| Background: The incidence rate of hepatocellular carcinoma(HCC)is high.It is a common malignant tumor worldwide.It has caused serious burden to the development of society and the patients themselves and families.Further strengthening the research on the incidence of liver cancer and improving the level of early diagnosis and treatment are of great significance.Microvascular invasion(MVI)is the main influencing factor of prognosis and recurrence of HCC.In recent years,more and more scholars pay attention to MVI.Based on the new progress of research at home and abroad and the main risk factors of postoperative recurrence of HCC patients,the mode and mechanism of TACE effect.The author believes that prophylactic TACE can effectively reduce the recurrence rate of HCC patients with microvascular invasion.We speculate that the causes are as follows: first,for patients with HCC with microvascular tumor thrombus,surgery can not guarantee that all the microvascular tumor thrombus are removed,so the risk of recurrence in the near future is increased.Secondly,according to the principle of tumor cell proliferation kinetics,because of the reduction of tumor load after tumor resection,the growth of residual cancer cells will be faster,most of the cancer cells will enter the proliferation stage,and these tumor cells are more sensitive to chemotherapy drugs.After the operation,TACE was supplemented timely.The high concentration of chemotherapy drugs(platinum and anthracycline)gathered and used in the microvascular microcarcinoma thrombus,which could more effectively eliminate the cancer cells in the proliferative stage.Moreover,lipiodol might embolize the tumor microvasculature and further lead to tumor necrosis.Objective: To explore the effect of TACE on the recurrence and survival rate of patients with microvascular invasion of HCC after radical resection,and to analyze the influencing factors of postoperative recurrence,in order to provide a basis for making a reasonable comprehensive treatment plan for HCC.Methods: By retrospective analysis,78 cases of HCC with microvascular invasion(confirmed by postoperative pathology)who were treated in hepatobiliary surgery of our hospital from January 2013 to December 2014 were selected as the study objects.All patients underwent radical hepatectomy.According to the treatment methods of the patients,they were divided into observation group(with radical hepatectomy + TACE treatment,n = 42)and control group In the control group(radical resection only,n = 36).The patients were followed up regularly until December 2019.The shortest follow-up period was 21 months and the longest was 87 months.The general data,serological index,pathological index,imaging index,survival and recurrence of the patients were collected.The survival rate and recurrence of the patients in the two groups were compared in one year,two years and five years after operation.The multiple logistic regression analysis model was used to analyze the factors influencing the recurrence and survival rate of the patients.Results: 1.There was no significant difference between the two groups in age distribution,gender,BCLC stage,tumor number,tumor size,microvascular tumor thrombus,child Pugh classification of liver function,alpha fetoprotein,albumin,total bilirubin,glutamic pyruvic transaminase,glutamic oxaloaminase,?-glutamyltranspeptidase and other clinical baseline data(P > 0.05).2.The overall 1,2,5-year survival rates of 78 patients were 76.92%,67.95% and 46.15%,and the cumulative overall recurrence rates were 26.92%,39.74% and 71.79%.The survival rate of the patients in the observation group was significantly higher than that in the control group(88.10% vs 63.89%,78.57% vs 58.33%,all P<0.05),and the recurrence rate of the patients in the observation group was significantly lower than that in the control group(16.67% vs 38.89%,28.57% vs 52.78%,all P<0.05),but there was no significant difference in the survival rate and recurrence rate of the patients in the five years after the operation(54.76% vs 36.11%,71.43% vs 72.22%,P > 0.05).The results showed that the overall survival rate and recurrence free survival rate of HCC patients treated with TACE were significantly higher than those treated with radical resection alone in one and two years,but the overall survival rate and recurrence rate were not improved in five years.3.Single factor analysis showed that tumor size(P < 0.001,RR=4.763,95%CI:2.214-10.244),the presence of microvascular tumor thrombus(P < 0.001,RR = 7.289,95% CI: 3.110-17.081),alpha fetoprotein(P < 0.009,RR = 2.701,95% CI: 1.284-5.678),glutamic oxaloacetylase(P = 0.036,RR = 4.658,95% CI: 1.105-19.635),?-glutamyltransferase(P = 0.010,RR = 6.555,95% CI: 1.553-27.655)were independent risk factors for the survival of patients;Cox proportional risk model showed that the death risk of patients with tumor > 5 cm was 3.084 times higher than that of patients with tumor < 5 cm(95% CI: 1.332-7.136,and the death risk of patients with microvascular tumor thrombus was 3.045 times higher(95% CI: 1.227-7.558).4.Single factor analysis showed that tumor size(P = 0.020,RR = 2.031,95% CI: 1.115-3.696),presence of microvascular tumor thrombus(P = 0.003,RR = 3.215,95% CI: 1.487-6.952)were independent risk factors for relapse free survival;Cox proportional risk model showed that the risk of recurrence in patients with tumor > 5cm was 1.63 times higher than that in patients with tumor ? 5cm(95% CI: 0.845-3.146),The risk of recurrence in patients with tumor thrombus was 2.485 times higher than that in patients without tumor thrombus(95% CI: 1.069-5.777).Conclusions: 1.For HCC patients undergoing radical resection,postoperative TACE could improve the short-term relapse free survival rate and total survival rate,but not the long-term total survival rate and recurrence rate;2.Tumor size and microvascular invasion were independent risk factors for postoperative recurrence and survival of HCC patients. |
PDF Full Text Request