| Research BackgroundA recent survey showed that the incidence of hepatic carcinoma (PHC) has reached to the sixth position among all malignant tumors and 0.74 million people are diagnosed with PHC whose fatality rate is the third highest among cancer related mortalities. The histological type of PHC is as follows:hepatocellular carcinoma(HCC), cholangiocarcinoma and mixed cellular carcinoma, and above 90% is HCC. The main therapies of HCC include:complete resection of the tumor (hepatic resection, HR)、transcatheter hepatic arterial chemoembolization (TACE)、percutaneous ethanol injection (PEI)、radiofrequency ablation (RFA)、 liver transplantation and biological therapy. Among these methods, HR is the most common curative one now. But some recent study held that the one-year and the three-year recurrence rate is up to 35 percent and 70 percent respective. What’s more, most of the occurrence is in the first post-operation year. So, it is pivotal to look for effective measures to prevent the post-operative recurrence. And TACE is considered as the most effective assistant therapy at present.Research ObjectiveThe objective of his research is to analyze the influence factors for TACE after resection of HCC in order to guide clinical therapy and estimate prognosis through follow-up visit to 109 relative patients.Meterials and MethodsThe clinical and follow-up data of 109 consecutive patients who underwent TACE two to four weeks after complete tumor resection for HCC (verified by postoperative pathological examination) between January 2011 and December 2012 in the first hepatobilliary surgery department of Shandong University affiliated Shandong Provincial Qianfoshan Hospital were analyzed retrospectively. The expiration date is December 2015. During the period of follow-up visit, the parameters reflecting liver function and the concentration of alpha fetoprotein (AFP) of these patients were examined every month and abdominal type-B ultrasonic graphy, chest radiography, computed tomography (CT), and positron-emission tomography/Computerized tomography (PET-CT) in necessity were taken every two months, to detect the post-operational condition and tumor recurrence. The statistical and analytical factors include:age, sex, with or without hepatitis, with or without vascular tumor emboli, tumor differentiation degree, size of the tumor diameter, the integrity of the envelope, concentration of AFP in plasma, TNM staging, numbers of lesion, whether or not to penetrate liver capsule and with or without satellite node. Analyze influence of these factors on disease free survival. Using spss17.0 software analyzes the data. The Kaplan-meier method is used to evaluate the disease free survival. Log-rank test and Cox regression model are performed to analyze clinical pathological risk factors by univariate and multivariate analysis respectively. P value ≤0.05 is considered as statistical significance.ResultsNo tumor residue or recurrence was detected before TACE in all patients, which was verified by TACE examination later. During follow-up visit, there are 5 patients losing follow-up and 4 ones dying of non-tumorous disease, leading only 100 patients finishing the follow-up visit. Among these,80 patients suffered from tumor recurrence and the recurrence rate is 73.39%. There are 36 patients (1 year after operation),15 patients (2 years after operation) and 14 patients (3 years after operation) suffering from recurrence respectively while 29 patients didn’t suffer from recurrence, then the corresponding disease free survival (DFS) rate is 66.97%, 53.21% and 40.37% respectively.45 patients (56.25%) suffered from intra-hepatic recurrence,10 patients (10%) extra-hepatic and 25 patients (31.25%) intra- and extra-hepatic. And 26 patients (74.29%) suffered from lung metastasis,4 patients (11.43%) bone metastasis,2 patients (5.71%) brain metastasis and 3 patients (8.57%) abdominal omentum metastasis.Univariate analysis shows that sex, TNM staging, size of the tumor diameter, with or without vascular tumor emboli, the integrity of the envelope, tumor differentiation degree and whether or not to penetrate liver capsule have significant influence on the disease-free survival (P<0.05); age, concentration of AFP in plasma, numbers of lesion, with or without satellite node and with or without hepatitis have no significant influence on the disease-free survival (P>0.05).Multivariate analysis showed that size of the tumor diameter (>5cm) has significant influence on the disease-free survival (P<0.05), which is the independent risk factor predicting the DFS/ConclusionSize of the tumor diameter (>5cm) has a bad influence on tumor recurrence and DFS of HCC patients undertaking HR and post-operational assistant TACE. What’s more, sex, TNM staging, size of the tumor diameter, with or without vascular tumor emboli, the integrity of the envelope, tumor differentiation degree and whether or not to penetrate liver capsule have significant influence on the tumor recurrence and prognosis... |
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