Cheng Yi-Chiao, Chen Teng-Wei, Fan Hsiu-Lung, Yu Chih-Yung, Chang Heng-Cheng, Hsieh Chung-Bao
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Ann Transplant. 2014 Jun 30;19:309-16. doi: 10.12659/AOT.890505.
Transarterial chemoembolization (TACE) can reduce tumor progression and help achieve good locoregional effect in hepatocellular carcinoma (HCC) patients with intrahepatic multiple recurrence (IHMR) after liver resection (LR). The effect of TACE on HCC patients with IHMR after liver transplantation (LT) remains unclear. The purpose of this study was to investigate the effect of TACE on IHMR after LR or LT.
This hospital-based retrospective study included 968 and 180 HCC patients who had undergone LR or LT, respectively, in the past decade. Parameters included clinical characteristics, alpha-fetoprotein level, Child classification, tumor stage at first treatment, tumor size at recurrence, and recurrence and survival status. The groups were compared using the t test or chi-square test, and univariate and multivariate analyses were performed. Survival and recurrence were analyzed by the Kaplan-Meier method. Differences were significant at P<0.05.
During follow-up, 112 patients had IHMR: 101 after LR and 11 after LT. Age, sex distribution, and HCV infection rate differed significantly between the LR and LR groups. All patients in the LT group who had recurrent HCC died within 3 years. The risk factors for death from tumor recurrence included a larger tumor size at recurrence, poor Child classification at recurrence, hyperbilirubinemia, hypoalbuminemia, and no TACE treatment. In Cox regression analysis, only vessel invasion, Child class C, and no TACE treatment were independent risk factors for death from tumor recurrence.
TACE is beneficial for treating IHMR in patients after LR or LT.
经动脉化疗栓塞术（TACE）可降低肿瘤进展速度，并有助于在肝切除术后发生肝内多发复发（IHMR）的肝细胞癌（HCC）患者中取得良好的局部区域疗效。TACE对肝移植（LT）后发生IHMR的HCC患者的疗效仍不明确。本研究的目的是探讨TACE对肝切除或肝移植后IHMR的影响。
这项基于医院的回顾性研究纳入了过去十年中分别接受肝切除或肝移植的968例和180例HCC患者。参数包括临床特征、甲胎蛋白水平、Child分级、首次治疗时的肿瘤分期、复发时的肿瘤大小以及复发和生存状态。采用t检验或卡方检验对各组进行比较，并进行单因素和多因素分析。采用Kaplan-Meier法分析生存和复发情况。P<0.05时差异具有统计学意义。
在随访期间，112例患者发生IHMR：肝切除术后101例，肝移植术后11例。肝切除组和肝移植组之间的年龄、性别分布和丙型肝炎病毒感染率存在显著差异。肝移植组中所有复发性HCC患者均在3年内死亡。肿瘤复发死亡的危险因素包括复发时肿瘤较大、复发时Child分级差、高胆红素血症、低白蛋白血症以及未接受TACE治疗。在Cox回归分析中，只有血管侵犯、Child C级和未接受TACE治疗是肿瘤复发死亡的独立危险因素。
TACE对肝切除或肝移植术后患者的IHMR治疗有益。
