术。比较两组患者的临床资料及术后无瘤生存状况,Kaplan-Meier法比较两组累积无瘤生存率及中位无瘤生存时间;Cox模型分析肿瘤数目、门静脉瘤栓、肝硬化、病理分级以及术后行预防性门静脉化疗等可能影响术后复发的因素,并分析各因素与复发时间之间的关系。结果:对照组患者术后0.5年、1年、2年及3年无瘤生存率分别为44.4%、38.9%、19.4%、14.3%;试验组患者分别为75.4%、61.3%、49.0%、31.5%,两组术后中位无瘤生存时间分别为5.6、15.5个月,差异有统计学意义(P<0.05)。Cox多因素分析结果表明:肿瘤数目、门静脉瘤栓以及预防性门静脉化疗是术后复发的影响因素,其中门静脉化疗可以提高肝癌患者术后1年内的无瘤生存率(P<0.05)。结论:对于伴门脉瘤栓或多发肿瘤的Ⅱ期肝癌患者行预防性门静脉化疗可以延缓术后肿瘤复发。BACKGROUND ＆ OBJECTIVE： Hepatectomy is now considered as the most effective treatment for hepatocellular carcinoma （HCC）. High recurrence rate after operation is the main factor to impact the curative effect. The options of treatment for preventing postoperative recurrence of HCC are controversial. This study was to explore the value of postoperative portal vein chemotherapy （PVC） in delaying recurrence of stage II HCC, and to evaluate the risk factors of recurrence. METHODS： A total of 51 patients with pathologically proved stage II HCC, who underwent radical resection from February 2003 to February 2007 in Xinjiang Tumor Hospital, were randomly divided into two groups 24 underwent radical resection alone （control group）, and 27 underwent prophylactic PVC after operation （study group）. Disease-free survival statuses and median survival time of the patients were analyzed by Kaplan-Meier method clinical and pathologic factors such as number of nodules, portal vein tumor thrombus, cirrhosis, differentiation level, prophylactic PVC were analyzed by Cox model. RESULTS. The 6-month, 1-, 2- and 3-year disease-free survival rates were 44.4%, 38.9%, 19.4% and 14.3% in control group, and 75.4%, 61.3%, 49.0% and 31.5% in study group. The median survival time was significantly higher in study group than in control group （15.5 months vs. 5.6 months, P〈0.05）. Cox multivariate analysis showed that number of nodules, portal vein tumor thrombus, and PVC were impact factors of the recurrence for stage II HCC （P〈0.05）. Furthermore, PVC significantly increased the 1- year disease-free survival rate of stage Ⅱ HCC patients after operation. CONCLUSION： Prophylactic PVC can delay early recurrence of stage Ⅱ HCC with multiple lesions or portal vein tumor thrombus.

关 键 词：肝肿瘤/外科手术 根治性切除 门静脉灌注化疗 复发 

分 类 号：R735.7[医药卫生—肿瘤]