微波消融辅助肝切除联合术后TACE治疗BCLC-B期肝细胞癌临床疗效分析

背景与目的:研究显示,术后行经肝动脉化疗栓塞(TACE)治疗可以给肝细胞癌(HCC)患者尤其是存在复发高危因素的HCC患者带来生存获益,但在获益患者群体的确定上仍存在较大争议。因此,本研究探讨微波消融辅助肝切除联合术后TACE治疗BCLC-B期HCC的临床疗效。方法:收集空军军医大学第二附属医院2010年1月—2014年12月收治的经微波消融辅助肝切除治疗的BCLC-B期2～3个肿瘤、最大直径3cm且微血管侵犯(MVI)阳性HCC患者的临床资料,根据是否行术后辅助TACE治疗分为观察组与对照组,采用Kaplan-Meier曲线进行生存分析,Log-rank检验两组生存差异,并采用Cox回归模型分析影响患者预后的危险因素。结果:共纳入344例患者,其中173例患者接受术后TACE治疗(观察组),171例患者未行术后TACE治疗(对照组)。两组患者基线资料具有可比性。观察组和对照组的1、3、5年总生存率(OS)分别为82.7%、47.4%、28.8%和69.0%、22.3%、15.9%;观察组和对照组的0.5、1、3年无瘤生存率(DFS)分别为86.7%、75.0%、29.6%和73.8%、60.4%、10.6%,观察组的OS与DFS均明显优于对照组(均P0.001)。单因素与多因素分析结果显示,治疗方式、肿瘤直径、白蛋白、总胆红素、HBs Ag阳性均为影响OS与DFS的独立危险因素(均P0.05)。结论:微波消融辅助肝切除联合术后TACE可以给2～3个肿瘤,最大直径3cm且MVI阳性的BCLC-B期HCC患者带来明显的生存获益,但此结论仍需多中心、大样本、高质量研究加以验证。

Analysis of clinical efficacy of microwave ablation-assisted liver resection combined with postoperative TACE in treatment of BCLC-B stage hepatocellular carcinoma

Background and Aims: Studies have demonstrated that postoperative transarterial chemoembolization (TACE) may provide survival benefit in patients with hepatocellular carcinoma (HCC), especially those with high risk factors for recurrence. However, the definition of the patient populations benefited from this treatment remains controversial. Therefore, this study was conducted to investigate the clinical efficacy of microwave ablation-assisted liver resection combined with postoperative TACE in treatment of BCLC stage B HCC.   Methods: The clinical data of HCC patients in BCLC stage B with 2 or 3 tumors, tumor maximum diameter >3 cm and positive microvascular invasion (MVI) undergoing microwave ablation-assisted liver resection from January 2010 to December 2014 in the Second Affiliated Hospital, Airforce Military Medical University were collected. The patients were divided into observation group and control group according to whether the postoperative TACE was performed. The survival analysis was performed by Kaplan-Meier method and the survival difference between the two groups was compared by Log-rank test. The factors affecting the prognosis of the patients were analyzed by Cox-proportional hazard regression model.  Results: A total of 344 eligible patients were enrolled, of whom, 173 cases received postoperative TACE (observation group) and 171 cases did not undergo postoperative TACE (control group). The baseline data were comparable between the two groups of patients. The 1-, 3- and 5-year overall survival rates (OS) were 82.7%, 47.4% and 28.8% for observation group, and were 69.0%, 22.3% and 15.9% for control group; the 0.5-, 1- and 3-year disease-free survival rates (DFS) were 87.6%, 75.0% and 29.6% for observation group, and were 73.8%, 60.4% and 10.6% for control group, respectively. Both OS and DFS in observation group were significantly better than those in control group (both P<0.001). The results of univariate and multivariate analysis showed that treatment method, tumor size, albumin, total bilirubin, platelet and HBsAg were associated with OS (P<0.05). The multivariate analysis demonstrated that treatment method, tumor size, albumin, total bilirubin and HBsAg were associated with DFS (all P<0.05). Conclusion: Microwave ablation-assisted liver resection combined with postoperative TACE can offer significant survival benefit in patients in BCLC stage B with 2-3 tumors, tumor maximal diameter larger than 3 cm and positive MVI. However, this conclusion still needs to be verified by multi-center and high-quality studies with large sample size.