肝动脉化疗栓塞对肝细胞癌切除术后预防复发的研究

刘光华，夏芳，欧阳强

肝动脉化疗栓塞对肝细胞癌切除术后预防复发的研究

刘光华，夏芳，欧阳强

目的探讨预防性TACE对原发性肝细胞癌（HCC）根治性切除术后复发的影响。方法回顾性分析2008年5月—2012年3月行根治性切除并经病理学确诊的557例HCC患者，根据术后2个月内是否行预防性TACE分为两组：预防性介入组（n=327）和未施预防性介入组（n=230），分析两组间的一般临床病理资料的差异，利用Kaplan-Meier计算复发时间，log-rank检验评估不同组别患者的复发差异，采用Cox比例风险模型分析HCC术后复发的独立危险因素，并对相关独立危险因素按是否接受预防性介入进行分层分析。结果两组患者在一般临床病理资料比较差异无统计学意义。经Cox比例风险模型多因素分析发现，年龄（≤50岁）、血清甲胎蛋白（AFP，＞20 ng/ml）水平、肿瘤直径（＞5 cm）、手术切缘（＜1 cm）、微血管癌栓（MVI）以及术后行预防性TACE是影响HCC术后复发的独立危险因素。进一步分层分析，上述5个因素的患者中，预防性TACE组的复发率较未预防性TACE组低且差异有统计学意义。结论HCC根治性切除术后，预防性TACE可降低肝癌的总体复发率；对于肝癌确诊年龄小、术前AFP阳性、肿瘤直径＞5 cm、手术切缘＜1 cm和有MVI的HCC患者，预防性TACE可显著降低术后的复发率。

肝细胞癌；肝切除；预防性；肝动脉化疗栓塞术；复发

【Abstract】Objective To investigate the effect of prophylactic hepatic arterial chemoembolization（TACE）on the recurrence of hepatocellular carcinoma（HCC）following curative liver resection.M ethods A total of 557 pathologically-proved HCC patients，who were admitted to authors'hospital during the period from May 2008 to March 2012 and were treated with radical hepatectomy，were enrolled in this study. According to whether or not the patients had accepted prophylactic TACE within 2 months after hepatectomy，the patients were divided into prophylactic TACE group（n=327）and non-prophylactic TACE group（n= 230）.The clinical data were retrospectively analyzed.The clinical and pathological characteristics were compared between the two groups.The tumor recurrence curves were calculated by using Kaplan-Meier method and the difference in tumor recurrence was evaluated using log-rank test.Cox proportional hazards models were applied to identify the independent risk factors for tumor recurrence，the risk factors were further evaluated with stratified analysis based on whether or not the prophylactic TACE was employed.Results No significant differences in general clinical and pathological data existed between the two groups.Cox proportional hazard model by multivariate analysis indicated that age（≤50 years），serum alpha-fetoprotein（AFP＞20 ng/mL）level，tumor size（＞5 cm），surgical margins（＜1 cm），microvascular invasion（MVI）and postoperative preventive TACE were independent risk factors for HCC recurrence.Further stratified analysis（concerning the above mentioned five factors）showed that statistically significant differences in the cumulative recurrent rates existed between the prophylactic TACE group and non-prophylactic TACE group. ConclusionProphylactic TACE can effectively reduce the overall recurrence rate of HCC after curative resection.For HCC patients，who are young and who have positive preoperative AFP，tumor diameter＞5 cm，surgical margins＜1 cm and the presence of MVI，prophylactic TACE can significantly reduce postoperative recurrence rate of HCC.（J Intervent Radiol，2015，24：125-129）

【Key words】hepatocellular carcinoma；hepatectomy；prevention；hepatic arterial chemoembolization；recurrence

肝细胞肝癌（简称“肝癌）是常见的恶性肿瘤，为肿瘤相关性死亡原因的第3位［1］。手术切除仍是目前治疗肝癌的主要根治手段，肿瘤复发仍是影响术后长期生存的重要因素，其累积5年复发率仍高。预防肝癌术后复发对提高患者长期生存意义重大。……