Sorafenib And Prophylactic TACE On Liver Cancer Patients With MVI After Radical Hepatectomy

BackgroundChina is a major country of liver cancer,at present,the treatment methods for liver cancer are various,including surgical resection and liver transplantation,interventional therapy(radiofrequency microwave argon helium knife,etc.)and oral biological immunotherapy with molecular targeted drugs,immunotherapy,etc,among which surgical resection is the most important treatment method,however,5 years after the operation,the recurrence rate was as high as 70%,and the long-term prognosis was not good;In recent years,more and more studies have shown that MVI(microvascular invasion)is an independent risk factor closely related to liver cancer recurrence and metastasis,significantly affecting the prognosis of liver cancer,and the diagnosis of MVI depends on the pathological examination after surgery,therefore,how to control the development of MVI after surgery will be beneficial to improve the prognosis of HCC.ObjectiveThe purpose of this study was to investigate the effects of oral sorafenib and prophylactic TACE on the postoperative tumor-free survival rate of liver cancer patients with MVI,in order to provide a basis for the formulation of a reasonable comprehensive treatment plan for liver cancer.MethodTo collect the clinicopathological data of 149 cases of hepatocellular carcinoma patients with MVI confirmed by postoperative pathological results in the first affiliated hospital of zhengzhou university who underwent radical resection between January 1,2015 and January 31,2018.According to the different treatment methods,the patients were divided into the group of simple radical resection,the group of radical resection+ postoperative oral sorafenib,and the group of radical resection+postoperative prophylactic TACE.The general clinicopathological data of the three groups of patients were collected(such as gender,age,hepatitis b infection,serum AFP level,liver function grade,liver cirrhosis,tumor characteristics,ICG-R15,etc.),tumor-free survival time within 3 years after surgery,and recurrence type of the patients;SPSS 22.0 software was used for data analysis and processing to compare the differences among the three groups of data;Kaplan-meier method was used to calculate the 1-year,2-year and 3-year tumor-free survival rate of the three groups,and log-rank test was used to compare the differences in survival curves of each group;Univariate analysis was conducted on the clinicopathological data affecting the postoperative tumor-free survival of liver cancer patients with MVI,and COX proportional risk model was used for multivariate analysis of statistically significant indicators,so as to screen out independent risk factors affecting the postoperative tumor-free survival of liver cancer patients with MVI;The recurrence types of patients in the three groups were compared.ResultsThere was no statistically significant difference in baseline data between the three groups(all P>0.05).The 1?2?3-year tumor-free survival rate of 53 patients with radical resection alone(group A)was 71.7%51.0%37.7%,the 1?2?3-year tumor-free survival rate of 41 cases of radical resection+postoperative oral sorafenib patients(group B)was 87.8%75.6%65.9%,and the 1?2?3-year tumor-free survival rate of 55 patients with radical resection and postoperative prophylactic TACE(group C)was 83.6%74.5%54.5%.Compared with group B and group A,there was a statistically significant difference in the 1?2?3-year tumor-free survival rate(x2=7.596,P=0.006),The tumor-free survival rate was significantly improved in group B.Compared with group A and group C,there was a statistically significant difference in the 1?2?3-year tumor-free survival rate(x2=4.468,P=0.035),The tumor-free survival rate was significantly improved in group C.There was no statistically significant difference between group B and group C in 1,2 and 3-year tumor-free survival(x2=1.107,P=0.313);Single factor analysis showed that age(P=0.034)maximum tumor diameter(P=0.040)postoperative prophylactic TACE(P=0.035)postoperative oral sorafenib(P=0.009)was a risk factor for postoperative recurrence of HCC in patients with MVI;COX multivariate analysis results showed that:age(HR=1.974,1.112,3.502;P=0.020);Maximum tumor diameter(HR=2.095,1.158,3.790;P=0.014)whether prophylactic TACE was performed after surgery(HR=0.534,0.316,0.902;P=0.019);Whether to take sorafenib orally after surgery(HR=0.391,0.208,0.734;P=0.003)was an independent risk factor for postoperative recurrence of HCC in patients with MVI.In terms of recurrence type,among the 33 patients in group A,20 were intrahepatic multiple(60.6%).Among the 14 relapsing patients in group B,9 were intrahepatic single(64.3%).Of the 25 patients with recurrence in group C,15(60.0%)had intrahepatic multiple cases,and in group B,the incidence was mainly intrahepatic single,while in group A and C,the incidence was mainly intrahepatic multiple.Conclusion1.Age,the largest diameter of tumor,postoperative oral administration of sorafenib and postoperative prophylactic TACE were independent risk factors for postoperative recurrence of HCC in patients with MVI.2.For patients with liver cancer who underwent radical surgery and were confirmed by pathological examination to be complicated with MVI,postoperative oral sorafenib or prophylactic TACE could reduce the recurrence rate within 3 years.