肝细胞癌切除术后肝动脉栓塞化疗在减少术后复发中的作用

目的探讨肝细胞癌切除术后肝动脉栓塞化疗（transarterial chemoembolization，TACE）在减少术后复发中的作用。方法进入研究180例，根据是否存在肿瘤残留危险因素以及术后有无接受预防性TACE分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四组。其中存在肿瘤残留危险因素者101例，58例曾接受预防性TACE治疗（Ⅰ组），43例未接受预防性TACE治疗（Ⅱ组）；另外不存在肿瘤残留危险因素者79例，49例曾接受预防性TACE治疗（Ⅲ组），30例未接受预防性TACE治疗（Ⅳ组）。比较各组病人无瘤生存率及逐年肿瘤复发率，采用Cox回归分析有关因素对生存时间的影响。结果Ⅰ、Ⅱ组病人之间总体无瘤生存率差异有统计学意义（P〈0．05），Ⅲ、Ⅳ组病人之间无瘤生存率差异无统计学意义（P〉1）．05）；Ⅰ、Ⅱ组病人之间仅第1年肝癌复发率差异有统计学意义（P〈0．05），Ⅲ、Ⅳ组病人各年度间的肝癌复发率差异均无统计学意义（P〉0．05）；Cox回归分析显示，血管侵犯、肿瘤直径及肿瘤数目是影响预后的独立危险因素；而TACE是影响预后的独立保护因素。结论对于合并有肿瘤直径〉5cm、多结节、血管侵犯等肿瘤残留危险因素的肝癌病人，术后预防性TACE能降低1年以内的近期复发率，可作为常规的干预手段。

The effect of postoperative transarterial chemoembolization on reducing recurrence in hepatocellular carcinoma patients

Objective To discuss the effect of postoperative transarterial chemoembolization （TACE） on reducing recurrence in hepatocellular carcinoma（HCC）patients. Methods 180 HCC patients after curative resection were classified into 4 groups in terms of with/without residual tumor risk factors and with/without prophylactic TACE. In 10l patients with residual tumor risk factors,58 cases accepted postoperative prophylactic TACE（Group Ⅰ ）, and the remaining 43 cases did not accept TACE （Group Ⅱ ）. In 79 patients without residual tumor risk factors,49 cases accepted postoperative prophylactic TACE（Group Ⅳ ）,and the remaining 30 cases did not accept TACE（Group Ⅳ ）. Chi-square,Kaplan-Meier and Cox model were used to analyze prognostic factors. Results There was significant difference in tumor free survival between group Ⅰ and group Ⅱ （P〈0. 05）, but no significant difference between group Ⅲ and group Ⅳ（P〉0. 05）. Between group Ⅰ and group Ⅱ ,TACE only significantly decreased the tumor recurrence rate in the 1st year after operation（P〈0. 05）. There was no significant difference in tumor recurrence rate by year between group Ⅱ and group Ⅳ （P〉0. 05）. Cox model revealed that vascular invasion, tumor diameter and tumor number were the independent risk factors, but prophylactic TACE was the independent protective factors. Conclusion For HCC patients with residual tumor risk factors（single tumor〉5 cm in diameter, or with multiple tumors,vascular invasion）, postoperative prophylactic TACE can decrease the recurrent rate within 1 year after the tumor resection.