Zhou Wei-Ping, Lai Eric C H, Li Ai-Jun, Fu Si-Yuan, Zhou Jian-Ping, Pan Ze-Ya, Lau Wan Yee, Wu Meng-Chao
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Ann Surg. 2009 Feb;249(2):195-202. doi: 10.1097/SLA.0b013e3181961c16.
To evaluate the effect of preoperative transarterial chemoembolization (TACE) for resectable large hepatocellular carcinoma (HCC).
Resection of HCC is potentially curative, but local recurrence is very common. There is currently no effective neoadjuvant or adjuvant therapy.
From July 2001 to December 2003, 108 patients (hepatitis B carrier = 98.1%) with resectable HCC (> or =5 cm) was randomly assigned to preoperative TACE treatment (n = 52) or no preoperative treatment (control group) (n = 56).
Five patients (9.6%) in the preoperative TACE group did not receive surgical therapy because of extrahepatic metastasis or liver failure. The preoperative TACE group had a lower resection rate (n = 47, 90.4% vs. n = 56, 100%; P= 0.017), and longer operative time (mean, 176.5 minutes vs. 149.3 minutes; P= 0.042). No significant difference was found between the 2 groups in operative blood loss, surgical morbidity, and hospital mortality.At a median follow-up of 57 months, 41 (78.8%) of 52 patients in the preoperative TACE group and 51 (91.1%) of 56 patients in the control group had recurrent disease (P= 0.087). The 1-, 3-, and 5-year disease-free survival rates were 48.9%, 25.5%, and 12.8%, respectively, for the preoperative TACE group and 39.2%, 21.4%, and 8.9%, respectively, for the control group (P= 0.372). The 1-, 3-, and 5-year overall survival rates were 73.1%, 40.4%, and 30.7%, respectively, for the preoperative TACE group and 69.6%, 32.1%, and 21.1%, respectively, for the control group (P= 0.679).
Preoperative TACE did not improve surgical outcome. It resulted in drop-out from definitive surgery because of progression of disease and liver failure.
评估术前经动脉化疗栓塞术（TACE）对可切除的大肝细胞癌（HCC）的疗效。
肝癌切除可能治愈，但局部复发很常见。目前尚无有效的新辅助或辅助治疗方法。
2001年7月至2003年12月，108例可切除HCC（直径≥5 cm）患者（乙肝携带者占98.1%）被随机分为术前TACE治疗组（n = 52）和未进行术前治疗的对照组（n = 56）。
术前TACE组有5例患者（9.6%）因肝外转移或肝功能衰竭未接受手术治疗；术前TACE组的切除率较低（n = 47，90.4% 对比n = 56，100%；P = 0.017），手术时间更长（平均176.5分钟对比149.3分钟；P = 0.042）。两组患者手术失血量、手术并发症和医院死亡率无显著差异。中位随访57个月时，术前TACE组52例患者中有41例（78.8%）复发，对照组56例患者中有51例（91.1%）复发（P = 0.087）。术前TACE组1年、3年和5年无病生存率分别为48.9%、25.5%和12.8%，对照组分别为39.2%、21.4%和8.9%（P = 0.372）；术前TACE组1年、3年和5年总生存率分别为73.1%、40.4%和30.7%；对照组分别为69.6%、32.1%和21.1%（P = 0.679）。
术前TACE未改善手术效果，因疾病进展和肝功能衰竭导致部分患者无法接受根治性手术。
