术前辅助性肝动脉化疗栓塞对巨块型肝癌预后的影响
|
摘要
目的评价术前辅助性肝动脉化疗栓塞(transcatheter hepatic arterial chemoemb-olization,TACE)对巨块型肝癌预后的影响。方法收集2010年1月～2015年3月收入院手术治疗的31例巨块型肝癌患者,均为经术后病理确诊肝细胞性肝癌的病例,对该患者的资料进行回顾性分析,根据手术前是否行TACE术分组为一期手术组(n=21)与术前辅助性TACE术联合降期手术组(n=10),两组均行巨块型肝癌切除手术,比较两组的总体生存率与无瘤生存率。结果一期手术组和术前辅助性TACE术联合降期手术组1、3年总体生存率分别为70.70%(7/10)、20.00%(1/5)和100.00%(10/10)、71.40%(5/7),平均生存时间分别为(45.429±5.122)个月和(26.399±4.658)个月,两组术后生存率的差异有统计学意义(P=0.041)。两组1年的无瘤生存率分别是26.67%(4/15)和75.00%(6/8),两组术后无瘤生存率有统计学差异(P=0.031)。结论术前辅助性TACE术能使巨块型肝癌的肿块减小,增加手术切除机会,减少明显的肝功能损害,降低手术难度,对术后恢复影响小,对提高巨块型肝癌的术后总生存率及无瘤生存率有帮助。
Objective To evaluate the effect of preoperative assisted transcatheter hepatic arterial chemoembolization(TACE) on the prognosis of massive liver cancer. Methods Thirty-one patients with massive liver cancer who underwent surgical treatment from January 2010 to March 2015 were collected. All of these patients were diagnosed with hepatocellular carcinoma by postoperative pathology. The patients' data were retrospectively analyzed. According to whether TACE was performed before surgery, the patients were divided into one-stage operation group(n=21) and preoperative auxiliary TACE combined with descending-stage operation group(n=10). Massive liver cancer resection was performed in all patients, and the overall survival rate and tumor-free survival rate were compared between the two groups. Results The 1-and 3-year overall survival rates of the two groups were 70.00%(7/10), 20.00%(1/5), and100.00%(10/10), 71.40%(5/7), and the average survival time was(45.429±5.122) months and(26.399±4.658) months.There were statistically significant differences in postoperative survival rates between the two groups( P=0.041). The1-year tumor-free survival rates of the two groups were 26.67%(4/15) and 75.00%(6/8), respectively, and the difference was statistically significant(P=0.031). Conclusion Preoperative assisted TACE can reduce the mass of massive liver cancer, increase the chance of surgical resection, reduce obvious liver function damage, reduce the difficulty of surgery,with little effect on postoperative recovery, and can improve the postoperative total survival rate and tumor-free survival rate in patients with massive liver cancer.
Objective To evaluate the effect of preoperative assisted transcatheter hepatic arterial chemoembolization(TACE) on the prognosis of massive liver cancer. Methods Thirty-one patients with massive liver cancer who underwent surgical treatment from January 2010 to March 2015 were collected. All of these patients were diagnosed with hepatocellular carcinoma by postoperative pathology. The patients' data were retrospectively analyzed. According to whether TACE was performed before surgery, the patients were divided into one-stage operation group(n=21) and preoperative auxiliary TACE combined with descending-stage operation group(n=10). Massive liver cancer resection was performed in all patients, and the overall survival rate and tumor-free survival rate were compared between the two groups. Results The 1-and 3-year overall survival rates of the two groups were 70.00%(7/10), 20.00%(1/5), and100.00%(10/10), 71.40%(5/7), and the average survival time was(45.429±5.122) months and(26.399±4.658) months.There were statistically significant differences in postoperative survival rates between the two groups( P=0.041). The1-year tumor-free survival rates of the two groups were 26.67%(4/15) and 75.00%(6/8), respectively, and the difference was statistically significant(P=0.031). Conclusion Preoperative assisted TACE can reduce the mass of massive liver cancer, increase the chance of surgical resection, reduce obvious liver function damage, reduce the difficulty of surgery,with little effect on postoperative recovery, and can improve the postoperative total survival rate and tumor-free survival rate in patients with massive liver cancer.
引文
[1]吴孟超,沈锋.肝癌[M].北京:北京大学医学出版社,2010:13.
[2]Wang M,Wang Y,Feng X,et al.Contribution of hepatitis B virus and hepa titis C virus to liver cancer in China north areas:Experience of the Chinese national cancer center[J].Int J Infect Dis,2017,65:15-21.
[3]吴孟超,汤钊猷,刘允怡,等.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.
[4]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[5]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[6]吴力群,张斌,郭卫东,等.巨大肝细胞癌患者R0切除术的预后[J].中华肝胆外科杂志,2012,18(8):597-600.
[7]肖恩华,胡国栋,李锦清,等.经导管动脉化疗栓塞治疗肝细胞癌的疗效观察[J].中华肿瘤杂志,2005,27(8):478-482.
[8]Wu CC,Ho YZ,Ho WL,et al.Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma:A reappraisal[J].British Journal of Surgery,1995,82(1):122-126.
[9]陈晓明,罗鹏飞,邵培坚,等.肝癌栓塞化疗后肝脏的形态和功能变化及意义[J].中华医学杂志,1996,76(8):609-610.
[10]Huo YR,Eslick GD.Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma:A systematic review and meta-analysis[J].JAMA Oncol,2015,1(6):756.
[11]Sugo H,Futagawa S,Beppu T,et al.Role of preoperative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma:Relation between postoperative course and the pattern of tumor recurrence[J].World Journal of Surgery,2003,27(12):1295-1299.
[12]吴孟超.肝癌外科治疗的近期进展[J].中国普外基础与临床杂志,2006,13(2):125-128.
[13]Peng SY,Chen WJ,Lai PL,et al.High alfha-fetoprotein level correlates with high stage,early recurrence and poor prognosis of hepatocellular carcinoma:Significance of hepatitis virus infection,age,p53 and beta-cateninmutations[J].Int J Cancer,2004,112(1):44-50.
[14]Yamamoto K,Imamura H,Matsuyama Y,et al.Significance of alpha-fetoprotein and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma undergoing hepatectomy[J].Ann Surg Oncol,2009,16(10):2795-2804.
[15]卢先东,时国兵.肝动脉介入化疗栓塞术后甲胎蛋白的应答对进展期肝癌预后的影响[J].肝脏,2018,23(8):689-692.
[2]Wang M,Wang Y,Feng X,et al.Contribution of hepatitis B virus and hepa titis C virus to liver cancer in China north areas:Experience of the Chinese national cancer center[J].Int J Infect Dis,2017,65:15-21.
[3]吴孟超,汤钊猷,刘允怡,等.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.
[4]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[5]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[6]吴力群,张斌,郭卫东,等.巨大肝细胞癌患者R0切除术的预后[J].中华肝胆外科杂志,2012,18(8):597-600.
[7]肖恩华,胡国栋,李锦清,等.经导管动脉化疗栓塞治疗肝细胞癌的疗效观察[J].中华肿瘤杂志,2005,27(8):478-482.
[8]Wu CC,Ho YZ,Ho WL,et al.Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma:A reappraisal[J].British Journal of Surgery,1995,82(1):122-126.
[9]陈晓明,罗鹏飞,邵培坚,等.肝癌栓塞化疗后肝脏的形态和功能变化及意义[J].中华医学杂志,1996,76(8):609-610.
[10]Huo YR,Eslick GD.Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma:A systematic review and meta-analysis[J].JAMA Oncol,2015,1(6):756.
[11]Sugo H,Futagawa S,Beppu T,et al.Role of preoperative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma:Relation between postoperative course and the pattern of tumor recurrence[J].World Journal of Surgery,2003,27(12):1295-1299.
[12]吴孟超.肝癌外科治疗的近期进展[J].中国普外基础与临床杂志,2006,13(2):125-128.
[13]Peng SY,Chen WJ,Lai PL,et al.High alfha-fetoprotein level correlates with high stage,early recurrence and poor prognosis of hepatocellular carcinoma:Significance of hepatitis virus infection,age,p53 and beta-cateninmutations[J].Int J Cancer,2004,112(1):44-50.
[14]Yamamoto K,Imamura H,Matsuyama Y,et al.Significance of alpha-fetoprotein and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma undergoing hepatectomy[J].Ann Surg Oncol,2009,16(10):2795-2804.
[15]卢先东,时国兵.肝动脉介入化疗栓塞术后甲胎蛋白的应答对进展期肝癌预后的影响[J].肝脏,2018,23(8):689-692.