| Background:Primary hepatocellular carcinoma is a common malignant tumor in human.It was the fourth most common malignant tumor in our country,and the third in the list of deaths from malignant tumors,which seriously threatens the life and health of the people.Primary hepatocellular carcinoma is insidious.In the early stage of the disease,there is no obvious clinical symptoms and signs.When fever,pain in the liver area,the whole body and the gastrointestinal symptoms appear,the disease has developed to middle and late stage,the radical resection rate is low and the prognosis is poor.The treatment of liver cancer includes surgical resection,liver transplantation,ablation,intervention,immunization,and gene therapy.Among them,radical resection is the most effective method of choice.Massive hepatocellular carcinoma with large size,mostly with satellite foci,low resection rate,high postoperative recurrence rate and poor overall prognosis.It is reported that after radical resection,the 5 year survival rate is only 12.2%~29.3%.Therefore,how to improve the surgical resection rate and reduce the postoperative recurrence rate is an important issue to improve the prognosis of the massive hepatocelluar carcinoma.Trancatheter Arterial Chemoembolization means after the right femoral artery puncture,through the injection of contrast agents to check the size of the tumor and blood supply,and nourish the tumor intravascular injection of embolic agents and chemotherapy drugs,make the tumor blood supply artery occlusion,leading to tumor tissue ischemia,necrosis,narrow,It is recognized as an important treatment method for non-resectable massive hepatocellular carcinoma.But for resectable large hepatocellular carcinoma,whether adjuvant TACE can improve the survival time and prognosis of patients,the views of scholars at home and abroad have not yet been unified.Microvascular invasion refers to the pathological examination of the tumor cell nests lined by endothelial cells under microscope.It is a manifestation of tumor invasion and development.It is recognized as an important factor affecting the recurrence and prognosis of the tumor after hepatectomy.Objective:A retrospective analysis was conducted to follow up the clinical data of massive hepatocellular carcinoma patients,the effect of transcatheter arterial chemoembolization on the survival rate before and after hepatectomy,and to further explore the effect of hepatic arterial chemoembolization combined with surgical resection on the prognosis of massive hepatocellular carcinoma patients.Methods:A total of 89 patients with massive hepatocellular carcinoma confirmed by pathology from March 2013 to October 2017 in the Department of general surgery of the Second Affiliated Hospital of Guangzhou Medical University.The patients were collected and divided into preoperative adjuvant TACE treatment group,simple operation group and postoperative adjuvant TACE treatment group,the Clinical data,tumor and liver function changes,intraoperative conditions,microvascular invasion,and survival time were recorded,Kaplan-Meier method and Log-Rank test were used to evaluate the effect of adjuvant TACE therapy on prognosis in different periods.Results:1.In the adjuvant TACE treatment group,11 cases had significantly reduced of tumor volume,accounting for 35.48%(11/31),and 3 cases of tumor volume increased significantly,accounting for 9.68%(11/31)after TACE.Besides,the tumor necrosis rate was 87.10%(27/31)in the preoperative adjuvant TACE treatment group after TACE treatment.Among them,total necrosis accounted for 6.45%(2/31),most necrosis accounted for 41.94%(13/31),and partial necrosis accounted for 38.71%(12/31).In the simple operation group,the tumor necrosis rate was 28.57%(8/28),the majority necrosis was 7.14%(2/28),some necrosis accounted for 21.43%(6/28),and there was no case of complete necrosis of tumor.There was a significant difference in the degree of tumor necrosis between the two groups(P < 0.05).2.Before and after TACE treatment,there was no statistically significant difference in liver function(ALT,ALB,PT,TBIL)in the treatment group before and after TACE treatment(P>0.05).There was no significant difference in liver function(ALT,ALB,PT,TBIL)between the two groups after first,third,seventh days of tumor resection(P>0.05).In addition,according to the intraoperative condition,22 cases of adhesion between tumor and surrounding tissue in preoperative adjuvant TACE treatment group accounted for 70.97%,There were 9 cases of adhesion between tumor and surrounding tissues in 32.14% cases of simple operation group,accounting for 32.14%.There was a significant difference between the two groups(P=0.004).The mean operation time in the adjuvant TACE treatment group was(187.3 + 57.4)min,and the average operation time in the simple operation group was(153.1 + 63.7)min,and there was significant difference between the two groups(P=0.032).There was no significant difference in occlusion time of the hepatic portal and the average amount of bleeding between the two groups(P>0.05).3.The 1,2 and 3 year survival rates of preoperative adjuvant TACE treatment group were 62.2%,50% and 33.3%,respectively.The survival rate of simple operation group was 1,2 and 3 years 67%,44.2%,and 44.2% respectively.There was no significant difference in the survival rate between the two groups(?2=0.164,P=0.686),the median survival time of the two groups was 24 months(95%CI:6.95~41.05 months)and 22 months(95%CI:14.84~29.17 months).In addition,the tumor free survival time of the two groups was 14 months(95%CI:6.72~21.3 months)and 16 months(95%CI:8.45~23.51 months)respectively,and there was no significant difference in the tumor free survival time between the two groups(?2=0.679,P=0.410).4.The 1,2 and 3 year survival rates of postoperative adjuvant TACE group were 79.5%,65.1% and 48.2%,while the 1,2 and 3 year survival rates in the simple operation group were 67%,44.2% and 33.7% respectively.The median survival time of the two groups was 36 months(95%CI:24.63~47.37 months)and 22 months(95%CI:14.84~29.17 months),there was a significant difference in the survival rate between the two groups(?2=4.167,P=0.041).According to the presence of microvascular invasion and postoperative adjuvant TACE treatment,the two groups were divided into MVI with postoperative adjuvant TACE treatment group(n=16),MVI without postoperative adjuvant TACE treatment group(n=13),none MVI with postoperative adjuvant TACE treatment group(n=14),none MVI without postoperative adjuvant TACE treatment group(n=15),The results suggest: The 1,2,and 3 year survival rates of MVI with postoperative adjuvant TACE treatment group and MVI without postoperative adjuvant TACE treatment group were 81.2%,61.4%,46% and 59.8%,29.9%,10%,respectively.The survival rates between the two groups were statistically significant difference(?2=6.663,P=0.010),and the median survival time of the two groups was 35 months(95%CI:19.15~50.85 months)and 17 months(95%CI:3.91~30.09 months).The 1,2,and 3 year survival rates were 77.4%,69.6%,50.8% and 71.7%,56.6%,33.9% in the none MVI with postoperative adjuvant TACE treatment group and the none MVI and without postoperative adjuvant TACE treatment group.There was no significant difference in the survival rate between the two groups(?2=0.427,P=0.514),and the median survival time of the two groups was 38 months(95%CI:17.45~58.55 months)and 38 months(95%CI:25.06~50.91 months)respectively.Conclusion:1.For resectable massive hepatocellular carcinoma,preoperative adjuvant TACE therapy can increase the risk of tumor shrinkage and necrosis.But at the same time,the tissue adhesion increased and the operation time prolonged,and the overall survival rate and tumor free survival time could not be improved.2.For massive hepatocellular carcinoma patients with microvascular invasion,postoperative adjuvant TACE is an effective means to improve their survival rate and prevent tumor recurrence..For patients without microvascular invasion,postoperative adjuvant TACE can not improve their survival and prognosis. |
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