预防性肝动脉化疗栓塞联合抗肿瘤药物对合并微血管侵犯肝癌术后近期复发的影响  

Impact of adjuvant transcatheter arterial chemoembolization with anti-tumor drug for prevention early recurrence of hepatocellular carcinoma patients with microvascular invasion after radical hepatectomy

作　　者：刘鹏[1] 解宇威 张露旬 徐翔宇 王一休 裴金宇 谭斌[1] 王聪[1] 刘奎[1] 李坤[1] 逄锦忠 曹景玉[1] Liu Peng;Xie Yuwei;Zhang Luxun;Xu Xiangyu;Wang Yixiu;Pei Jinyu;Tan Bin;Wang Cong;Liu Kui;Li Kun;Pang Jinzhong;Cao Jingyu(Second Department of general surgery,Qingdao west coast new area central hospital,Qingdao 266555,China;Depaartment of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266555,China;Depaartment of Gynecology,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院肝胆胰外科,266555 [2]青岛大学附属医院妇科,266555 [3]复旦大学附属肿瘤医院肝脏外科,上海200030

出　　处：《中华肝胆外科杂志》2021年第9期652-657,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨预防性经导管肝动脉化疗栓塞(TACE)联合抗肿瘤药物对合并微血管侵犯(MVI)的肝细胞癌(HCC)根治术后近期复发的影响。方法回顾分析2015年1月至2018年12月在青岛大学附属医院行根治性肝切除术且术后病理报告为HCC合并MVI的169例患者临床资料,其中男性147例,女性22例,年龄范围32~79岁,中位年龄56岁。根据肝切除术后治疗方式不同,分为单纯手术组(n=62,无处理),TACE组(n=42,术后预防性应用TACE),联合组(n=65,术后预防性TACE联合抗肿瘤药物治疗)。随访三组患者术后肿瘤复发情况。Kaplan-Meire法计算累积无瘤生存率,采用log-rank检验比较组间差异。结果169例患者术后1、2年累积无瘤生存率分别为59.2%、40.8%。术后1、2年累积无瘤生存率单纯手术组为45.2%、25.8%,TACE组61.9%、40.5%,联合组70.8%、52.3%。联合组累积无瘤生存率优于TACE组和单纯手术组,TACE组累积无瘤生存率优于单纯手术组,差异有统计学意义(均P<0.05)。在TACE组与联合组中,M1(轻度MVI)患者累积无瘤生存率优于M2(重度MVI)患者,差异有统计学意义(均P<0.05)。M1级别和M2级别中,联合组累积无瘤生存率优于单纯手术组、TACE组,差异有统计学意义(均P<0.05)。不同抗肿瘤药物对累积无瘤生存率无明显影响。结论术后TACE可预防合并MVI的HCC术后近期复发,而TACE联合抗肿瘤药物能明显改善合并MVI肝癌术后近期复发。Objective To study combined adjuvant transcatheter arterial chemoembolization(TACE)with anti-tumor drug treatment on early hepatocellular carcinoma(HCC)recurrence in patients with microvascular invasion(MVI)after partial hepatectomy with curative intent.Methods The clinical and pathological data of 169 patients with HCC who underwent partial hepatectomy with curative intent from January 2015 to December 2018 at the Affiliated Hospital of Qingdao University were retrospectively analyzed.MVI was diagnosed by postoperative histopathology.There were 147 males and 22 females,with the median age 56 years(ranged 32-79 years).The patients were divided into surgery group(n=62,patients who did not receive adjuvant therapy),TACE group(n=42,patients who only received TACE)and combined group(n=65,patients who received TACE with anti-tumor drug)according to the therapies after resection.Patients in each group were further divided into grade M1(mild)and grade M2(severe)subgroups according to the severity of MVI.All patients were followed-up for observing tumor recurrence.The relapse-free survival in the three groups were compared using the Kaplan-Meier method and the log-rank test was used to compare the tumor-free survival rates.Results The tumor-free survival rates of 169 patients at 1 and 2 years after operation were 59.2%and 40.8%.The tumor-free survival rates at 1 and 2 years after operation were 45.2%and 25.8%in surgery group,61.9%and 40.5%in TACE group,70.8%and 52.3%in combined group respectively.The differences among the three groups were significant:TACE group was better than surgery group,and combined group was better than TACE group,combined group was better than surgery group(all P<0.05).In TACE group and combined group,tumor-free survival rates of M1patients better than M2 patients,and the difference was significant(P<0.05).Among M1 patients and M2 patients,tumor-free survival rates of combined group patients were better than surgery group and TACE group,the difference was significant(all P<0.05).The cumulative tum

关 键 词：癌 肝细胞 微血管 经导管肝动脉化疗栓塞术 复发 

分 类 号：R735.7[医药卫生—肿瘤]