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肝癌术后行预防性肝动脉化疗栓塞适应证的初步探讨

Exploration of indication of prophylactic transcatheter arterial chemoembolization on postoperative recurrence of hepatocellular carcinoma

摘要:

目的 探讨预防性经皮肝动脉化疗栓塞(TACE)对肝细胞癌(简称肝癌)患者术后复发的影响.方法 回顾性分析2004年1月至2007年6月期间在第二军医大学东方肝胆外科医院行肝切除术的260例肝癌患者的临床资料,男性235例,女性25例,年龄14~79岁,中位年龄50.5岁.其中术后行预防性TACE 104例,未行预防性TACE 156例.结果 全组术后1、2年生存率分别为84.1%、70.5%,1、2年无瘤生存率分别为69.2%、58.4%,TACE组与非TACE组1、2年累积无瘤生存率差异均无统计学意义(P=0.145,P=0.405).肿瘤直径≥10 cm的62例患者中,TACE组与非TACE组1、2年累积无瘤生存率差异均有统计学意义(P=0.025,P=0.025).有血管癌栓的38例患者中,TACE组与非TACE组1年累积无瘤生存率差异有统计学意义(P=0.025),2年累积无瘤生存率差异无统计学意义(P=0.122).结论 对于肿瘤直径≥10 cm、有血管癌栓的肝癌患者,术后行预防性TACE可减少或延缓术后肝内复发.

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abstracts:

Objective To evaluate the efficacy of prophylactic transcatheter arterial chemoembolization(TACE) on postoperative recurrence of hepatocellular carcinoma.Methods A retrospective analysis was performed on clinicopathologic data of 260 hepatocellular carcinoma patients who underwent curative hepatectomy in Eastern Hepatobiliary Surgery Hospital,Second Military Medical University from January 2004 to June 2007.Among the 260 patients,104 underwent postoperative prophylactic TACE and the other 156 were not.Results The overall survival rates at 1- and 2- years were 84.1% and 70.5%respectively.The overall disease-free survival rates at 1- and 2- years were 69.2% and 58.4%respectively.Of 260 overall patients,the disease-free survival rates at 1- and 2- years were 72.8% and 54.9%respectively in TACE group,and 66.9% and 59.7% respectively in non-TACE group,statistically significant difference of the cumulative disease-free survival rates at 1- and 2- years between TACE group and non-TACE group were not observed(P=0.145,P=0.405).Of 62 patients with tumor size ≥10 cm,the disease-free survival rates at 1- and 2- years were respectively 66.6% and 48.7% in TACE group,and respectively 44.6% and 31.2% years between TACE group and non-TACE group were observed(P=0.025,P=0.025).Of 38 patients with vascular tumor thrombi,the disease-free survival rates at 1- and 2- years were respectively 33.0% and 0 in TACE group,and respectively 26.2% and 21.8% in non-TACE group,statistically significant difference of the cumulative disease-free survival rates at 1- years between TACE group and non-TACE group was observed (P=0.025),and not at 2- years (P=0.122).Conclusions In non-TACE group,statistically significant difference of the cumulative disease-free survival rates at 1- and 2- Prophylactic TACE is preferred for hepatocellular carcinoma patients with high risk factors for recurrence such as tumor size ≥10 cm and presented vascular tumor thrombi.

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