小肝细胞癌根治性切除术后预防性经动脉化疗栓塞的意义：一项回顾性分析。

The significance of prophylactic transarterial chemoembolization after radical resection of small hepatocellular carcinoma: A retrospective analysis.

作者信息

Fan Sunfu, Yu Bingqi, Wang Xinbao

机构信息

Department of General Surgery, Zhejiang Hospital, Hangzhou, China.

Department of Radiotherapy, Zhejiang Hospital, Hangzhou, China.

出版信息

J Cancer Res Ther. 2017;13(5):773-777. doi: 10.4103/jcrt.JCRT_662_17.

DOI:10.4103/jcrt.JCRT_662_17

PMID:29237902

Abstract

PURPOSE

To clarify the necessity of prophylactic transarterial chemoembolization (pTACE) after radical resection for small hepatocellular carcinoma (sHCC) (<3.0 cm) and identify prognostic determinants.

MATERIALS AND METHODS

Consecutive 161 patients with sHCC in Zhejiang Cancer Hospital from May 2009 to May 2014 were retrospectively studied. In these patients, 87 patients only received radical resection alone (control group), while other 74 patients received pTACE after radical resection (pTACE group). The overall survival (OS) and recurrence-free survival (RFS) were evaluated by Kaplan-Meier method and the related factors on OS and RFS were analyzed by Cox regression analysis.

RESULTS

The median OS for all patients was 33.6 months. The median OS in the pTACE and control group was 34.1 and 33.4 months, respectively (P = 0.508). The 1-, 3-, and 5-year survival rates were 91.9%, 73.4%, and 42.7% in the pTACE group and 93.1%, 77.9%, and 51.4% in the control group, respectively. The median RFS in pTACE and control group was 21.6 and 31.3 months (P = 0.002), respectively. The 1-, 3-, and 5-year RFS rate in pTACE group and control group was 81.0%, 47.4%, and 27.6% and 86.9%, 71.7%, and 49.9%, respectively. Preoperative gamma-glutamyl transferase (GGT) serum level ≥60 U/L (hazard ratio [HR] = 2.603, 95% confidence interval [CI] =1.506-4.501, P = 0.001) and recurrence (HR = 6.034, 95% CI = 2.931-12.421, P = 0.003) were independent prognostic determinants associated with poor prognosis in multivariate analysis. Resection followed by pTACE (HR = 2.046, 95% CI = 1.262-3.319, P = 0.004) and preoperative GGT serum level ≥60 U/L (HR = 1.864, 95% CI = 1.152-3.017, P = 0.011) were independent prognostic factors associated with higher rate of recurrence.

CONCLUSIONS

Instead of improving the survival time, postoperative pTACE increased the rate of recurrence in sHCC patients. Preoperative GGT serum level ≥60 U/L and recurrence were independent prognostic determinants associated with poor prognosis.

摘要

目的

阐明小肝细胞癌（sHCC，<3.0 cm）根治性切除术后预防性经动脉化疗栓塞术（pTACE）的必要性，并确定预后决定因素。

材料与方法

回顾性研究2009年5月至2014年5月在浙江省肿瘤医院连续收治的161例sHCC患者。在这些患者中，87例仅接受了根治性切除术（对照组），而其他74例患者在根治性切除术后接受了pTACE（pTACE组）。采用Kaplan-Meier法评估总生存期（OS）和无复发生存期（RFS），并通过Cox回归分析分析OS和RFS的相关因素。

结果

所有患者的中位OS为33.6个月。pTACE组和对照组的中位OS分别为34.1个月和33.4个月（P = 0.508）。pTACE组的1年、3年和5年生存率分别为91.9%、73.4%和42.7%，对照组分别为93.1%、77.9%和5***4%。pTACE组和对照组的中位RFS分别为21.6个月和31.3个月（P = 0.002）。pTACE组和对照组的1年、3年和5年RFS率分别为81.0%、47.4%和27.6%以及86.9%、71.7%和49.9%。术前γ-谷氨酰转移酶（GGT）血清水平≥60 U/L（风险比[HR]=2.603，95%置信区间[CI]=1.506-4.501，P = 0.001）和复发（HR = 6.034，95% CI = 2.931-12.421，P = 0.003）是多变量分析中与预后不良相关的独立预后决定因素。根治性切除术后行pTACE（HR = 2.046，95% CI = 1.262-3.319，P = 0.004）和术前GGT血清水平≥60 U/L（HR = 1.864，95% CI = 1.152-3.017，P = 0.011）是与复发率较高相关的独立预后因素。