残癌危险因素对肝癌切除术后肝动脉栓塞化疗效果的影响  

Effect of postoperative transcatheter arterial chemoembolization on hepatocellular carcinoma patients with residual tumor

作　　者：任正刚[1] 林芷英[1] 夏景林[1] 张博恒[1] 叶胜龙[1] 陈世耀[2] 干育红[1] 吴晓凤[1] 陈漪[1] 葛宁灵[1] 吴志全[3] 马曾辰[3] 周信达[3] 樊嘉[3] 钦伦秀[3] 叶青海[3] 孙惠川[3] 周俭[3] 汤钊猷[3] 

机构地区：[1]复旦大学肝癌研究所复旦大学附属中山医院肝肿瘤内科,上海200032 [2]复旦大学肝癌研究所复旦大学附属中山医院内科,上海200032 [3]复旦大学肝癌研究所复旦大学附属中山医院肝肿瘤外科,上海200032

出　　处：《中华肿瘤杂志》2004年第2期116-118,共3页Chinese Journal of Oncology

摘　　要：目的　探讨术后辅助性肝动脉栓塞化疗对残癌低危和残癌高危患者预后的不同影响。方法　进入研究的病例分为干预组 (辅助性动脉栓塞化疗组 )和对照组 (未行辅助性动脉栓塞化疗 ) ,根据残癌的高危因素将肝癌切除术的患者分为残癌高危者和残癌低危者 ,采用病例对照实验设计 ,以单因素统计方法和Cox模型 ,分析研究术后辅助性肝动脉栓塞化疗对肝癌切除术患者预后的影响 ,以及残癌高危因素对辅助性动脉栓塞化疗作用的影响。结果　对于残癌低危患者 ,干预组和对照组术后 1,2 ,3,4年生存率分别为 97.2 %、78.0 %、6 6 .5 %、6 6 .5 %和 91.2 %、81.4 %、70 .3%、5 4 .4 % ,生存率差异无显著性 (P =0 .76 6 7) ;而对于残癌高危患者 ,干预组和对照组术后 1,2 ,3,4年生存率分别为89 .5 %、73.4 %、5 9.2 %、5 3.8%和 70 .5 %、6 1.9%、4 6 .8%、4 6 .8% ,生存率差异有显著性 (P =0 .0 0 2 9)。Cox比例风险模型分析结果显示 ,辅助性动脉栓塞化疗对切除术后肝癌患者预后的影响 ,决定于患者有无残癌的危险因素 ,辅助性动脉栓塞化疗不是影响患者预后的独立因素。结论　术后给予辅助性肝动脉栓塞化疗 ,可延长有残癌高危因素患者的生存期 ,而对于无残癌危险因素的患者 ,术后辅助性肝动脉栓塞化疗不能延长生存期。Objective To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC) patients with residual tumor. Methods The patients were classified into intervention group (with adjuvant TACE) and control group (without adjuvant TACE) who were further stratified to those with high risk (patients with single tumor >5 cm in diameter, or with multiple tumors, invasion to blood vessels), and low risk factors. Univariate analysis and Cox model were used to analyse prognostic factors. Results In low risk patients with residual tumor, the 1-, 2-, 3-, 4-year survival rate was 97.2%, 78.0%, 66.5% and 66.5% in the intervention group, and 91.2%, 81.4%, 70.3% and 54.4% in the control group, respectively. There was no statistical difference between the two groups in survival (log-rank P= 0.7667). Comparing with the control group, the 1-, 2-,3-,4-year survival rate was 89.5%, 73.4%, 59.2% and 53.8% in the intervention group, and 70.5%, 61.9%, 46.8% and 46.8% in the control group, respectively. Postoperative adjuvant TACE significantly prolonged the survival in high risk patients with residual tumor (P= 0.0029). Cox model revealed that the benefit of adjuvant TACE was significantly increased by the high risk factors in HCC patients with residual tumor. Conclusion The beneficial effect of postoperative TACE was only observed in high risk patients with residual tumor but not in the low risk patients with residual tumor.

关 键 词：残癌 危险因素 肝癌切除术 肝动脉栓塞 化疗 肝肿瘤 肝细胞 

分 类 号：R735.7[医药卫生—肿瘤]