Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
J Gastroenterol Hepatol. 2014 May;29(5):1056-64. doi: 10.1111/jgh.12507.
BACKGROUND/AIMS: Microvascular invasion (MVI) is a well-known prognostic factor of postoperative recurrence and of overall survival (OS) in patients with hepatocellular carcinoma (HCC). We compared the treatment outcomes of transarterial chemoembolization (TACE) and surgery/radiofrequency ablation (RFA) according to the presence of MVI in patients with early or late recurrent HCC that presented as Barcelona Clinical Liver Cancer (BCLC) stage 0 or A after curative resection for HCC.
A consecutive 68 patients with recurrent HCC of BCLC stage 0 or A at our institution between 1998 and 2012 were retrospectively enrolled. We compared the outcomes of patients treated by TACE or surgery/RFA. Tumor recurrence after curative resection was classified as early (≤ 12 months) or late (> 12 months) recurrence.
Median tumor size was 1.5 cm (range, 1-10 cm), and 67 (98.5%) had HCCs within the Milan criteria. Median post-retreatment follow-up duration was 27 months (range, 1-109 months). Of the 68 patients, 19 (27.9%) underwent surgery/RFA, 47 (69.1%) TACE, and 2 (2.9%) were lost to follow-up. After retreatment, TACE showed significantly higher OS and recurrence-free survival rates than surgery/RFA in MVI-positive patients (P = 0.03 and P = 0.05, respectively), but not in MVI-negative patients (P = 0.95 and P = 0.98, respectively). In particular, in early recurred MVI-positive patients, TACE had a significantly higher OS rate than surgery/RFA (P = 0.01).
TACE may be the more effective treatment option for recurrent HCC of BCLC stage 0 or A than surgery/RFA in MVI-positive patients, especially in those that recur early after curative resection.
背景/目的：微血管侵犯（MVI）是肝癌（HCC）患者术后复发和总体生存（OS）的一个著名的预后因素。我们比较了经动脉化疗栓塞（TACE）和手术/射频消融（RFA）在巴塞罗那临床肝癌（BCLC）分期 0 或 A 期根治性切除术后出现早期或晚期复发 HCC 患者中的治疗效果，这些患者的 MVI 为阳性。
回顾性分析了 1998 年至 2012 年期间我院收治的 68 例 BCLC 分期 0 或 A 期复发性 HCC 患者的临床资料。我们比较了接受 TACE 或手术/RFA 治疗的患者的结果。根治性切除术后肿瘤复发分为早期（≤12 个月）和晚期（>12 个月）复发。
中位肿瘤直径为 1.5cm（范围 1-10cm），67 例（98.5%）患者的 HCC 符合米兰标准。中位随访时间为 27 个月（范围 1-109 个月）。68 例患者中，19 例（27.9%）接受手术/RFA，47 例（69.1%）接受 TACE，2 例（2.9%）失访。在补救治疗后，MVI 阳性患者中 TACE 的 OS 和无复发生存率明显高于手术/RFA（P=0.03 和 P=0.05），但在 MVI 阴性患者中无统计学差异（P=0.95 和 P=0.98）。特别是在早期复发的 MVI 阳性患者中，TACE 的 OS 率明显高于手术/RFA（P=0.01）。
与手术/RFA 相比，MVI 阳性的 BCLC 分期 0 或 A 期复发性 HCC 患者中，TACE 可能是更有效的治疗选择，特别是在根治性切除术后早期复发的患者中。
