辅助性肝动脉灌注化疗对接受手术治疗的选择性肝细胞癌患者有益。

Adjuvant hepatic arterial infusion chemotherapy is beneficial for selective patients with Hepatocellular carcinoma undergoing surgical treatment.

机构信息

Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan.

Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan.

出版信息

Int J Surg. 2017 Sep;45:35-41. doi: 10.1016/j.ijsu.2017.07.071. Epub 2017 Jul 17.

DOI:10.1016/j.ijsu.2017.07.071

PMID:28728985

Abstract

BACKGROUND

Recurrence rate after curative surgical resection of Hepatocellular carcinoma (HCC) remains high. Postoperative hepatic arterial infusion chemotherapy (HAIC) has been suggested to improve survival. This study is to investigate the efficacy of HAIC in the patients with poor tumor factors such as vascular invasion or multiplicity.

METHODS

From 2006 to 2014, 221 patients with HCC undergoing hepatectomy and pathologically staged as ≧ T2 (American Joint Committee on Cancer TNM staging system, 7th edition) were included. 61 patients received adjuvant HAIC with 5-fluorouracil, cisplatin, and epirubicin. 160 patients received surgery alone. The overall survival time (OST) and disease free survival time (DFST) were compared between the two groups.

RESULTS

In all patients, the multivariate analysis of survival data showed that resection margin less than 10 mm was the independent poor prognostic factors. The median OST and DFST between the HAIC and surgery alone groups were 56.4 vs. 56.9 months (p = 0.76), and 50.6 vs. 54.5 months (p = 0.905), respectively. There was no significant difference. For patients with multiple tumors and concomitantly microvascular invasion, the OST was better in the HAIC group (69.7 vs. 54.6 months, p < 0.05). Based on the image and operative finding, we classified multiple HCC's into two types. Type A: multiple small nodules were close to each other or a huge tumor with several satellite nodules. Type B: two or more tumors scattering in separate segments. Our study showed that type A group benefits from adjuvant HAIC much more than type B. (the median OST in type A versus type B were 85.06 vs. 41.53 months, p = 0.0036).

CONCLUSION

The surgical outcome for the patients with multiple HCC's and vascular invasion was poor. Our study showed adjuvant HAIC was beneficial in these patients and formed the basis for further randomized controlled trials.

摘要

背景

根治性肝切除术后肝癌（HCC）的复发率仍然很高。术后肝动脉灌注化疗（HAIC）已被证明可以提高生存率。本研究旨在探讨 HAIC 对血管侵犯或多发性等肿瘤因素不良的患者的疗效。

方法

2006 年至 2014 年，共纳入 221 例接受肝切除术且病理分期≧T2（美国癌症联合委员会 TNM 分期系统，第 7 版）的 HCC 患者。61 例患者接受 5-氟尿嘧啶、顺铂和表柔比星辅助 HAIC。160 例患者仅接受手术治疗。比较两组患者的总生存时间（OS）和无病生存时间（DFS）。

结果

在所有患者中，生存数据分析的多因素分析显示，切缘<10mm 是独立的不良预后因素。HAIC 组与手术组中位 OST 和 DFST 分别为 56.4 个月比 56.9 个月（p=0.76）和 50.6 个月比 54.5 个月（p=0.905），差异无统计学意义。对于多发性肿瘤伴微血管侵犯的患者，HAIC 组的 OST 更好（69.7 个月比 54.6 个月，p<0.05）。根据影像学和手术发现，我们将多发性 HCC 分为两种类型。A 型：多个小结节彼此靠近或巨大肿瘤伴多个卫星结节。B 型：两个或多个肿瘤散在不同的节段。我们的研究表明，A 型组从辅助 HAIC 中获益更多，而 B 型组则不然。（A 型组中位 OST 与 B 型组分别为 85.06 个月比 41.53 个月，p=0.0036）。