CAJ | 학술논문

目的观察辅助性肝动脉化疗栓塞(TACE)对肝细胞癌根治术后近期(<2年)复发的作用.方法回顾性收集自2000年11月至2007年12月间2591例接受根治性手术切除的肝细胞癌患者的资料.根据术后是否行辅助性TACE分为干预组和对照组;再根据肿瘤直径、数目以及有无镜下癌栓将入选病例分为肿瘤直径≤5 cm的残癌低危、高危组以及肿瘤直径>5 cm的残癌低危、高危组.其中残癌低危定义为肿瘤单个且无镜下癌栓;残癌高危为肿瘤数目2～3个和(或)有镜下癌栓.分析辅助性TACE对近期复发的影响.结果对照组与干预组比较,术后3个月内的复发率在肿瘤直径≤5 cm的残癌低危组和高危组分别为1.34%比4.14%(P=0.002)和3.17%比8.15%(P=0.011),肿瘤直径>5 cm的残癌低危组和高危组分别为5.33%比12.88%(P=0.002)和8.43%比14.29%(P=0.045);6个月内的复发率在肿瘤直径≤5 cm的残癌低危组和高危组分别为4.63%比6.71%(P=0.133)和8.73%比13.48%(P=0.070),肿瘤直径>5 cm的残癌低危组和高危组分别为11.50%比21.02%(P=0.052)和19.64%比23.94%(P=0.070).那些6个月内未发生复发的患者,其术后9、12、18、24个月内的复发率在各亚组的对照组与干预组间均无明显差异.结论术后辅助性TACE治疗本身并不能预防近期复发,但其操作过程有助于早期发现术后残癌和复发灶.
목적 관찰보조성간동맥화료전새(TACE)대간세포암근치술후근기(<2년)복발적작용.방법 회고성수집자2000년11월지2007년12월간2591례접수근치성수술절제적간세포암환자적자료.근거술후시부행보조성TACE분위간예조화대조조;재근거종류직경、수목이급유무경하암전장입선병례분위종류직경≤5 cm적잔암저위、고위조이급종류직경>5 cm적잔암저위、고위조.기중잔암저위정의위종류단개차무경하암전;잔암고위위종류수목2～3개화(혹)유경하암전.분석보조성TACE대근기복발적영향.결과 대조조여간예조비교,술후3개월내적복발솔재종류직경≤5 cm적잔암저위조화고위조분별위1.34%비4.14%(P=0.002)화3.17%비8.15%(P=0.011),종류직경>5 cm적잔암저위조화고위조분별위5.33%비12.88%(P=0.002)화8.43%비14.29%(P=0.045);6개월내적복발솔재종류직경≤5 cm적잔암저위조화고위조분별위4.63%비6.71%(P=0.133)화8.73%비13.48%(P=0.070),종류직경>5 cm적잔암저위조화고위조분별위11.50%비21.02%(P=0.052)화19.64%비23.94%(P=0.070).나사6개월내미발생복발적환자,기술후9、12、18、24개월내적복발솔재각아조적대조조여간예조간균무명현차이.결론 술후보조성TACE치료본신병불능예방근기복발,단기조작과정유조우조기발현술후잔암화복발조.
Objective To explore the effect of postoperative adjuvant transarterial chemoembolization (TACE) upon early recurrence of hepatocellular carcinoma (HCC) patients after radical resection. Methods Between November 2000 and December 2007, 2591 HCC patients undergoing radical resection were retrospectively recruited. Patients undergoing resection alone were selected as control group while those receiving post-operative adjuvant TACE as intervention group. The patients were further stratified into tumor ≤5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor. A low risk factor for residual tumor was defined as single tumor and without microscopic tumor thrombus while a high risk factor for residual tumor was defined as 2 -3 nodules or with the presence of microscopic tumor thrombus. The effect of adjuvant TACE upon early (≤ 2 years) recurrence was evaluated. Results Recurrent rates of tumor ≤ 5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor at Month 3 post-resection were 1.34%, 3. 17%, 5.33% and 8.43% in the control group versus 4. 14% (P =0. 002), 8. 15% (P= 0. 011), 12. 88% (P = 0. 002) and 14. 29% (P = 0. 045) respectively in the intervention group; recurrence rates at Month 6 post-resection were 4. 63%, 8. 73%, 11.50% and 19.46% in the control group versus 6. 71% (P =0. 133), 13.48% (P =0. 070), 21.02% (P =0. 052) and 23.94% (P =0. 210) respectively in the intervention group. For patients remaining recurrence free within the first 6 months post-resection, there were no significant differences in recurrence rates at Months 9, 12, 18 and 24 post-operation between each intervention group and control group. Conclusion Postoperative adjuvant TACE has no preventive effect upon early recurrence, but may be of benefit to detect residual tumor and early recurrence.