不同治疗模式对不能切除的肝癌二期手术预后的影响  

Influence of different treatment modalities on survival of patients with two-stage resection of unresectable hepatocellular carcinoma

作　　者：樊嘉[1] 吴志全[1] 汤钊猷[1] 马曾辰[1] 周信达[1] 林芷英[1] 叶胜龙[1] 周俭[1] 邱双健[1] 钦伦秀[1] 叶青海[1] 

机构地区：[1]复旦大学医学院附属中山医院肝癌研究所,上海200032

出　　处：《中华外科杂志》2001年第10期745-748,共4页Chinese Journal of Surgery

基　　金：上海市百人计划基金 (97BR0 2 9) ;上海市科技发展基金 (9844190 67)资助项目

摘　　要：目的　探讨不能切除的肝细胞癌 (HCC)经皮穿刺肝动脉化疗栓塞 (TACE)及经手术肝动脉结扎、置管化疗栓塞 (HALCE)缩小后二期切除的疗效 ,并比较不同治疗模式对预后的影响。方法2 0 4例HCC二期切除患者 ,分成TACE组及HALCE组。TACE组 112例 ,行TACE 1～ 7次 (中位 2 4)。HALCE组 92例 ,其中 49例行HALCE ,7例行HALCE +肝脏外放射治疗 ,36例行HALCE +导向内放射治疗。肿瘤缩小后予以切除。选择 7个可能对HCC二期切除术后预后产生影响的临床因素通过单因素、多因素Cox模型对预后进行分析。　结果　随访至 1999年 6月 ,首次TACE及HALCE后 1、3、5、7年生存率分别为 95 7%、6 9 3%、5 6 5 %及 44 5 % ,切除肿瘤后 1、3、5、7年生存率分别为 88 5 %、6 4 9%、5 1 9%及 38 3%。TACE组及HALCE组 1、3、5、7年生存率分别为 94 1%、6 4 7%、5 1 2 %、40 8%和 96 3%、73 9%、6 1 6 %、45 2 % ,2组差异无显著性意义 (P >0 0 5 )。影响预后的主要因素是肝硬化程度和肿瘤坏死程度 (P <0 0 5 )。TACE组中肝硬化程度、缩小后肿瘤有无包膜及肿瘤坏死程度是影响预后的主要因素 (P <0 0 5 ) ,而HALCE组各因素对预后影响差异无显著性意义 (P >0 0 5 )。　结论　不能一期切除的HCC缩小后应进行二期切除 。Objective To study the therapeu tic results of hepatic resection for shrunk hepatocellular carcinoma (HCC) after tanscatheter arterial chemoembolization (TACE) and hepatic artery ligation and chemoembolization (HALCE) in patients with unresectable HCC, and compare the influence of the above different treatment modalities on the prognosis. Methods Two hundred and four patients with pathologic ally proven HCC by two stage liver resection were classified into two groups: TACE group (n=112) and HALEC group (n=92). The patients in the TACE gro up received a total of 1-7 consecutive treatment courses (average, 24±12 c ourses). HALCE was done in 49 patients. HALCE+alternating fractionated radiothe rapy was employed in 7 patients and HALCE + targeting regional internal radiothe rapy in 36. Shrunk tumors were surgically removed by two-stage operation in all the patients with unresectable HCC. Seven possible factors influencing the resu lts of two-stage resection of HCC were studied. Results All the patients were fellowed up to June, 1999. The 1-, 3-, 5-, and 7- year survival rates were 957%, 693%, 565% and 445% after the fir st TACE and HALCE, respectively and 885%, 649%, 519% and 383% after rese ction of the shrunk HCC, respectively. The 1-, 3-, 5- and 7-year survival ra tes were 941%, 647%, 512% and 408% respectively in the TACE group and 96 3%, 739%, 616% and 452% respectively in the HALCE group. There were no s tatistically differences between the survival rates in the TACE and HALCE groups . The extent of cirrhotic liver and percentage of tumor necrosis were of prognos tic significance. In the TACE group, the extent of cirrhotic liver, the percenta ge of tumor necrosis and whether capsule of shrunk tumor was complete or in comp lete were of prognostic significance. In the HALCE group, however, the 7 factors were not found to be statistically significant for the prognosis. Conclusions Sequential resection should be done after cytor eduction of tumor for the patients with unresectable HCC, which might

关 键 词：肝细胞癌 化学栓塞治疗 预后 治疗模式 HCC TACE HALCE 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]