Zhang Guo-Qing, Ge Lei, Ding Wei, Li Hai-Jun
Department of Hepatobiliary Surgery, Tumor Hospital, Xinjiang Medical University, Urumqi, Xinjiang, 830011, PR China.
Ai Zheng. 2008 Dec;27(12):1297-301.
BACKGROUND & OBJECTIVE: Hepatectomy is now considered as the most effective treatment for hepatocellular carcinoma (HCC). High recurrence rate after operation is the main factor to impact the curative effect. The options of treatment for preventing postoperative recurrence of HCC are controversial. This study was to explore the value of postoperative portal vein chemotherapy (PVC) in delaying recurrence of stage II HCC, and to evaluate the risk factors of recurrence.
A total of 51 patients with pathologically proved stage II HCC, who underwent radical resection from February 2003 to February 2007 in Xinjiang Tumor Hospital, were randomly divided into two groups: 24 underwent radical resection alone (control group), and 27 underwent prophylactic PVC after operation (study group). Disease-free survival statuses and median survival time of the patients were analyzed by Kaplan-Meier method; clinical and pathologic factors such as number of nodules, portal vein tumor thrombus, cirrhosis, differentiation level, prophylactic PVC were analyzed by Cox model.
The 6-month, 1-, 2-and 3-year disease-free survival rates were 44.4%, 38.9%, 19.4% and 14.3% in control group, and 75.4%, 61.3%, 49.0% and 31.5% in study group. The median survival time was significantly higher in study group than in control group (15.5 months vs. 5.6 months, P<0.05). Cox multivariate analysis showed that number of nodules, portal vein tumor thrombus, and PVC were impact factors of the recurrence for stage II HCC ( P<0.05). Furthermore, PVC significantly increased the 1-year disease-free survival rate of stage II HCC patients after operation.
Prophylactic PVC can delay early recurrence of stage II HCC with multiple lesions or portal vein tumor thrombus.
肝切除术目前被认为是肝细胞癌（HCC）最有效的治疗方法。术后高复发率是影响疗效的主要因素。预防HCC术后复发的治疗方案存在争议。本研究旨在探讨术后门静脉化疗（PVC）在延缓Ⅱ期HCC复发中的价值，并评估复发的危险因素。
选取2003年2月至2007年2月在新疆肿瘤医院接受根治性切除的51例病理确诊为Ⅱ期HCC的患者，随机分为两组：24例仅接受根治性切除（对照组），27例术后接受预防性PVC（研究组）。采用Kaplan-Meier法分析患者的无病生存状态和中位生存时间；采用Cox模型分析结节数量、门静脉癌栓、肝硬化、分化程度、预防性PVC等临床和病理因素。
对照组6个月、1年、2年和3年的无病生存率分别为44.4%、38.9%、19.4%和14.3%，研究组分别为75.4%、61.3%、49.0%和31.5%。研究组的中位生存时间显著高于对照组（15.5个月对5.6个月，P<0.05）。Cox多因素分析显示，结节数量、门静脉癌栓和PVC是Ⅱ期HCC复发的影响因素（P<0.05）。此外，PVC显著提高了Ⅱ期HCC患者术后1年的无病生存率。
预防性PVC可延缓具有多个病灶或门静脉癌栓的Ⅱ期HCC的早期复发。
