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中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (06) : 441 -446. doi: 10.3877/cma.j.issn.1674-0793.2013.06.006

所属专题: 文献

论著

术前介入对合并门脉侵犯肝癌术后生存影响的前瞻性研究
张永法1, 郭荣平1, 邹如海2, 韦玮1, 欧阳晗月1, 石明1,()   
  1. 1. 510060 广州,华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心肝胆科
    2. 510060 广州,华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心超声科
  • 收稿日期:2013-09-03 出版日期:2013-12-01
  • 通信作者: 石明
  • 基金资助:
    国家自然科学基金项目(81272639); 广东省科技计划项目(2010B031600221); 高校基本科研基金项目(09ykpy53); 中山大学5010计划项目(2007043)

Effect of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: A prospective non-random study

Yong-fa ZHANG1, Rong-ping GUO1, Ru-hai ZOU2, Wei WEI1, Han-yue OUYANG1, Ming SHI1,()   

  1. 1. Department of Hepatobiliary Oncology, Collaborative Innovation Center for Cancer Medicine, Cancer Center of Sun Yat-sen University, Guangzhou 510060, China
  • Received:2013-09-03 Published:2013-12-01
  • Corresponding author: Ming SHI
  • About author:
    Corresponding author: SHI Ming, Email:
引用本文:

张永法, 郭荣平, 邹如海, 韦玮, 欧阳晗月, 石明. 术前介入对合并门脉侵犯肝癌术后生存影响的前瞻性研究[J/OL]. 中华普通外科学文献(电子版), 2013, 07(06): 441-446.

Yong-fa ZHANG, Rong-ping GUO, Ru-hai ZOU, Wei WEI, Han-yue OUYANG, Ming SHI. Effect of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: A prospective non-random study[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(06): 441-446.

目的

前瞻性对合并门脉侵犯可切除肝癌患者术前行肝动脉栓塞化疗(TACE),研究探讨该方法的有效性及安全性。

方法

术前影像学及多学科诊断为可切除肝癌合并门脉侵犯患者219例,按初始治疗分为一期手术切除的手术组(132例)和TACE组(87例),TACE组患者先行TACE治疗后再行手术切除。分层分析两组间的生存差异。

结果

手术组和TACE组1、3、5年生存率和中位生存时间分别为52.4%、19.1%、13.1%、13.87个月和57.1%、27.2%、21.1%、16.13个月(P=0.037)。亚组分析中,段叶级癌栓手术组和TACE组1、3、5年生存率分别为61.0%、32.1%、20.1%和92.9%、55.7%、47.8%(P=0.012)。主分支癌栓中两组生存率差异无统计学意义(P=0.272)。两组术后死亡率及并发症发生率差异无统计学意义。

结论

伴有门脉侵犯可切除肝癌术前行肝动脉栓塞化疗安全有效,尤其可以显著延长伴有段叶级侵犯肝癌患者的生存。

Objective

To explore the efficacy and safety of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein invasion.

Methods

Two hundred and nineteen patients, diagnosed as rescetable HCC and portal vein tumor thrombus (PVTT) via preoperative imaging and multidisciplinary consultation, were prospectively enrolled and allocated into two groups. In the immediate resection group (132 cases), patients received immediate surgical resection. In the preoperative TACE group (87 cases), patients underwent TACE before surgical resection. Stratal analysis was carried out of the survival difference between the two groups.

Results

The 1-, 3-, 5-year overall survival rates and the median survival time were 52.4%, 19.1%, 13.1%, and 13.87 months for the immediate resection group; 57.1%, 27.2%, 21.1%, and 16.13 months for the preoperative TACE group (P=0.037). On the strata analysis of segmental PVTT group, the overall survival rates of the immediate resection group and preoperative TACE group were 61.0% and 92.9% at 1-year, 32.1% and 55.7% at 3-year, 20.1% and 47.8% at 5-year, respectively (P=0.012). However, comparing the 1-, 3-, 5-year overall survival rates between the two groups respectively, no significant difference was found of major PVTT group (P=0.272). No significant difference was found between the 2 groups in postoperative complications and hospital mortality.

Conclusion

The preoperative TACE is a safe and effective procedure for patients diagnosed as HCC with portal vein tumor thrombi, and will not increase the incidence of complications, especially for resectable HCC with segmental PVTT.

表1 219例伴有门脉侵犯可切除肝癌患者临床基本资料(例)
表2 手术组与TACE-手术组术中及术后情况比较
表3 手术组与TACE组治疗相关并发症(≥3级)的比较(例)
图1 Group A组(手术组)与Group B组(TACE组)生存曲线比较(P=0.037)
图2 亚组分析,段叶级癌栓Group A1组(手术组)和Group A2组(TACE组)生存曲线比较(P=0.012),A1组和A2组的1、3、5年生存率和中位生存期分别为61.0%、32.1%、20.1%、19.5个月和92.9%、55.7%、47.8%、46.07个月
图3 亚组分析,主分支癌栓Group B1组(手术组)和Group B2组(TACE组)生存时间差异无统计学意义(P=0.272),B1组和B2组的1、3、5年生存率和中位生存期分别为46.8%、9.3%、9.3%、11.03个月和40.5%、14.9%、10.3%、11.37个月
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