Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor:A retrospective control study

AIM:To evaluate the effect of postoperative adjuvanttranscatheter arterial chemoembolization(TACE)on theprognosis of hepatocellular carcinoma(HCC)patients withor without risk factors for the residual tumor.METHODS:From January 1995 to December 1998,549consecutive HCC patients undergoing surgical resectionwere included in this research.There were 185 patientswho underwent surgical resection with adjuvant TACE and364 patients who underwent surgical resection only.Tumorswith a diameter more than 5 cm,multiple nodules,andvascular invasion were defined as risk factors for residualtumor and used for patient stratification.Kaplan-Neiermethod was used to analyze survival curve and Coxproportional hazard model was used to evaluate theprognostic significance of adjuvant TACE.RESULTS:In the patients without any risk factors for theresidual tumor,the 1-,3-,5-year survival rates were 93.48%,75.85%,62.39% in the control group and 97.39%,70.37%,50.85% in the adjuvant TACE group,respectively.Therewas no significant difference in the survival between twogroups(P=0.3956).However,in the patients with riskfactors for residual tumor,postoperative adjuvant TACEsignificantly prolonged the patients' survival.There was astatistically significant difference in survival between twogroups(P=0.0216).The 1-,3-,5-year survival rates were69.95%,49.86%,37.40% in the control group and 89.67%,61.28%,44.36% in the adjuvant TACE group,respectively.Cox proportional hazard model showed that tumor diameterand cirrhosis,but not the adjuvant TACE,were the significantlyindependent prognostic factors in the patients without riskfactors for residual tumor.However,in the patients withrisk factors for residual tumor adjuvant TACE,and alsotumor diameter,AFP level,vascular invasion,were thesignificantly independent factors associated with thedecreasing risk for patients'death from HCC.CONCLUSION:Postoperative adjuvant TACE can prolongthe survival of patients with risk factors for residual tumor,but can not prolong the survival of patients without riskfactors for residual tumor.     

Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus

AIM:To evaluate the survival benefits of different treatment strategies for hepatocellular carcinoma(HCC)patients with portal vein tumor thrombus(PVTT)and to determine the prognosis factors.METHODS:Between 2007 and 2009,338 HCC patients treated for PVTT were retrospectively studied.The patients were divided into 4 groups that underwent different treatments:the conservative treatment group(n=75),the transarterial chemoembolization(TACE)group(n=86),the hepatic resection group(n=90),and the hepatic resection associated with postoperative TACE group(n=87).Survival rates were determined using the Kaplan-Meier method and differences between the groups were identified through log-rankanalysis.Cox’s proportional hazard model was used to identify the risk factors for survival.RESULTS:The mean survival periods for patients in the conservative treatment,TACE,hepatic resection and hepatic resection associated with postoperative TACE groups were 3.8,7,8.2 and 15.1 mo,respectively.Significant differences were observed in the survival rates.For the surgical resection associated with postoperative TACE group,the survival rates after 1,2 and3 years were 49%,37%and 19%,respectively.These results were significantly higher than those of the other groups(P<0.05).Meanwhile,the 1,2 and 3 year survival rates for the surgical resection group were 28%,20%and 15%,whereas those for the TACE group were17.5%,0%and 0%,respectively.These values significantly increased after hepatic resection compared with those after TACE(P<0.05).CONCLUSION:Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and results in high hepatic functional reserve.For patients who can tolerate the procedure,postoperative TACE is necessary to prevent recurrence and prolong the survival period.     

Role of surgical resection for multiple hepatocellular carcinomas

AIM:To clarify the role of surgical resection for multiple hepatocellular carcinomas(HCCs)compared to transarterial chemoembolization(TACE)and liver transplantation(LT). METHODS:Among the HCC patients who were managed at Yonsei University Health System between January 2003 and December 2008,160 patients who met the following criteria were retrospectively enrolled:(1) two or three radiologically diagnosed HCCs;(2)no radiologic vascular invasion;(3)Child-Pugh class A;(4) main tumor smaller than 5 cm in diameter;and(5) platelet count greater than 50 000/mm3.Long-term outcomes were compared among the following three treatment modalities:surgical resection or combined radiofrequency ablation(RFA)(n=36),TACE(n=107), and LT(n=17).The survival curves were computed using the Kaplan-Meier method and compared with a log-rank test.To identify the patients who gained a survival benefit from surgical resection,we also investigated prognostic factors for survival following surgical resection.Multivariate analyses of the prognostic factors for survival were performed using the Cox proportional hazard model. RESULTS:The overall survival(OS)rate was significantly higher in the surgical resection group than in the TACE group(48.1%vs 28.9%at 5 years,P<0.005). LT had the best OS rate,which was better than that of the surgical resection group,although the difference was not statistically significant(80.2%vs 48.1%at 5 years,P=0.447).The disease-free survival rates were also significantly higher in the LT group than in the surgical resection group(88.2%vs 11.2%at 5 years, P<0.001).Liver cirrhosis was the only significant prognostic factor for poor OS after surgical resection. Clinical liver cirrhosis rates were 55.6%(20/36)in the resection group and 93.5%(100/107)in the TACE group.There were 19 major and 17 minor resections. En bloc resection was performed in 23 patients,multisite resection was performed in 5 patients,and combined resection with RFA was performed in 8 patients. In the TACE group,only 34 patients(31.8%)were record     

A three-factor preoperative scoring model predicts risk of recurrence after liver resection or transplantation in hepatocellular carcinoma patients with preserved liver function

BACKGROUND: No staging systems of hepatocellular carcinoma(HCC) are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment(liver resection or transplantation).METHODS: We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection(n=184) or transplantation(n=102). Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS: Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows: 0.758×HBs Ag status(negative: 0; positive: 1)+0.387×plasma fibrinogen level(≤3.24 g/L: 0; 3.24 g/L: 1)+0.633×total tumor volume(≤107.5 cm3: 0; 107.5 cm3: 1). The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score 1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group(67.9% vs 41.3%, P0.001). In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group(80.0% vs 64.0%, P0.01). Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar(80.0% vs 79.3%, P=0.906).CONCLUSION: Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.     

Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

AIM:To determine the risk factors for hepatocellular carcinoma(HCC) rupture,and report the management and long-term survival results of patients with spontaneous rupture of HCC.METHODS:Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006,200(4.8%) patients with ruptured HCC(case group) were studied retrospectively in term of their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment,transarterial embolization(TACE) or hepatic resection.Results of various treatments in the case group were evaluated and compared with the control group(202 patients) without ruptured HCC during the same study period.Continuous data were expressed as mean ± SD or me-dian(range) where appropriate and compared using the unpaired t test.Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate.The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.RESULTS:Compared with the control group,more patients in the case group had underlying diseases of hypertension(7.5% vs 3.0%,P =0.041) and liver cirrhosis(87.5% vs 56.4%,P 0.001),tumor size 5 cm(83.0% vs 57.4%,P 0.001),tumor protrusion from the liver surface(66.0% vs 44.6%,P 0.001),vascular thrombus(30.5% vs 8.9%,P 0.001) and extrahepatic invasion(36.5% vs 12.4%,P 0.001).On multivariate logistic regression analysis,underlying diseases of hypertension(P = 0.002) and liver cirrhosis(P 0.001),tumor size 5 cm(P 0.001),vascular thrombus(P = 0.002) and extrahepatic invasion(P 0.001) were predictive for spontaneous rupture of HCC.Among the 200 patients with spontaneous rupture of HCC,105 patients underwent hepatic resection,33 received TACE,and 62 were managed with conservative treatment.The median survival time(MST) of all patients with spontaneous rupture of HCC was 6 mo(range,1-72 mo),and the overall survival at 1,3 and 5 years were 32.5%,10% and 4%,respectively.The MST was 12 mo(range,1-72 mo) in the surgical group,4 mo(range,1-30 mo) in the TACE group and 1 mo(range,1-19 mo) in the conservative group.Ninety-eight patients in the control group underwent hepatic resection,and the MST and median diseasefree survival time were 46 mo(range,6-93 mo) and 23 mo(range,3-39 mo) respectively,which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection(P 0.001).The 1-,3-,and 5-year overall survival rates and the 1-,3-and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%,19.0% and 7.6%,27.6%,14.3% and 3.8%,respectively,compared with those of 77.1%,59.8% and 41.2%,57.1%,40.6% and 32.9% in 98 patients with-CONCLUSION:Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy,although the survival results were inferior to those of the patients without ruptured HCC.     

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection:a matched study

BACKGROUND: Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear.
METHODS: We compared the prognoses of 110 HCC patients without BDTT (group A) to 22 cases with BDTT (group B). The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Addi-tionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors.
RESULTS: The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively (P=0.043). The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gamma-glutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage III-IV was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage I-II after R0 resection (hazard ratio=6.056,P=0.014). Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage III-IV were independent risk fac-tors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection (31.0 vs 4.0 months,P=0.007).
CONCLUSIONS: R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.     

Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis

AIM: To evaluate the efficacy of different treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and investigate factors influencing prognosis. METHODS: One hundred and seventy-nine HCC patients with macroscopic PVTT were enrolled in this study. They were divided into four groups and underwent different treatments: conservative treatment group (n = 18), chemotherapy group (n = 53), surgical resection group (n = 24) and surgical resection with postoperative chemotherapy group (n = 84). Survival rates of the patients were analyzed by the Kaplan-Meier method. A log-rank analysis was performed to identify group differences. Cox's proportional hazards model was used to analyze variables associated with survival. RESULTS: The mean survival periods of the patients in four groups were 3.6, 7.3,10.1, and 15.1 mo respectively. There were significant differences in the survival rates among the groups. The survival rates at 0.5-, 1-, 2-, and 3-year in surgical resection with postoperative chemotherapy group were 55.8%, 39.3%, 30.4%, and 15.6% respectively, which were significantly higher than those of other groups (p<0.001). Multivariate analysis revealed that the strategy of treatment (P<0.001) and the number of chemotherapy cycles (P = 0.012) were independent survival predictors for patients with HCC and PVTT. CONCLUSION: Surgical resection of HCC and PVTT combined with postoperative chemotherapy or chemoembolization is the most effective therapeutic strategy for the patients who can tolerate operation. Multiple chemotherapeutic courses should be given postoperatively to the patients with good hepatic function reserve.     

Hepatocellular carcinoma: Clinical study of long-term survival and choice of treatment modalities

AIM: To analyze the prognostic factors of 5-year survival and 10-year survival in hepatocellular carcinoma (HCC) patients, and to explore the reasons for longterm survival and provide choice of treatment modalities for HCC patients. METHODS: From January 1990 to October 2012, 8450 HCC patients were included in a prospective database compiled by the Information Center after hospital admission. Long-term surviving patients were included in a 10-year survival group (520 patients) and a 5-year survival group (1516 patients) for analysis. The long-term survival of HCC patients was defined as the survival of 5 years or longer. Clinical and biologic variables were assessed using univariate and multivariate analyses. The survival of patients was evaluated by follow-up data. RESULTS: The long-term survival of HCC patients was associated with the number of lesions, liver cirrhosis and Child-Pugh classification. It was not found to be associated with tumor diameter, histological stage, and pretreatment level of serum α-fetoprotein. The differences in clinical factors between the 5-year survival and the 10-year survival were found to be the number of lesions, liver cirrhosis, Child-Pugh classification, and time elapsed until first recurrence or metastasis. The survival period of different treatment modalities in the patients who survived for 5 years and 10 years showed significant differences: (in order of significance) surgery alone > surgery-transcatheter arterial chemoembolization (TACE) > TACE-radiofrequency ablation (RFA) > TACE alone > surgery-TACE-RFA. The 10-year survival of HCC patients was not associated with the choice of treatment modality.CONCLUSION: This retrospective study elucidated survival outcomes, prognostic factors affecting survival and treatment modalities in HCC patients.     

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP).CUP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not pubhshed. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection.METHODS: A retrospective survey was carried out in 174patients undergoing resection of HCC from January 1986 toJune 1998. Six patients who died in the hospital afteroperation and 11 patients with the recurrence of the diseasewere excluded at 1 month after hepatectomy. By the end ofJune 2001, 4 patients were lost and 153 patients with curativeresection have been followed up for at least three years.Among 153 patients, 115 developed intrahepatic recurrenceand 10 developed extrahepatic recurrence, whereas the other28 remained free of recurrence. Recurrences were classifiedinto early ( ＜ / = 3 year) and late ( ＞ 3 year) recurrence. TheCLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portalthrombosis (0-1)o By contrast, portal vein thrombosis wasdefined as the presence of tumor emboli within vascularchannel analyzed by microscopic examination in this study.Risk factors for recurrence and prognostic factors forsurvival in each group were analyzed by the chi-square test,the Kaplan-Meier estimation and the COX proportionalhazards model respectively.RESULTS: The 1-, 3-, 5-, 7-, andl0-year disease-free survivalrates after curative resection of HCC were 57.2 %、 28.3 %、23.5 %、 18.8 % and 17.8 %, respectively. Median survivaltime was 28,16,10,4,and 5 mo for CLIP score 0,1,2,3, and 4to 5, respectively. Early and late recurrence developed in109 patients and 16 patients respectively. By the chi-squaretest, tumor size, micrusatsllite, venous invasion, tumortype (uninodular, muitinodular, massive), tumor extension( ＜ / = or ＞ 50 % of liver parenchyna replaced by tumor),TNM stage,CLIP score,and resection margin were the risk factors for early recurrence,whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. in univariate survival analysis,Child-Pugh stages,resection margin,tumor size,microsatellite,venous invasion,tumor type,tumor extension,TNM stages,and CLIP score were associated with prognosis.The multivariale analysis by COX proportional hazards modes showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION:CLIP score has displayed a unique superiority in predictin the tumor early and late recurrence and prognosis in the patients with HCC after resection.     

Giant malignant gastrointestinal stromal tumors： Recurrence and effects of treatment with STI-571

AIM: Malignant gastrointestinal stromal tumors (GISTs) are rare. Tumors larger than 10 cm tend to recur earlier: the larger the volume of the tumor, the worse the prognosis. We hypothesized that treatment with imatinib mesylate (Gleevec; STI-571), a c-kit tyrosine kinase inhibitor, as palliative therapy would prolong the survival of patients with recurrent giant malignant GISTs after resection. METHODS: We performed a retrospective analysis of the effects of resection on patients with giant GISTs (>10 cm in diameter) to determine the overall survival and recurrence rates. Twenty-three patients diagnosed with giant GISTs were included from June 1996 to December 2003. STI-571 was not available until January 2000. After that time, 9 patients received this drug. The factors of age, sex, tumor location, histological surgical margin, and STI-571, tumor size changes and drug side effects were reviewed. We compared the survival rate to determine the prognostic factors and the effects of STI-571 on patients with recurrent malignant gastrointestinal stromal tumor. RESULTS: The positive surgical margin group had a significantly higher recurrence rate than the negative margin group (P=0.012). A negative surgical margin and palliative treatment with STI-571 were significant prognostic variables (Log-rank test, P<0.05). Age, sex and tumor location were not significant prognostic variables. The 5-year survival rate of the surgical margin free patients was 80% and the 2-year survival rate of the surgical margin positive patients was 28%. The 5-year survival rate was 80% for the patients given STI-571 and 30% for the patients not given STI-571. The use of STI-571 gave a significant tumor shrinkage (6/9) rate in patients with giant GIST recurrence after resection. CONCLUSION: A negative surgical margin and the use of STI-571 after surgical resection were good prognostic indicators. Achieving a tumor-free surgical margin is still the best primary treatment for patients with such tumors. If STI-571 is used immediately when the surgical margin is positive and the tumor recurs after resection, then the prognosis of patients with giant GISTs can be improved.     

肿瘤切除前TACE对巴塞罗那临床肝癌分期B期患者预后的影响

目的探讨肿瘤切除术前行经皮股动脉穿刺肝动脉化疗栓塞术（TACE）对巴塞罗那临床肝癌（BCLC）分期B期患者预后的影响。方法对309例首次行肝癌切除术的BCLC分期B期患者的临床资料进行回顾性分析,根据术前是否行TACE分为联合组和手术组,用两独立样本t检验和PearsonX2检验比较两组一般临床资料,用Log—rank检验和Cox比例风险回归模型比较两组生存率。结果两组一般临床资料无统计学差异（P〉0．05）;联合组和手术组中位生存期分别为36、26个月,组间比较P〈0．05（X2=9．226）;治疗方式、肿瘤直径、手术切缘和血清AFP水平是影响患者生存率的危险因素（P〈0．05）,且治疗方式是影响患者预后的独立危险因素（RR为1．576,95％CI为1．157—2．146,P=0．004）。结论对于BCLC分期B期患者,在切除术前给予辅助性TACE治疗有望延长术后生存时间。     

肝细胞癌根治术后辅助性肝动脉化疗栓塞对远期复发的影响

目的 研究肝细胞癌根治术后早期(术后2个月内)行辅助性肝动脉化疗栓塞(TACE)对远期复发的影响.方法 2001-2007年行根治性手术切除的2436例肝细胞癌患者纳入本研究.根据术后是否行辅助性TACE治疗分为对照组和干预组;再根据肿瘤直径、数目以及有无镜下癌栓将入选病例分为肿瘤≤5 cm的复发低危、高危组以及肿瘤>5 cm的复发低危、高危组.肿瘤单个且无镜下癌栓为复发低危;否则为复发高危.研究辅助性TACE对各亚组患者远期(>2年)复发的影响.连续性变量用Student't检验比较;分类变量用χ2检验比较;用Kaplan-Meier法统计算生存率和复发率,用Log-rank法比较;用Cox回归模型分析影响患者远期预后的因素. 结果 对照组与干预组术后2年的复发率,在肿瘤≤5 cm的复发低危组分别为20.38%和25.41%,高危组分别为33.06%和39.61%;在肿瘤>5 cm的复发低危组分别为30.54%和40.55%,高危组分别为50.82%和51.57%;各对照组与干预组间的差异均无统计学意义(P>0.05).术后2年内发生复发或死亡患者的中位生存时间,肿瘤>5 cm的复发高危组中,对照组和干预组分别为12个月比24个月;仅在该亚组中,对照组与干预组间生存率差异有统计学意义(χ2=17.59,P<0.01).术后2年内未发生复发和死亡患者的复发率在各对照组与干预组间的差异均无统计学意义(P>0.05);但在肿瘤≤5 cm的复发低危组中,术后3、4、5年的生存率在对照组分别为93.95%、91.50%、88.42%,在干预组分别为91.70%、81.32%、78.19%,差异有统计学意义(χ2=7.48,P<0.05);其他亚组中对照组和干预组间差异均无统计学意义(P>0.05).Cox分析结果 显示,辅助性TACE不是影响远期复发的独立危险因素,但有增加影响这些患者死亡的趋势(HR=1.50,P>0.05).结论 辅助性TACE能够对术后残癌及早期复发灶进行及时诊治,但不能延缓或预防远期复发.对低复发风险(主要是肿瘤≤5 cm的复发低危组)患者给予辅助性TACE治疗可能是弊大于利.     

The Effect of Postoperative TACE on Prognosis of HCC with Microscopic Venous Invasion

Background/Aims: The aim of this study was to evaluate the clinical efficacy of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC) with microscopic venous invasion. Methodology: Data from 76 patients with HCC who underwent hepatectomy with or without postoperative adjuvant TACE between July 2005 and August 2010 were retrospectively reviewed. Kaplan-Meier method was used to compare survival between the groups and prognostic factors were evaluated by Cox proportional hazard model. Results: The 1-, 3- and 5-year disease- free survival rates were 76.3%, 44.5% and 31.8%, respectively, for the adjuvant TACE group (35 patients) and 60.1%, 39.3% and 21.5%, respectively, for the control group (41 patients). The 1-, 3- and 5-year overall survival rates were 88.6%, 67.2% and 42.3%, respectively, for the TACE group and 77.5%, 58.0% and 40.5%, respectively, for the control group. Although improving trends of both disease-free survival and overall survival were observed in adjuvant TACE group, there was no significant difference between the two groups (p>0.05). Cox regression analysis revealed that tumor size and differentiation were significant independent prognostic factors. Conclusions: Postoperative adjuvant TACE may improve 1, 3 and 5 year disease-free and overall survival rates of HCC patients with microscopic venous invasion but no statistical significance was found. It can be used as a preventative treatment but not a routine procedure for such patients.     

肝细胞癌患者外科手术根治术后生存分析

目的 探讨肝细胞癌（HCC）患者行外科手术切除后5年生存情况的独立影响因素。方法 收集我院2008年10月~2010年10月收治的112例接受外科手术治疗的HCC患者的临床资料,行腹部CTA检查,观察患者相关临床指标,运用Cox风险比例回归模型进行单因素和多因素分析,得出独立影响因素,运用Kaplan-Meier 法和Log-Rank 检验比较这些因素在生存曲线分布上的变化情况。结果多因素Cox回归模型分析结果 显示,微血管浸润、肿瘤数目、肿瘤大小、肿瘤细胞分化程度和术后行肝动脉灌注化疗栓塞术（TACE）为影响此类患者生存情况的独立影响因素,其OR值分别为2.61、2.57、2.01、1.37、0.31,Kaplan-Meier 法和Log-Rank 检验显示38例TACE治疗组1 a、3 a、5 a累计生存率分别为90.6%、83.2%、80.5%,显著高于74例未行TACE治疗组的88.2%、41.5%、30.9%（P<0.05）。结论 肝癌根治术后给予TACE治疗可提高HCC患者生存率,延长生存期,有助于改善患者预后。     

肝细胞癌自发性破裂出血的治疗对策选择（附30例报告）

目的探讨肝细胞癌（HCC）自发破裂出血患者在治疗对策上的选择。方法对本院2008年1月-2011年12月收治的30例HCC破裂出血患者的临床资料进行回顾性分析,其中行Ⅰ期手术9例,急诊经导管肝动脉化疗栓塞术（TACE）治疗21例,TACE治疗后再手术切除10例,其余11例均为单纯TACE治疗,从临床治疗效果进行评价分析。计数资料比较采用卡方检验或Fisher′s检验。结果21例经急诊TACE治疗者止血成功率为100%,其中10例患者TACE治疗后2~5周内进行Ⅱ期手术,术后病理证实均为HCC,术后3个月复查均未见腹腔肿瘤种植转移灶,术后1 年存活率70%（7/10）; 9例行Ⅰ期手术切除的患者中,围手术期内死亡2例,3个月内发生腹腔或切口种植转移者5例（5/7）,术后1 年存活率44.4%（4/9）;11例单纯TACE治疗患者术后1 年存活率为27.3%（3/11）。急诊TACE联合手术切除HCC破裂出血在提高抢救成功率、减少术后并发症及提高患者生存时间上均优于急诊手术切除及单纯的TACE治疗。结论HCC自发性破裂出血患者应首选急诊TACE治疗,再联合手术切除,可以明显提高抢救成功率和手术切除率,并可显著降低肿瘤腹腔种植转移率,延长患者生存时间。     

肝动脉化疗栓塞对肝癌术后高危复发患者的疗效分析

目的 探讨原发性肝癌切除术后肝动脉化疗栓塞(TACE)的疗效.方法 将86例肝癌术后的高危复发患者分为干预组(TACE治疗组)和对照组(未行TACE治疗组).术后高危复发的标准为:①单发病灶>5 cm;②病灶数≥2处;③术后病理检查有镜下癌栓.符合其中任意一条为术后高危复发患者.干预组术后1～2月行TACE治疗.结果 ...     

Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: Propensity score analysis

AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.     

Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma after radical hepatectomy: a real world study

Abstract

Objective: To investigate the clinical value of the adjuvant transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) after radical resection, and identify the potential beneficiaries.

Methods: Patients were identified through the primary liver cancer big data (PLCBD) between 2012 and 2015. Overall survival (OS) between adjuvant TACE group and non-TACE was evaluated by Kaplan-Meier before and after propensity scoring match (PSM). Subgroup analysis was conducted stratified by risk factors.

Results: A total of 2066 HCC patients receiving radical resection were identified. Patients with multiple tumors, tumor diameter >5?cm, satellite, and advanced stage were more likely to accept adjuvant TACE. Before PSM, the 1-, 3-, and 5-year OS rates in the TACE group and non-TACE group were 89%, 58%, 17%, and 88%, 53%, 13% (p?=?.43), respectively. While, the corresponding rates were 89%, 58%, 17%, and 86%, 49%, 11%, (p?=?.038), respectively after 1:1 PSM. In addition, patients were found to significantly benefit from adjuvant TACE if they had age ≥50?years, no cirrhosis, AFP ≤ 200?ng/ml, surgical margin <1?cm, tumor diameter >5?cm, no capsule, no satellite, or CN stage Ib/IIa (all p?<?.05), but patients with age < 50?years, tumor size ≤5?cm, or CN stage Ia were found to significantly benefit from radical resection in DFS (all p?<?.05).

Conclusion: Currently, we concluded that not all of patients with HCC would benefit from adjuvant TACE. Patients with age ≥50?years, tumor size >5?cm, or CN stage Ib/IIa were strongly recommended to receive adjuvant TACE.