| 摘要: |
| 目的 通过随机对照试验(RCT)探讨经肝动脉化疗栓塞(transchatheter arterial chemoembolization,TACE)对小肝细胞癌(small hepatocellular carcinoma,SHCC)术后复发的影响。方法 2008年9月至2009年12月接受根治性肝切除术后1个月的符合条件SHCC患者117例,随机分为两组: A组(治疗组或TACE组，59例)接受辅助性TACE治疗,B组(对照组，58例)不做任何辅助性治疗,此后定期随访并统计分析患者术后2年的无瘤生存时间及复发率。结果 中位随访时间为29个月。共有33例患者复发,1年内复发22例,全部复发发生在2年内。A组平均无瘤生存(DFS)时间为5～29(28.93±1.40)个月,B组为3～35(26.94±1.62)个月,P=0.443。A、B两组半年、1年及2年复发率分别为: 10.2% vs 13.8%,20.3% vs 20.7%,20.7% vs 31.3%(P=0.443)。单因素分析提示HBV DNA、输血、肿瘤大小(3 cm为界)及Edmondson-Steiner分级与术后早期复发相关(P<0.05)。COX多因素回归分析P<0.2的危险因素，提示HBV DNA、输血及肿瘤大小是肿瘤术后早期复发的独立危险因素。结论 对于SHCC这类复发风险相对较低的肝癌,辅助性TACE并不能减少术后早期复发,不宜作为常规预防复发的治疗方法 。其能否影响SHCC患者远期复发及总生存情况,需进一步随访证实。 |
| 关键词: 肝肿瘤 肝细胞癌 肝切除术 治疗性化学栓塞 肿瘤复发 无病生存 |
| DOI：10.3724/SP.J.1008.2012.00274 |
| 投稿时间：2012-01-11修订日期：2012-02-13 |
| 基金项目: |
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| Is postoperative adjuvant transchatheter arterial chemoembolization necessary for small hepatocellular carcinoma patients: a randomized controlled trial |
| XU Feng△,HUANG Yang-qing△,LI Ye-sheng,WU Lu,YANG Jia-mei* |
(Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To evaluate whether adjuvant transchatheter arterial chemoembolization (TACE) can reduce early recurrence of small hepatocellular carcinoma (SHCC) patients after surgical treatment using randomized controlled trial. Methods A total of 117 patients, who underwent radical hepatectomy from Sept. 2008 to Dec. 2009, were randomly divided into 2 groups. Fifty-nine patients (group A or TACE group) received adjuvant TACE one month after hepatectomy, and 58 (group B or control group) did not receive any adjuvant therapies. Follow-up was done regularly. The disease-free survival (DFS) time and recurrence rate within the following two years were analyzed. Results The median follow-up duration was 29 months in our study. Twenty-two recurrences happened within one year and all recurrences happened within two years. The mean DFS periods were (28.93±1.40) months (range: 5-29 months) and (26.94±1.62) months (range: 3-35 months) (P=0.443) in group A and B, respectively. The half-year, 1-year and 2-year recurrence rates of group A vs group B were 10.2% vs 13.8%, 20.3% vs 20.7%, 25.7% vs 31.2% (P=0.443), respectively. Univariate analysis showed that infection of HBV DNA, blood transfusion, Edmondson-Steiner grade and tumor diameter (3 cm as cut-off point) were correlated with tumor recurrence (P<0.05). Multivariate COX regression analysis indicated that HBV DNA, blood transfusion, and tumor diameter (3 cm as cut-off point) were independent factors of early recurrence. Conclusion Adjuvant TACE can not reduce early recurrence of SHCC with a low risk of recurrence, so it is not recommended as a routine therapy to prevent early tumor recurrence. Further study is needed to verify whether TACE can benefit the long-term recurrence and overall survival of patients. |
| Key words: liver neoplasms hepatocellular carcinoma hepatectomy therapeutic chemoembolization neoplasm recurrence disease-free survival |
