摘要
目的探讨早期肝细胞癌(HCC)复发患者重复肝切除/消融后辅助经导管肝动脉化疗栓塞(TACE)的近期疗效及远期预后。方法回顾性分析2020年1月至2023年5月在吉林省肿瘤医院因早期肿瘤复发(术后2年内)接受重复根治性肝切除或消融的178例HCC患者。根据是否接受辅助TACE治疗,将复发性HCC患者分为TACE组(重复肝切除或消融后辅助TACE,n=89)和对照组(重复肝切除或消融后密切监测,n=89)。记录患者的不良反应,随访无复发生存(RFS)。结果全组患者中位随访时间为23.0(4.0~60.0)个月,累积再复发率为71.91%(128/178),死亡75例。至随访截止,TACE组和对照组无复发生存分别为29例和21例,TACE组中位RFS时间长于对照组(28个月vs.16个月),但是差异无统计学意义(Log-rankχ^(2)=2.897,P=0.084)。最常见的TACE相关不良反应是发热(40例,44.94%)。其他不良事件包括肝酶升高、腹痛、胆红素升高、恶心/呕吐、白细胞减少症。不良反应均为3级以下,无TACE相关死亡。经多因素Cox回归分析结果显示,射频消融(RFA)、肝内多中心复发灶、Child-Pugh分级、肝硬化和微血管侵袭是影响RFS的显著预测因素(P<0.05)。基于RFA、肝内多中心复发灶、Child-Pugh分级和微血管侵袭4项指标相应的Cox回归系数计算生存风险评分。根据生存风险评分截断阈值(-0.29)分层:高危组和低危组各89例。在高危组中,辅助TACE患者中位RFS时间较未辅助TACE组更长(17.0个月vs.13.0个月,HR=5.367,95%CI:2.036~11.759,P=0.021)。结论早期复发性HCC患者重复根治性治疗后辅助TACE与整体队列的RFS无显著关联,但是对于具有复发高危因素的特定亚群可能是有益处的,包括接受二线RFA、肝内多中心复发灶、Child-Pugh分级B级和微血管侵袭的患者。
Objective To explore the short-term efficacy and long-term prognosis of transcatheter arterial chemoembolization(TACE)after repeated hepatectomy/ablation in patients with recurrent early hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on 178 HCC patients who underwent repeated radical hepatectomy or ablation due to early tumor recurrence(within 2 years after surgery)at Jilin Provincial Cancer Hospital from January 2020 to May 2023.According to whether they received adjuvant TACE treatment,patients with recurrent HCC were divided into the TACE group(adjuvant TACE after repeated liver resection or ablation,n=89)and the control group(close monitoring after repeated liver resection or ablation,n=89).Record the adverse reactions of the patients and follow up on recurrence-free survival(RFS).Results The median follow-up time for all patients in the group was 23.0(4.0-60.0)months,the cumulative recurrence rate was 71.91%(128/178),and 75 cases died.By the end of the follow-up,the recurrence-free survival in the TACE group and the control group was 29 cases and 21 cases,respectively.The median RFS time in the TACE group was longer than that in the control group(28 months vs.16 months),but the difference was not statistically significant(Log-rankχ^(2)=2.897,P=0.084).The most common adverse reaction related to TACE was fever(40 cases,44.94%).Other adverse events include elevated liver enzymes,abdominal pain,elevated bilirubin,nausea/vomiting,and leukopenia.All adverse reactions were grade 3 or below,and there were no deaths related to TACE.The results of multivariate Cox regression analysis showed that radiofrequency ablation(RFA),multicenter recurrent lesions in the liver,Child-Pugh classification,liver cirrhosis and microvascular invasion were significant predictive factors affecting RFS(P<0.05).The survival risk score was calculated based on the Cox regression coefficients corresponding to the four indicators of RFA,multicenter recurrent lesions in the liver,Child-Pugh classification and microvascular invasion.Stratification was based on the cut-off threshold of survival risk score(−0.29):89 cases in the high-risk group and 89 cases in the low-risk group.In the high-risk group,compared with the control group,the median RFS time of patients in the TACE group was longer(17.0 months vs.13.0 months,Log-rankχ^(2)=5.367,P=0.021).Conclusion Adjuvant TACE after repeated radical therapy in patients with early recurrent HCC has no significant association with RFS in the overall cohort.However,it may be beneficial for specific subgroups with high-risk factors for recurrence,including patients receiving second-line RFA,those with multicenter intrahepatic recurrence foci,Child-Pugh grade B,and those with microvascular invasion.
作者
王储
刘东辉
金刚
孟繁增
翟进京
张东旭
于士龙
WANG Chu;LIU Donghui;JIN Gang;MENG Fanzeng;ZHAI Jinjing;ZHANG Dongxu;YU Shilong(Interventional Department,Jilin Provincial Cancer Hospital,Changchun 130000,China)
出处
《临床肿瘤学杂志》
2025年第12期1185-1191,共7页
Chinese Clinical Oncology
关键词
肝细胞癌
复发
经导管肝动脉化疗栓塞
临床疗效
预后
hepatocellular carcinoma
recurrence
transcatheter arterial chemoembolization
clinical efficacy
prognosis
