肝细胞癌根治性切除术后复发患者不同局部治疗方法疗效比较

doi:10.3877/cma.j.issn.2095-3232.2018.04.012

目的

探讨肝细胞癌（肝癌）根治性切除术后复发的几种局部治疗方法的疗效。

方法

回顾性分析2012年6月至2013年6月在华中科技大学同济医学院附属同济医院行肝癌根治性切除术后复发的78例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男72例，女6例；年龄25～73岁，中位年龄52岁；共185个复发病灶。根据术后首发病灶的直径（D）将患者分为2组：D<3 cm组（55例）、D≥3 cm组（23例）；同时，D<3 cm的病灶按治疗方法分为3组：微波（MWA）组（97个）、MWA+TACE组（21个）、TACE组（35个）。采用Kaplan-Meier生存曲线和Log-rank检验进行生存分析，率的比较采用χ²检验。

结果

D<3 cm组总体生存明显优于D≥3 cm组（χ²=12.65，P<0.05）；其中D<3 cm组2、3年生存率及显效率分别为98.11%、80.00%、78.18%，D≥3 cm相应为73.91%、47.82%、39.13%，差异有统计学意义（χ²=11.69，8.07，11.13；P<0.05）。MWA组、TACE组1、2、3年疗效维持率分别为63.91%、48.45%、22.68%和17.14%、14.29%、5.71%；有效率及显效率分别为98.97%、93.81%和85.71%、62.86%。MWA组的1、2年疗效维持率明显优于TACE组（χ²=22.53，10.49；P<0.05/3）；MWA组有效率及显效率明显优于TACE组（χ²=10.41，20.00；P<0.05/3）。

结论

肝癌根治性切除术后复发患者的预后与复发病灶的直径密切相关。病灶直径<3 cm患者预后明显好于直径≥3 cm患者。直径<3 cm时，局部治疗可首先考虑MWA治疗。

关键词: 癌，肝细胞, 肝切除术, 导管消融术, 化学栓塞，治疗性

Objective

To compare the efficacy of several local therapies for patients with hepatocellular carcinoma (HCC) recurrence after radical resection.

Methods

Clinical data of 78 patients with HCC recurrence after radical resection in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2012 to June 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 72 males and 6 females, with an age of 25-73 years, median age of 52 years and 185 recurrent lesions. The patients were divided into 2 groups according to the diameter (D) of focal lesion first relapsed after operation: group D<3 cm (n=55) and group D≥3 cm (n=23). Meanwhile, lesion D<3 cm were divided into 3 subgroups according to different treatments: group microwave (MWA, 97 lesions), group MWA+TACE (21 lesions) and group TACE (35 lesions). Survival analysis was performed using Kaplan-Meier survival curve and Log-rank test, and rates were compared using Chi-square test.

Results

The total survival of group D<3 cm was significantly better than that of group D≥3 cm (χ²=12.65, P<0.05). The 2- and 3-year survival and marked improvement rate of group D<3 cm were 98.11%, 80.00% and 78.18%, respectively, and those of group D≥3 cm were 73.91%, 47.82% and 39.13%, respectively, where significant differences were observed (χ²=11.69, 8.07, 11.13; P<0.05). The 1-, 2- and 3-year efficacy maintenance rate of group MWA was 63.91%, 48.45% and 22.68%, respectively, and those of group TACE was 17.14%, 14.29% and 5.71%, respectively. Their efficacy and marked improvement rate were 98.97%, 93.81% and 85.71% and 62.86%, respectively. The 1- and 2-years efficacy maintenance rate of group MWA were significantly better than those of group TACE (χ²=22.53, 10.49; P<0.05/3). The efficacy and marked improvement rate of group MWA were significantly better than those of group TACE (χ²=10.41, 20.00; P<0.05/3).

Conclusions

The prognosis of patients with HCC recurrence after radical resection is closely related to the diameter of recurrent lesion. The prognosis of patients with a lesion diameter <3 cm is better than that of patients with a lesion diameter≥3 cm. For patients with lesion diameter <3 cm, MWA can be first considered as a local treatment.

Key words: Carcinoma, hepatocellular, Hepatectomy, Catheter ablation, Chemoembolization, therapeutic

图1 肝癌复发局部治疗后影像学检查图

表1 D< 3 cm组与D≥3 cm组肝癌患者一般资料比较（例）

参数		D<3 cm组	D≥3 cm组	统计值	P值
性别		?	?	χ²=0.05	>0.05
?	男	51	21	?	?
?	女	4	2	?	?
年龄（岁）		51±11	50±10	t=0.40	>0.05
乙型病毒性肝炎（例）		53	22	χ²=0.02	>0.05
Child-Pugh分级		?	?	χ²=0.02	>0.05
?	A	53	22	?	?
?	B	2	1	?	?
?	C	0	0	?	?
AFP≥200 μg/L		16	8	χ²=0.25	>0.05
首次复发灶（个）		?	?	χ²=0.98	>0.05
?	单发	46	17	?	?
?	多发	9	6	?	?

表1 D< 3 cm组与D≥3 cm组肝癌患者一般资料比较（例）

参数		D<3 cm组	D≥3 cm组	统计值	P值
性别		?	?	χ²=0.05	>0.05
?	男	51	21	?	?
?	女	4	2	?	?
年龄（岁）		51±11	50±10	t=0.40	>0.05
乙型病毒性肝炎（例）		53	22	χ²=0.02	>0.05
Child-Pugh分级		?	?	χ²=0.02	>0.05
?	A	53	22	?	?
?	B	2	1	?	?
?	C	0	0	?	?
AFP≥200 μg/L		16	8	χ²=0.25	>0.05
首次复发灶（个）		?	?	χ²=0.98	>0.05
?	单发	46	17	?	?
?	多发	9	6	?	?

图2 D<3 cm组与D≥3 cm组肝癌患者Kaplan-Meier生存曲线

表2 MWA组、MWA+TACE组和TACE组肝癌患者疗效及预后比较（%）

组别	病灶数	有效率	显效率	疗效维持率
组别	病灶数	有效率	显效率	1年	2年	3年
MWA组	97	98.97	93.81	63.91	48.25	22.68
MWA+TACE组	21	100.00	95.24	76.19	38.09	19.04
TACE组	35	85.71	62.86	17.14	14.29	5.71
P值^a	?	>0.05/3	>0.05/3	>0.05/3	>0.05/3	>0.05/3
P值^b	?	<0.05/3	<0.05/3	<0.05/3	<0.05/3	>0.05/3
P值^c	?	>0.05/3	<0.05/3	<0.05/3	>0.05/3	>0.05/3

表2 MWA组、MWA+TACE组和TACE组肝癌患者疗效及预后比较（%）

组别	病灶数	有效率	显效率	疗效维持率
组别	病灶数	有效率	显效率	1年	2年	3年
MWA组	97	98.97	93.81	63.91	48.25	22.68
MWA+TACE组	21	100.00	95.24	76.19	38.09	19.04
TACE组	35	85.71	62.86	17.14	14.29	5.71
P值^a	?	>0.05/3	>0.05/3	>0.05/3	>0.05/3	>0.05/3
P值^b	?	<0.05/3	<0.05/3	<0.05/3	<0.05/3	>0.05/3
P值^c	?	>0.05/3	<0.05/3	<0.05/3	>0.05/3	>0.05/3

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选择文件类型/文献管理软件名称

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Comparison of efficacy of different local therapies for patients with hepatocellular carcinoma recurrence after radical resection

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选择文件类型/文献管理软件名称

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Comparison of efficacy of different local therapies for patients with hepatocellular carcinoma recurrence after radical resection