基于NDR评分评估多发性肝癌根治术后经导管动脉化疗栓塞治疗效果研究

目的 探讨NDR评分与多发性肝癌肝切除术后经导管动脉化疗栓塞术（TACE）疗效的关系。方法 回顾性分析2009年3月至2015年3月在海军军医大学东方肝胆外科医院行肝切除术的505例多发性肝癌病人的临床资料。根据术后是否行辅助性TACE将病人分为TACE组（n=272）和非TACE组（n=233），采用倾向得分匹配（PSM）对病人行1∶1配对。应用Kaplan-Meier法分析术后无复发存活率（RFS）和总体存活率（OS）的差异，并分析NDR评分与TACE疗效的关系。结果 PSM后，TACE组1、3、5年RFS和OS均高于非TACE组（66.8%、41.2%和27.6%；49.6%、37.2%和27.7%，P=0.031；86.1%、63.7%和42.6%；69.1%、49.0%和37.2%，P=0.002）。NDR评分≤2分时，TACE 组1、3、5年RFS和OS与非 TACE 组差异无统计学意义（68.6%、44.1%、29.0% vs. 58.0%、43.3%、35.2%，P=0.445；88.3%、65.0%、44.4% vs. 76.4%、55.0%、45.7%，P=0.109）；NDR评分>2分时，TACE 组1、3、5年RFS和OS均高于非TACE组（60.5%、34.2%、28.5% vs. 20.3%、16.2%、8.1%，P=0.001；78.9%、51.6%、42.8% vs. 43.8%、29.9%、15.9%，P=0.007）。PSM后NDR评分>2分时，多因素分析显示，甲胎蛋白（AFP）和辅助性TACE是无复发生存的独立影响因素（HR=1.90、0.43；P<0.05）；AFP、肿瘤最大最小径比值和辅助性TACE是总体生存的独立影响因素（HR=2.23、2.96、0.53；P<0.05）。结论 NDR评分>2分时，肝癌肝切除术后行辅助性TACE可有效减少术后复发，改善远期生存。对NDR评分>2分的多发性肝癌病人，推荐辅助性TACE作为术后抗复发治疗手段。

Effect of postoperative transcatheter arterial chemoembolization after liver resection of multiple hepatocellular carcinomas based on NDR scoring system

Effect of postoperative transcatheter arterial chemoembolization after liver resection of multiple hepatocellular carcinomas based on NDR scoring system XIE Zhi-hao，ZHANG Xiao-feng，BAI Shi-lei，et al. No.4 Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital，Naval Medical University，Shanghai 200433，China
Corresponding author：SHEN Feng，E-mail：shenfengehbh@sina.com
XIE Zhi-hao and ZHANG Xiao-feng are the first authors who contributed equally to the article
Abstract Objective To investigate the effect of adjuvant transcatheter arterial chemoembolization (TACE) after liver resection (LR) with different NDR scores. Methods The clinical data of 505 patients who underwent LR in the Eastern Hepatobiliary Surgery Hospital，Naval Medical University between March 2009 and March 2015 were retrospectively analyzed. The patients were divided into the adjuvant TACE group (n=272) and the non-TACE group (n=233). Patients were 1:1 matched by propensity score matching (PSM) method due to differences in baseline between the groups. Kaplan-meier method was applied to compare postoperative recurrence-free survival and overall survival，and the relationship between NDR score and TACE efficacy was analyzed. Results After PSM，the 1-，3-，5-year recurrence-free survival rate and overall survival rate of TACE group was significantly higher than those in non-TACE group (both P<0.05). Among patients with NDR score ≤2 points，the 1-，3-，5-year recurrence-free survival rate and overall survival rate in the TACE group were not significantly different from that in the non-TACE group. Among patients with NDR score >2 points，the 1-，3-，5-year recurrence-free survival rate and overall survival rate in the TACE group were better than those in the non-TACE group (both P<0.05). Among patients with NDR score >2 points after PSM，multivariate analysis indicated that AFP level and adjuvant TACE treatment were independent factors affecting the recurrence-free survival(HR=1.90，0.43；P<0.05); AFP level，tumor maximum diameter/tumor minimum diameter and adjuvant TACE treatment were independent factors affecting the overall survival (HR=2.23，2.96，0.53；P<0.05). Conclusion When the NDR score >2，adjuvant TACE could effectively reduce postoperative recurrence and improve long-term survival. For multiple hepatocellular carcinomas with NDR score >2，adjuvant TACE should be recommended as a postoperative anti-recurrence treatment.