| Objective: To compare the difference in efficacy between primary hepatic carcinoma postoperative adjuvant TACE and surgery alone,and to provide a theoretical basis for the selection of multidisciplinary treatment methods for primary hepatic carcinoma.Methods: A retrospective analysis of patients with surgical treatment,clinical data and pathological findings were confirmed as hepatocellular carcinoma from January 2010 to December 2017 in Affiliated Hospital of Zunyi Medical University.Follow-up by telephone,clinic,review etc.The deadline for follow-up was December 2018,at which time,there were 106 eligible cases.According to the treatment,the surgery alone cohort(control cohort)and the postoperative adjuvant TACE cohort(study cohort)were compared.The survival rates,overall survival and disease-free survival were compared at1,2,3,and 5 years after the hepatectomy.The statistical analyses of the data were performed using SPSS 18 for Windows.Kaplan-Meier method for survival analysis and single factor analysis,and COX regression model analysis for multivariate analysis.Results:1.There was no statistical difference in the general clinical data between the study group and the control cohort.The 1-,2-,3-,and 5-year survival rates were 85.8%,73.6%,51.9%,26.2% and the median survival time was 38 months in all patients.The 1-,2-,3-,and 5-year survival rates were 83.3%,69.8%,44.1% and 20.4% in control cohort,respectively,and the study cohort was 91.2%,81.8%,67.3% and 37.2%.There was no significant difference in the 1st and 2nd year survival rate between two groups(P>0.05).The difference in survival rate between the two groups at the 3rd and 5th years was statistically significant(P<0.05).The median survival time was 32 months in the controlcohort,which was significantly different from the overall survival and median survival time in the study cohort(49 months)(P=0.025).It is indicated that postoperative adjuvant TACE can improve the long-term survival rate and overall survival of patients.2.The 1-,2-,3-,and 5-year disease-free survival rates were 75.0%,50.0%,39.8%,and 17.7% and the median tumor-free survival time was 23 months in all patients.The 1-,2-,3-,and 5-year survival rates were 71.5%,40.9%,32.5% and 13.7% in control cohort,respectively,and the study cohort was 82.4%,67.3%,53.5% and 24.8%.There was no significant difference in the 1st year survival rate between two groups(P > 0.05).The difference in disease-free survival rate between the two groups at the 2nd?3rd and 5th years was statistically significant(P<0.05).The median disease-free survival time was 20 months in the control cohort,which was significantly different from the overall survival and median survival time in the study cohort(36 months)(P=0.016).3.Multivariate analysis showed that the maximum diameter of the tumor was an independent risk factor for the prognosis of patients with primary hepatic carcinoma(OR=1.010,P=0.022).Postoperative adjuvant TACE was a protective factor affecting the prognosis of patients(OR=0.517,P=0.018).TACE treatment after hepatectomy was a protective factor affecting postoperative tumor-free survival(OR=0.513,P=0.009),tumor size(OR=1.011,P=0.008),and Child-Pugh classification of liver function(OR=2.485,P=0.029)is an independent risk factor affecting the tumor-free survival rate of HCC.Conclusion: The results of this study suggest that active combined with TACE after hepatectomy can prolong the overall survival time,disease-free survival time,and improve long-term survival rate. |
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