R0肝切除术后辅助性经导管动脉化疗栓塞可改善伴有微血管侵犯的肝细胞癌患者的预后。
Postoperative Adjuvant Transcatheter Arterial Chemoembolization After R0 Hepatectomy Improves Outcomes of Patients Who have Hepatocellular Carcinoma with Microvascular Invasion.
作者信息
Sun Jing Jian, Wang Kang, Zhang Cun Zhen, Guo Wei Xing, Shi Jie, Cong Wen Ming, Wu Meng Chao, Lau Wan Yee, Cheng Shu Qun
机构信息
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
出版信息
Ann Surg Oncol. 2016 Apr;23(4):1344-51. doi: 10.1245/s10434-015-5008-z. Epub 2015 Dec 29.
BACKGROUND
Microvascular invasion (MiVI) is a major risk factor of survival outcomes after curative resection for patients with hepatocellular carcinoma (HCC). This study aimed to investigate the impact of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) on HCC patients with MiVI.
METHODS
From January 2004 to June 2013, HCC patients with histologically confirmed MiVI and well-tolerated liver function who underwent PA-TACE after R0 hepatectomy (RH) or RH alone were studied retrospectively. In the PA-TACE group, PA-TACE was given 4 weeks after RH. Uni- and multivariate analyses were used to identify the prognostic significance of PA-TACE.
RESULTS
Of the 322 HCC patients with MiVI included in the analysis, 185 entered into the RH group and 137 entered into the PA-TACE group. The baseline characteristics of the two groups were similar except for alanine aminotransferase (ALT) level (p = 0.037). The 1-, 2-, 3-, and 5-year recurrence-free survival (RFS) rates were respectively 69.3, 55.5, 46.7, and 35.0 % for the PA-TACE group and 47.0, 36.2, 34.1, and 30.3 % for the RH group (log-rank, χ(2) = 6.309; p = 0.012). The 1-, 2-, 3-, and 5-year overall survival (OS) rates were respectively 94.2, 78.8, 71.5, and 54.0 % for the PA-TACE group and 78.9, 62.2, 54.1, and 43.2 % for the RH group (log-rank, χ(2) = 7.537; p = 0.006). Multivariate Cox proportional hazards regression analysis showed PA-TACE to be an independent risk factor of postoperative RFS and OS.
CONCLUSIONS
This study showed that PA-TACE may be beneficial for HCC patients with MiVI.
背景
微血管侵犯（MiVI）是肝细胞癌（HCC）患者根治性切除术后生存结局的主要危险因素。本研究旨在探讨术后辅助经动脉化疗栓塞术（PA-TACE）对伴有MiVI的HCC患者的影响。
方法
回顾性研究2004年1月至2013年6月期间，经组织学证实存在MiVI且肝功能耐受良好、在R0肝切除（RH）术后或仅行RH后接受PA-TACE的HCC患者。在PA-TACE组中，RH术后4周给予PA-TACE。采用单因素和多因素分析确定PA-TACE的预后意义。
结果
纳入分析的322例伴有MiVI的HCC患者中，185例进入RH组，137例进入PA-TACE组。除丙氨酸转氨酶（ALT）水平外，两组的基线特征相似（p = 0.037）。PA-TACE组1年、2年、3年和5年无复发生存（RFS）率分别为69.3%、55.5%、46.7%和35.0%，RH组分别为47.0%、36.2%、34.1%和30.3%（对数秩检验，χ(2)=6.309；p = 0.012）。PA-TACE组1年、2年、3年和5年总生存（OS）率分别为94.2%、78.8%、71.5%和54.0%，RH组分别为78.9%、62.2%、54.1%和43.2%（对数秩检验，χ(2)=7.537；p = 0.006）。多因素Cox比例风险回归分析显示，PA-TACE是术后RFS和OS的独立危险因素。
结论
本研究表明，PA-TACE可能对伴有MiVI的HCC患者有益。
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