吉西他滨联合奥沙利铂经肝动脉化疗栓塞防治肝癌术后复发

目的:探讨吉西他滨联合奥沙利铂经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)在防治肝癌高危患者术后复发中的价值.方法:回顾性分析肝癌术后复发高危患者120例,88例术后3-6wk接受TACE治疗为TACE组,其中43例采用吉西他滨联合奥沙利铂组成的GEMOX方案(GEMOX组),45例使用传统化疗药物方案(对照组);32例因其他原因未接受TACE治疗作为为单纯手术组.通过6mo、12mo的随访,比较各组6mo、12mo术后复发率.结果:TACE组术后6mo、12mo肝内复发率(20.5%、43.8%)明显低于单纯手术组(37.5%、59.4%),两者均有统计学意义(χ2=6.512、4.573,P<0.05).在TACE组中,GEMOX组6mo术后复发率(11.6%)较对照组(28.9%)低,差异有统计学意义(χ2=4.026,P<0.05),两组12mo术后复发率无明显差异(χ2=0.876,P>0.05);在TACE不良反应中,GEMOX组白细胞减少及恶心、呕吐发生率较对照组低,差异有统计学意义(Z=-2.156、-2.295,P<0.05).结论:对肝癌术后复发高危患者进行预防性TACE有助于减少或延缓术后近期复发率,吉西他滨联合奥沙利铂方案疗效更佳.

Value of transcatheter arterial chemoembolization with gemcitabine plus oxaliplatin in preventing postoperative recurrence of hepatocellular carcinoma in high-risk patients

AIM:To investigate the value of transcatheter arterial chemoembolization (TACE) with gemcitabine plus oxaliplatin (GEMOX) in preventing postoperative recurrence of hepatocellular carcinoma (HCC) in high-risk patients.METHODS:The clinical data for 120 HCC patients with high risk factors for postoperative recurrence were analyzed retrospectively.Eightyeight patients (TACE group) received TACE 3-6 weeks postoperatively,of them 43 (GEMOX group) received new chemotherapeutics including gemcitabine and oxaliplatin and 45 (control group) received conventional chemotherapeutics.Thirty-two patients (operation group) did not receive TACE.The recurrence rate of HCC was compared between these groups within 6 months and 1 year of follow-up.RESULTS:The recurrence rate of HCC was significantly lower in the TACE group than in the operative group within either 6 months (20.5% vs 37.5%) or 1 year (43.8% vs 59.4%) after operative.The recurrence rate of HCC was significantly lower in the GEMOX group than in the control group within 6 months after operation,but showed no significant difference within 1 year of follow-up.The incidence rates of hyperleukocytosis,nausea and emesis in the GEMOX group were significantly lower than those in the control group.CONCLUSION:Prophylactic TACE contributes to reducing or postponing the short-term recurrence of HCC in patients with high risk factors for postoperative recurrence,and the chemotherapy regimen including gemcitabine and oxaliplatin shows better effects than conventional ones.