[米兰标准内肝细胞癌肝切除与经动脉化疗栓塞术的比较]

[Comparison of hepatic resection and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria].

作者信息

Guo Zhe, Xiang Bangde, Zhang Jun, Jiang Jinghang, Li Lequn

机构信息

Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, China.

Email:

出版信息

Zhonghua Yi Xue Za Zhi. 2014 May 27;94(20):1526-9.

PMID:25146737

Abstract

OBJECTIVE

To compare the long-term survival of hepatocellular carcinoma (HCC) patients within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE).

METHODS

A total of 159 HR and 42 TACE patients with HCC within the Milan criteria were retrospectively evaluated. Propensity-score matching (PSM) was used to generate matched controls. Long-term survival was evaluated by the Kaplan-Meier method. And independent prognostic predictors were determined by the Cox proportional hazard model.

RESULTS

After adjusting for baseline differences, 84 HR and 42 TACE patients were selected. Median survival time was 42.9 months in HR group versus 34.8 months in TACE group. The 1, 3 and 5-years survival rates were significantly higher in HR group (87.8%, 64.0%, 41.9%) than those in TACE group (85.7%, 47.6%, 26.0%; P = 0.028). Subgroup analysis showed that the patients with single-tumor HCC ≤ 5 cm had 1, 3 and 5-year overall survival rates of 86.3%, 61.3% and 42.9% after HR versus 90.3%, 61.3% and 33.2% after TACE (P = 0.332). Among those with multinodular HCC involving 2-3 tumors ≤ 3 cm, 1, 3 and 5-years survival rates were 93.8%, 75.0% and 39.3% after HR versus 72.7%, 45.5% and 9.1% after TACE (P = 0.002). Body mass index ≥ 23 kg/m(2), serum level of alpha-fetoprotein (AFP) ≥ 400 µg/L and TACE treatment significantly predicted poor survival according to the Cox proportional hazard model (all P < 0.05).

CONCLUSIONS

Hepatic resection provides better long-term survival than TACE for HCC patients within the Milan Criteria. In fact, HR provides significant long-term survival benefits for patients with multinodular HCC involving 2-3 tumors ≤ 3 cm. In contrast, both HR and TACE have similar survival rates among patients with single-tumor HCC ≤ 5 cm.

摘要

目的

比较符合米兰标准的肝细胞癌（HCC）患者接受肝切除术（HR）或经动脉化疗栓塞术（TACE）后的长期生存率。

方法

对159例接受HR治疗和42例接受TACE治疗且符合米兰标准的HCC患者进行回顾性评估。采用倾向评分匹配（PSM）方法生成匹配对照。采用Kaplan-Meier法评估长期生存率。通过Cox比例风险模型确定独立的预后预测因素。

结果

在调整基线差异后，选取了84例接受HR治疗的患者和42例接受TACE治疗的患者。HR组的中位生存时间为42.9个月，而TACE组为34.8个月。HR组的1年、3年和5年生存率（87.8%、64.0%、41.9%）显著高于TACE组（85.7%、47.6%、26.0%；P = 0.028）。亚组分析显示，单个肿瘤直径≤5 cm的HCC患者，HR治疗后的1年、3年和5年总生存率分别为86.3%、61.3%和42.9%，TACE治疗后分别为90.3%、61.3%和33.2%（P = 0.332）。在多结节HCC且肿瘤为2 - 3个、直径≤3 cm的患者中，HR治疗后的1年、3年和5年生存率分别为93.8%、75.0%和39.3%，TACE治疗后分别为72.7%、45.5%和9.1%（P = 0.002）。根据Cox比例风险模型，体重指数≥²³ kg/m²、血清甲胎蛋白（AFP）水平≥400 µg/L以及TACE治疗显著预示生存率较差（所有P < 0.05）。