术后辅助动脉化疗栓塞可提高有残留肿瘤危险因素的肝细胞癌患者的生存率：一项回顾性对照研究。
Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study.
作者信息
Ren Zheng-Gang, Lin Zhi-Ying, Xia Jing-Lin, Ye Sheng-Long, Ma Zeng-Chen, Ye Qing-Hai, Qin Lun-Xiu, Wu Zhi-Quan, Fan Jia, Tang Zhao-You
机构信息
Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
World J Gastroenterol. 2004 Oct 1;10(19):2791-4. doi: 10.3748/wjg.v10.i19.2791.
AIM
To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor.
METHODS
From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE.
RESULTS
In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%, 75.85%, 62.39% in the control group and 97.39%, 70.37%, 50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%, 61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC.
CONCLUSION
Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.
目的
评估术后辅助性经动脉化疗栓塞术（TACE）对有或无残留肿瘤危险因素的肝细胞癌（HCC）患者预后的影响。
方法
1995年1月至1998年12月，本研究纳入了549例连续接受手术切除的HCC患者。其中185例患者接受了手术切除并辅助TACE，364例患者仅接受了手术切除。将直径大于5cm、多发结节和血管侵犯的肿瘤定义为残留肿瘤的危险因素，并用于患者分层。采用Kaplan-Meier法分析生存曲线，采用Cox比例风险模型评估辅助TACE的预后意义。
结果
在无残留肿瘤危险因素的患者中，对照组1年、3年、5年生存率分别为93.48%、75.85%、62.39%，辅助TACE组分别为97.39%、70.37%、50.85%。两组生存率无显著差异（P = 0.3956）。然而，在有残留肿瘤危险因素的患者中，术后辅助TACE显著延长了患者的生存期。两组生存率有统计学显著差异（P = 0.0216）。对照组1年、3年、5年生存率分别为69.95%、49.86%、37.40%，辅助TACE组分别为89.67%、61.28%、44.36%。Cox比例风险模型显示，在无残留肿瘤危险因素的患者中，肿瘤直径和肝硬化是显著的独立预后因素，而辅助TACE不是。然而，在有残留肿瘤危险因素的患者中，辅助TACE以及肿瘤直径、甲胎蛋白水平、血管侵犯是与降低HCC患者死亡风险相关的显著独立因素。
结论
术后辅助TACE可延长有残留肿瘤危险因素患者的生存期，但不能延长无残留肿瘤危险因素患者的生存期。
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