To Investigate The Effect Of TACE On Recurrence Free Survival Of Patients With Hepatocellular Carcinoma Based On The Expression Of MVI And Ki-67

Background Radical resection is one of the possible methods to cure hepatocellular carcinoma,but the recurrence rate of five years after operation is as high as 60%-70%,which seriously restricts the survival time and quality of patients with hepatocellular carcinoma.Postoperative prophylactic transcatheter arterial chemoembolization(TACE)is one of the conventional methods to prevent recurrence in patients with hepatocellular carcinoma.However,many studies have shown that the therapeutic effect of TACE is not consistent.Objective In order to evaluate the preventive effect of postoperative TACE on postoperative recurrence of hepatocellular carcinoma,this subject collected the clinical,pathological and prognostic data of patients with hepatocellular carcinoma who underwent radical resection in our hospital,analyzed the effects of microvascular invasion(MVI)and Ki-67 level on TACE treatment,and discussed the effect of TACE on postoperative recurrence of patients with hepatocellular carcinoma,To explore the applicable population of TACE after hepatocellular carcinoma surgery.Methods Retrospective analysis was performed on the clinical,pathological and follow-up data of 400 patients who underwent radical resection of hepatocellular carcinoma in December January 2013,January 2013.The data included general information(age,gender,history of hepatitis B,drinking history),tumor markers,liver function data,and so on.Pathological data(tumor size,number of tumors,liver cirrhosis,satellite nodules,microvascular invasion,Ki-67 level).According to different treatment methods,the patients were divided into simple operation group(TACE treatment was not performed after radical operation)and operation + TACE group(radical operation combined with postoperative preventive TACE treatment),and were followed up.The recurrence of HCC patients within 1 year was analyzed by multivariate analysis to determine the possible risk factors of recurrence.In order to explore the therapeutic significance of TACE for different patients,patients were further divided into four subgroups according to different MVI and Ki-67 levels: group A(low expression of Ki-67 combined with MVI negative group),group B(high expression of Ki-67 combined with MVI negative group),group C(low expression of Ki-67 combined with MVI positive group)and group D(high expression of Ki-67 combined with MVI positive group).The recurrence free survival curve was drawn and analyzed by Kaplan Meier method according to the presence or absence of postoperative TACE treatment in each subgroup.Results All 400 patients were followed up completely,of which 210(52.5%)patients underwent radical resection of simple hepatocellular carcinoma and 190(47.5%)patients underwent radical resection + TACE.Among the 400 patients,there were 324 male patients and 76 female patients;The median age of the patients was 60 years(32-87 years).47.5%(190 / 400)patients were MVI positive,and 47.25%(189 / 400)patients showed high expression of Ki-67(≥ 27.5%).Cox regression analysis showed that MVI and Ki-67 levels were independent predictors of recurrence within 1 year after operation(HR: 2.103,P = 0.001,HR: 2.332,P = 0.000).Meanwhile,liver cirrhosis,the number of lesions and CA125 were also independent risk factors of recurrence within 1 year after operation.The Kaplan Meier method was used to establish the recurrence free survival(RFs)curve.The results showed that there was no significant difference in recurrence free survival within 1 year between patients undergoing radical surgery and TACE treatment.In the subgroup analysis,the low expression of Ki-67 combined with MVI negative subgroup,the recurrence free survival within 1 year in the simple operation group was significantly higher than that in the operation + TACE group(P = 0.004).In the subgroup with high expression of Ki-67 and negative MVI,there was no significant difference in recurrence free survival within 1 year between the simple operation group and the operation + TACE group(P = 0.917).In the subgroup with low expression of Ki-67 and positive MVI,there was no significant difference in recurrence free survival within 1 year between the simple operation group and the operation + TACE group(P = 0.909).In the subgroup of Ki-67 positive combined with MVI positive,TACE treatment can effectively improve the recurrence free survival of patients undergoing radical surgery within 1 year(P = 0.038).Conclusion Prophylactic TACE can effectively reduce the risk of recurrence within one year in patients with high expression of Ki-67(≥ 27.5%)and positive MVI.For postoperative pathology,Ki-67 negative(< 27.5%)combined with MVI negative is postoperative preventive TACE treatment,which may increase the risk of recurrence within 1 year and affect the prognosis of patients.