辅助性肝动脉化疗栓塞对原发性肝细胞癌切除术后复发的影响  

Adjuvant transcatheter arterial chemoembolization after curative liver resection for hepatocellular carcinoma

作　　者：冯鹏[1] 林桂宇[2] Feng Peng Lin Guiyu(Department of General Surgery, Nanyang First People＇s Hospital, Nanyang 473010, Henan Province, China)

机构地区：[1]河南省南阳市第一人民医院普外科,473010 [2]福建省第二人民医院普外科,福州350011

出　　处：《中华肝胆外科杂志》2016年第12期797-801,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的观察原发性肝细胞癌（PHC）切除术后辅助性经导管肝动脉化疗栓塞（TACE）对患者肝内复发的影响。方法将2010年6月至2013年2月人选的130例行肝癌切除术的PHC患者随机分为研究组（67例）和对照组（63例）。研究组术后实施1～4次辅助性TACE治疗，对照组不实施TACE治疗。术后随访36个月，比较两组术后复发率、无瘤生存时间与无瘤生存率。结果研究组术后半年血清AFP[（379．8±91．7）μg/L比（414．5±84．3）μg/L]及IGFBP-2水平[（2855．3±727．5）μg/L比（3259．6±894．1）μg/L]均显著低于对照组（P〈0．05）。研究组术后1年累积复发率（10．4％比28．6％）明显低于对照组（P〈0．05），2年和3年累积复发率差异无统计学意义（P〉0．05）。研究组术后3年累积无瘤生存率（81．0％比73．2％）显著高于对照组（P〈0．05）。研究组合并癌栓者术后1年（12．8％比31．6％）、2年（28．2％比50．0％）累积复发率、术前AFPI〉400μg/L者1年累积复发率（8．8％比30．6％）以及瘤体直径≥10cm者术后1年（11．8％比46．7％）、2年（35．3％比75．3％）、3年（47．1％比86．7％）累积复发率均明显低于对照组（P〈0．05）。1次TACE治疗与未进行TACE治疗复发率差异无统计学意义（P〉0．05），2次及以上TACE治疗者1年（4．3％比28．6％）、2年（15．2％比41．3％）、3年（26．1％比49．2％）累积复发率显著低于未进行TACE治疗者（P〈0．05）。3次及以上TACE治疗与2次TACE治疗累积复发率差异无统计学意义（P〉0．05）。结论辅助性TACE治疗有助于降低手术后高危期内复发率。临床应根据患者病情合理选择辅助性TACE治疗次数。Objective To study the effect of adjuvant transcatheter arterial chemoembolization （TACE） on intrahepatic recurrence after curative liver resection for primary hepatocellular carcinoma （PHC）. Methods 130 PHC patients who underwent curative liver resection from June 2010 to February 2013 were selected and randomly allocated to the study group （n = 67 ） and the control group （n = 63 ）. The study group underwent adjuvant TACE for 1 - 4 times, and the control group did not receive any adjuvant therapy. On follow-up for 36 months, the postoperative recurrence rates, tumour free survival time and tumor free survival rates of the two groups were compared. Results At 6 months after surgery, the serum AFP lev- el [ （379.8 ± 91.7） μg/L vs. （414.5 ± 84.3） μg/L and the IGFBP-2 level [ （2 855.3 ± 727.5 ） μg/L vs. （3 259.6 ±894. 1 ） μg/L 1 in the study group were significantly lower than the control group （ P 〈 0. 05）. The 1-year cumulative recurrence rate in the study group （ 10.4% vs. 28.6% ） was significantly lower than the control group （ P 〈 0.05 ）. However, the 2-year and 3-year cumulative recurrence rates were not significantly different between the two groups （ P 〉 0.05 ）. The 3-year cumulative tumor free survival rate of the study group （81.0% vs. 73.2% ） was significantly higher than the control group （P 〈 0.05 ）. Pa- tients in the study group with portal vein tumor thrombus had an 1-year cumulative recurrence rate of （12. 8% vs. 31.6% ） and a 2-year rate of （28.2% vs. 50.0% ）. In patients with a preoperative AFP ≥400μg/L, the 1-year cumulative recurrence rates were （8.8% vs. 30.6% ）. When the tumor diameter was ≥ 10 cm, the 1-year, 2 year and 3-year cumulative recurrence rates were significantly lower than the control group （P〈0.05, 11.8% vs. 46.7% ）, （35.3% vs. 75.3% ） and （47.1% vs. 86.7% ）, respec- tively. The recurrence rates in patients who had no cancer thrombus, a preoperative AFP ≤400μg/L and a tumor dia

关 键 词：肝细胞癌 经导管肝动脉化疗栓塞 病理特征 预后 

分 类 号：R735.7[医药卫生—肿瘤]