Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study.
Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study.
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DOI：
10.3748/wjg.v10.i19.2791
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发表时间：
2004-10
影响因子：
4.3
通讯作者：
Z. Ren;Zhi-ying Lin;J. Xia;S. Ye;Zeng-chen Ma;Q. Ye;L. Qin;Zhi-quan Wu;Jia Fan;Zhao-You Ta
中科院分区：
文献类型：
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作者：
Z. Ren;Zhi-ying Lin;J. Xia;S. Ye;Zeng-chen Ma;Q. Ye;L. Qin;Zhi-quan Wu;Jia Fan;Zhao-You Ta
目的探讨经导管动脉化疗栓塞（TACE）对存在或不存在残留肿瘤危险因素的肝细胞癌（HCC）患者术后预后的影响。方法1995年1月至1998年12月，549例连续行肝细胞癌手术切除的患者纳入本研究。185例患者行手术切除并辅助TACE， 364例患者仅行手术切除。将直径大于5cm、多发结节、血管侵犯的肿瘤定义为残留肿瘤的危险因素，并用于患者分层。采用Kaplan-Meier法分析生存曲线，采用Cox比例风险模型评价辅助TACE的预后意义。结果在无任何残留肿瘤危险因素的患者中，对照组1、3、5年生存率分别为93.48%、75.85%、62.39%，辅助TACE组为97.39%、70.37%、50.85%。两组患者的生存率差异无统计学意义（P = 0.3956）。而在存在残留肿瘤危险因素的患者中，术后辅助TACE可显著延长患者的生存期。两组患者的生存率比较，差异有统计学意义（P = 0.0216）。对照组1、3、5年生存率分别为69.95%、49.86%、37.40%，辅助TACE组分别为89.67%、61.28%、44.36%。Cox比例风险模型显示，在无残留肿瘤危险因素的患者中，肿瘤直径和肝硬化是显著独立的预后因素，而非辅助TACE。然而，在存在残余肿瘤辅助TACE危险因素的患者中，肿瘤直径、AFP水平、血管受侵程度是HCC患者死亡风险降低的显著独立因素。结论术后辅助TACE可延长有残留肿瘤危险因素患者的生存期，但不能延长无残留肿瘤危险因素患者的生存期。
AIM To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor. METHODS From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE. RESULTS In the patients without any risk factors for the residual 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. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 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 diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC. CONCLUSION Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.