术后肝动脉栓塞化疗对肝癌合并门脉癌栓患者手术疗效的影响及预后因素分析  

Transcatheter arterial chemoembolization after liver resection for hepatocellular carcinoma with portal vein tumor thrombus

作　　者：华永飞[1] 陆才德[1] 裘丰[1] 虞伟明[1] 吴胜东[1] 张贵军[1] 彭涛[1] 杨洪涛[1] 

机构地区：[1]宁波大学医学院附属李惠利医院肝胆胰外科,315040

出　　处：《中华肝胆外科杂志》2012年第5期357-360,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金资助（30872972）

摘　　要：目的探讨术后肝动脉栓塞化疗（TACE）对肝癌（HCC）合并门脉癌栓手术切除疗效的影响并分析其预后因素。方法2005年至2009年共358例患者接受了HCC切除术，其中55例合并门脉主干和（或）一级分支癌栓。收集该组病例的f临床和随访资料。按术后是否接受TACE治疗分为A组（术后TACE组）和B组（术后非TACE组）。统计分析两组可能影响预后的临床资料差异，重点考察术后TACE对手术疗效的影响及其可能影响预后的因素。结果55例患者中术后接受TACE治疗者29例，未接受26例，二组临床资料比较差异无统计学意义。55例总1、2、3年生存率分别为63．3％、51．4％和43．5％，中位生存时间为26．0个月。其中A组1、2和3年生存率分别为71．4％、60．1％和50．1％，B组为56．7％、21．7％和10．4％（P〈0．001）。术后TACE无论在单因素分析还是在多因素分析中均为显著影响术后生存的因素。此外，肿瘤多发、肝静脉癌栓、肝内转移、浸润型癌栓在单因素分析中是预后差的显著相关因素。多因素分析中，浸润型癌栓、肝静脉癌栓及肝内转移是预后不佳的独立相关因素。结论部分HCC合并门脉一级分支和主干癌栓患者手术切除后可获得较长的术后生存期。术后TACE可显著改善此类患者的预后，其他影响预后的因素有浸润型癌栓、肝静脉癌栓及肝内转移。Objective To study the efficacy of transeatheter arterial chemoembolization （TACE） after liver resection for hepatocellular carcinoma （HCC） with tumor thrombus in the main trunk and/or first branch of portal vein, and to clarify prognostic factors affecting survival. Methods From 2005 to 2009, there were 358 consecutive patients with HCC who underwent surgical resection in our Department. In 55 patients （15 %）, portal vein tumor thrombus （PVTT） was found intraopera-tively or postoperatively during histopathological examinations to involve the first portal branch, main portal trunk, or contralateral portal branch. In this retrospective study, these 55 patients were divided into two groups： Group A, 29 patients received postoperative TACE, and Group B, 26 patients who did not receive TACE. The clinical data and survivals were compared between the two groups. Prog-nostic factors were indentified using univariate analysis, followed by multivariate regression analysis using the Cox proportional hazards model. Results There were no significant differences in the demo-graphic clinical data between Group A and Group B. The overall 1-, 2- and 3-year survivals for the 55 patients were 63.3%, 51.4% and 43.5%, respectively. The accumulative 1-, 2- and 3-year sur-vivals for group A were 71.4%, 60.1% and 50.1%, respectively. The corresponding figures for group B were 56. 7%, 21.7% and 10. 4%, respectively. Multiple tumors, intrahepatic metastases, hepatic vein thrombus, and invasive type of tumor thrombus were found to be risk factors for short-term survival on uni-variate analysis, while the latter 3 factors were further found to be significant prognostic factors in the Cox proportional hazards model. Postoperative TACE was shown to be a significant factor in both univariate and multivariate analyses. Conclusion Liver resection was beneficial for some patients with portal vein tumor thrombus. Postoperative TACE further improved the prognosis and prolonged survivals in these patients.

关 键 词：肝细胞癌 门脉癌栓 手术切除 术后肝动脉栓塞化疗 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]