CAJ | 학술논문

目的探讨术后肝动脉栓塞化疗(TACE)对肝癌(HCC)合并门脉癌栓手术切除疗效的影响并分析其预后因素.方法 2005年至2009年共358例患者接受了HCC切除术,其中55例合并门脉主干和(或)一级分支癌栓.收集该组病例的临床和随访资料.按术后是否接受TACE治疗分为A组(术后TACE组)和B组(术后非TACE组).统计分析两组可能影响预后的临床资料差异,重点考察术后TACE对手术疗效的影响及其可能影响预后的因素.结果 55例患者中术后接受TACE治疗者29例,未接受26例,二组临床资料比较差异无统计学意义.55例总1、2、3年生存率分别为63.3％、51.4％和43.5％,中位生存时间为26.0个月.其中A组1、2和3年生存率分别为71.4％、60.1％和50.1％,B组为56.7％、21.7％和10.4％ (P＜0.001).术后TACE无论在单因素分析还是在多因素分析中均为显著影响术后生存的因素.此外,肿瘤多发、肝静脉癌栓、肝内转移、浸润型癌栓在单因素分析中是预后差的显著相关因素.多因素分析中,浸润型癌栓、肝静脉癌栓及肝内转移是预后不佳的独立相关因素.结论部分HCC合并门脉一级分支和主干癌栓患者手术切除后可获得较长的术后生存期.术后TACE可显著改善此类患者的预后,其他影响预后的因素有浸润型癌栓、肝静脉癌栓及肝内转移.
목적 탐토술후간동맥전새화료(TACE)대간암(HCC)합병문맥암전수술절제료효적영향병분석기예후인소.방법 2005년지2009년공358례환자접수료HCC절제술,기중55례합병문맥주간화(혹)일급분지암전.수집해조병례적림상화수방자료.안술후시부접수TACE치료분위A조(술후TACE조)화B조(술후비TACE조).통계분석량조가능영향예후적림상자료차이,중점고찰술후TACE대수술료효적영향급기가능영향예후적인소.결과 55례환자중술후접수TACE치료자29례,미접수26례,이조림상자료비교차이무통계학의의.55례총1、2、3년생존솔분별위63.3％、51.4％화43.5％,중위생존시간위26.0개월.기중A조1、2화3년생존솔분별위71.4％、60.1％화50.1％,B조위56.7％、21.7％화10.4％ (P＜0.001).술후TACE무론재단인소분석환시재다인소분석중균위현저영향술후생존적인소.차외,종류다발、간정맥암전、간내전이、침윤형암전재단인소분석중시예후차적현저상관인소.다인소분석중,침윤형암전、간정맥암전급간내전이시예후불가적독립상관인소.결론 부분HCC합병문맥일급분지화주간암전환자수술절제후가획득교장적술후생존기.술후TACE가현저개선차류환자적예후,기타영향예후적인소유침윤형암전、간정맥암전급간내전이.
Objective To study the efficacy of transcatheter arterial chemoembolization (TACE) after liver resection for hepatocellular carcinoma (HCC) with tumor thrombus in the main trunk and/or first branch of portal vein,and to clarify prognostic factors affecting survival.Methods From 2005 to 2009,there were 358 consecutive patients with HCC who underwent surgical resection in our Department.In 55 patients (15 ％),portal vein tumor thrombus (PVTT) was found intraoperatively or postoperatively during histopathological examinations to involve the first portal branch,main portal trunk,or contralateral portal branch.In this retrospective study,these 55 patients were divided into two groups:Group A,29 patients received postoperative TACE,and Group B,26 patients who did not receive TACE.The clinical data and survivals were compared between the two groups.Prognostic factors were indentified using univariate analysis,followed by multivariate regression analysis using the Cox proportional hazards model.Results There were no significant differences in the demographic clinical data between Group A and Group B.The overall 1-,2- and 3-year survivals for the 55 patients were 63.3 ％,51.4 ％ and 43.5 ％,respectively.The accumulative 1-,2- and 3-year survivals for group A were 71.4 ％,60.1 ％ and 50.1 ％,respectively.The corresponding figures for group B were 56.7％,21.7％ and 10.4％,respectively.Multiple tumors,intrahepatic metastases,hepatic vein thrombus,and invasive type of tumor thrombus were found to be risk factors for short-term survival on univariate analysis,while the latter 3 factors were further found to be significant prognostic factors in the Cox proportional hazards model.Postoperative TACE was shown to be a significant factor in both univariate and multivariate analyses.Conclusion Liver resection was beneficial for some patients with portal vein tumor thrombus.Postoperative TACE further improved the prognosis and prolonged survivals in these patients.