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肝切除与术前经导管动脉化疗栓塞术联合肝切除治疗可切除性肝细胞癌复发的对比研究

Resection versus Resection with Preoperative Transcatheter Arterial Chemoembolization for Resectable Hepatocellular Carcinoma Recurrence.

作者信息

Tao Qiang, He Wei, Li Binkui, Zheng Yun, Zou Ruhai, Shen Jingxian, Liu Wenwu, Zhang Yuanping, Yuan Yunfei

机构信息

State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.

Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.

出版信息

J Cancer. 2018 Jul 16;9(16):2778-2785. doi: 10.7150/jca.25033. eCollection 2018.

Abstract

The value of preoperative transcatheter arterial chemoembolization (TACE) for patients with recurrent hepatocellular carcinoma (rHCC) after liver resection is uncertain. We aimed to determine its effect on postoperative complication and survival. There were 33 patients who received preoperative TACE and repeated liver resection (TACE-LR) and 119 patients who received repeated liver resection (LR) alone for rHCC. Seventy-eight patients (TACE-LR, 28; LR, 50) were identified by propensity score matching (PSM) analysis for comparison of postoperative complication, disease-free survival (DFS) and overall survival (OS). Univariable and multivariable analyses were used to identify predictors for survival. Before matching, the TACE-LR group had more intraoperative blood loss than the LR group (P < 0.05). After matching, the TACE-LR group had more intraoperative blood loss and a longer operation time (Both P < 0.05). In all and matched patients, both groups had similar postoperative complications rate (TACE-LR, 21.2%; LR, 7.6%; P = 0.052 and TACE-LR, 21.4%; LR, 12.0%; P = 0.435), DFS (P = 0.81 and P = 0.41) and OS (P = 0.87 and P = 0.79). Preoperative TACE was not a predictor for DFS and OS in multivariable analyses. Preoperative TACE for resectable rHCC prolongs operating time and increases intraoperative blood loss without improving survival; thus, it should not be recommended as a routine procedure before repeated resection for patients with rHCCs.

摘要

肝切除术后复发性肝细胞癌(rHCC)患者术前经导管动脉化疗栓塞术(TACE)的价值尚不确定。我们旨在确定其对术后并发症和生存的影响。33例接受术前TACE及再次肝切除(TACE-LR)的患者和119例仅接受再次肝切除(LR)的rHCC患者。通过倾向评分匹配(PSM)分析确定78例患者(TACE-LR组28例,LR组50例)以比较术后并发症、无病生存期(DFS)和总生存期(OS)。采用单变量和多变量分析确定生存预测因素。匹配前,TACE-LR组术中失血量多于LR组(P<0.05)。匹配后,TACE-LR组术中失血量更多且手术时间更长(均P<0.05)。在所有患者及匹配患者中,两组术后并发症发生率(TACE-LR组21.2%,LR组7.6%;P=0.052;TACE-LR组21.4%,LR组12.0%;P=0.435)、DFS(P=0.81和P=0.41)及OS(P=0.87和P=0.79)相似。多变量分析中,术前TACE并非DFS和OS的预测因素。可切除性rHCC患者术前TACE会延长手术时间并增加术中失血量,且不能改善生存;因此,不建议将其作为rHCC患者再次切除术前常规操作。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56e1/6096377/8fcea0fa8254/jcav09p2778g001.jpg

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