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目的探讨不能切除肝细胞癌(HCC)经皮穿刺肝动脉化疗栓塞(TACE)缩小后切除的疗效及影响预后的因素。方法 12例二期切除 HCC 病人 TACE 前因肿瘤巨大或肿瘤虽不大但紧贴肝门或下腔静脉的大血管,无法达到根治性切除而行 TACE 治疗。共行 TACE 1～7次(平均2.4±1.2次)。肿瘤缩小后予以切除。选择7个可能对 HCC 二期切除后预后产生影响的临床因素通过单因素、多因素 Cox 模型进行分析。结果随访至2000年12月,TACE 后1,3,5,7年生存率分别为94.1%,64.7%,51.2%和40.8%;肿瘤切除后1,3,5,7年生存率分别为88.0%,59.6%,49.0%和37.1%。肝硬化程度、缩小后肿瘤有无包膜及肿瘤坏死程度是影响预后的主要因素(P<0.05)。结论不能切除的 HCC 经 TACE 缩小后应行二期切除,并可获得满意疗效。而肝硬化程度及肿瘤坏死程度是影响肝癌二期切除预后的主要因素。
Objective To investigate the effect of percutaneous transcatheter hepatic arterial chemoembolization (TACE) for reducing resection of hepatocellular carcinoma (HCC) and its prognostic factors. Methods TACE was performed in 12 patients with HCC who had undergone radical resection before TACE due to large tumors or small tumors but close to the large vessels of the hilar or inferior vena cava. Total TACE 1 to 7 times (average 2.4±1.2 times). After the tumor shrinks, it is removed. The selection of seven clinical factors that may have a prognostic impact on HCC secondary excision was analyzed by a single-factor, multi-factor Cox model. Results After follow-up to December 2000, the 1-, 3-, 5-, and 7-year survival rates after TACE were 94.1%, 64.7%, 51.2%, and 40.8%, respectively; the 1, 3, 5, and 7-year survival rates after tumor resection were 88.0. %, 59.6%, 49.0% and 37.1%. The degree of liver cirrhosis, shrinkage of the tumor, and the extent of tumor necrosis were the main factors affecting the prognosis (P<0.05). Conclusion Two-stage resection should be performed after the unresectable HCC is reduced by TACE, and satisfactory curative effect can be obtained. The degree of cirrhosis and the degree of tumor necrosis are the main factors affecting the prognosis of the second stage resection of liver cancer.