肝细胞癌手术后辅助肝动脉化疗栓塞与单纯手术的疗效比较  

Hepatic resection for hepatocellular carcinoma with or without postoperative adjuvant transarterial chemoembolization： a comparative study

作　　者：姜经航 郭哲[1] 梁泳荣[1] 柯阳[1] 钟鉴宏[1] 黎乐群[1] 向邦德[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2014年第5期333-337,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81260331）;国家科技重大专项课题（2012ZX10002010001009）

摘　　要：目的探讨肝细胞癌（HCC）根治性切除术后辅助肝动脉化疗栓塞（TACE）对患者生存期的影响。方法收集2007年3月至2010年3月229例肝细胞癌患者手术资料。其中手术后辅助TACE治疗91例，单纯手术138例。采用倾向性得分匹配法（PSM）均衡组问协变量，获得匹配患者并对其进行生存分析。结果经PSM匹配后得到67对患者。匹配后手术＋TACE组和单纯手术组中位生存期分别为32．1个月和28．3个月，1年、2年、3年生存率分别为94．0％、84．8％、75．3％和83．6％、69．9％、61．5％，两组间差异无统计学意义（P=0．062）。单因素分析结果显示，AFP水平、肿瘤大小、肿瘤数量、BCLC分期、辅助性TACE对HCC患者术后累计生存率有一定的影响（P〈0．05）。Cox回归模型分析表明AFP≥400μg／L、肿瘤直径〉5cm是影响HCC手术后累计生存率的独立危险因素（P〈0．05）。结论HCC患者手术后辅助TACE并不能显著提高患者的生存率，因此术后采用TACE须慎重。AFP≥400μg/L、肿瘤直径〉5cm是影响HCC手术后生存率的独立危险因素。Objective To explore the efficacy of postoperative adjuvant transarterial chemoembolization （TACE） on the survival of patients after radical resection for hepatocellular carcinoma （HCC）. Methods Between March 2007 and March 2010, 229 HCC patients who underwent radical resection were retrospectively studied. Patients who underwent resection alone were used as the control group （ 138 patients） while those who received post-operative adjuvant TACE was used as the interventional group. In order to balance the covariates between the groups, a matched comparison of the patients was done by selecting patients using the propensity score matching （PSM）. Then, the efficacy of adjuvant TACE upon survival was evaluated. Results After PSM, we obtained 67 pairs of patients. The survival time for the interventional and the control groups were 32.1 months and 28.3 months respectively. The survival rates at year 1, 2, 3 post-resection were 94.0%, 84.8% and 75.3% in the interventional group versus 83.6%, 69.9% and 61.5% in the control group respectively. There were no significant differences between the two groups （P = 0. 062）. Univariate analysis showed the serum level of AFP, tumor size, number of tumor, BCLC stage, and adjuvant TACE significantly affected the survival of HCC patients who received radical resection （P 〈 0. 05）. Cox model suggested that AFP≥400μg/L and tumor diameter 〉 5 cm were independent risk factors of survival for HCC patients who received radical resection （P 〈 0.05）. Conclusion Postoperative adjuvant TACE had no positive effect on survival, and AFP level ≥400μg/L and tumor size 〉 5 cm were independent risk factors of survival of HCC patients who received radical resection.

关 键 词：肝细胞癌 生存率 肝动脉化疗栓塞 倾向性得分匹配法 

分 类 号：R735.7[医药卫生—肿瘤]