Gao Zhendong, Du Gang, Pang Yuguang, Fu Zhihao, Liu Chongzhong, Liu Yi, Zhou Binghai, Kong Du, Shi Binyao, Jiang Zhengcheng, Jin Bin
Department of General Surgery, Qilu Hospital of Shandong University School of Medicine, Shandong University, Jinan Department of General Surgery, Renmin Hospital of Lingcheng, Dezhou, China.
Medicine (Baltimore). 2017 Aug;96(33):e7426. doi: 10.1097/MD.0000000000007426.
We aim to investigate the effects of postoperative adjuvant transarterial chemoembolization (TACE) on survival and recurrence in hepatocellular carcinoma (HCC) patients after radical resection. A total of 320 HCC patients underwent radical resection between January 2010 and January 2014 in Qilu Hospital, Shandong University were divided into 4 groups according to the frequency of postoperative adjuvant TACE. Patients were further stratified into subgroups (tumor diameter ≤5 or >5 cm) with low or high risk factors for recurrence or death. A low risk factor for recurrence or death was defined as Edmondson grade I/II without microvascular invasion (MiVI), while a high risk factor was defined as Edmondson grade III/IV or with MiVI. Survival data and recurrence rates were compared using the Kaplan-Meier method. Uni- and multivariate analyses were based on the Cox proportional analysis. Compared to those received no TACE, patients underwent 2 (log-rank, χ = 9.054, P = .003) or 3 (log-rank, χ = 4.228, P = .04) TACE showed delayed recurrence. Patients received 2 or 3 TACE showed extended overall survival (OS) compared with the other patients. No statistical differences were found between all the disease-free survival (DFS) and OS in low-risk subgroups. In the patients of the high-risk subgroup with a tumor diameter of ≤5, those received 2 TACE showed delayed recurrence compared with those received no TACE, and TACE (twice or thrice) can improve OS. For those of the high-risk subgroup with a tumor diameter of >5, TACE (twice or thrice) can delay recurrence and improve OS. Adjuvant TACE (twice or thrice) after radical resection is beneficial for HCC patients with poor differentiation and MiVI, especially for those with a tumor diameter of >5 cm.
我们旨在研究术后辅助经动脉化疗栓塞术（TACE）对肝细胞癌（HCC）患者根治性切除术后生存及复发的影响。2010年1月至2014年1月期间，山东大学齐鲁医院共有320例行根治性切除的HCC患者，根据术后辅助TACE的次数分为4组。患者进一步根据复发或死亡的低或高风险因素分层为亚组（肿瘤直径≤5或>5 cm）。复发或死亡的低风险因素定义为Edmondson分级I/II且无微血管侵犯（MiVI），而高风险因素定义为Edmondson分级III/IV或有MiVI。采用Kaplan-Meier法比较生存数据和复发率。单因素和多因素分析基于Cox比例分析。与未接受TACE的患者相比，接受2次（对数秩检验，χ = 9.054，P = 0.003）或3次（对数秩检验，χ = 4.228，P = 0.04）TACE的患者复发延迟。接受2次或3次TACE的患者与其他患者相比总生存期（OS）延长。低风险亚组的所有无病生存期（DFS）和OS之间未发现统计学差异。在肿瘤直径≤5的高风险亚组患者中，接受2次TACE的患者与未接受TACE的患者相比复发延迟，且TACE（两次或三次）可改善OS。对于肿瘤直径>5的高风险亚组患者，TACE（两次或三次）可延迟复发并改善OS。根治性切除术后辅助TACE（两次或三次）对分化差和有MiVI的HCC患者有益，尤其是肿瘤直径>5 cm的患者。
