Comparison Of Therapeutic Effects And Prognostic Factors Between TACE And Surgical Resection In The Treatment Of Primary Large Hepatocellular Carcinoma And Giant Hepatocellular Carcinoma

Objective:To compare the efficacy of TACE and surgical resection in the treatment of primary large hepatocellular carcinoma and giant hepatocellular carcinoma,and to analyze the prognostic factors of the patients,so as to provide some suggestions for clinical treatment.Methods:The clinical data of 100 patients with large liver cancer or giant liver cancer who were hospitalized in the Department of General surgery or Department of Infectious Diseases,affiliated Provincial Hospital of Shandong University from June 2013 to December 2016 were collected by telephone follow-up and consulting clinical data.All the patients were treated with TACE or surgical resection.Fifty patients treated with TACE were classified into TACE group.The other fifty patients who received surgical resection were defined as operation group.All data analyses were performed with SPSS 21.0 statistical software.Kaplan-Meier method was used for univariate analysis and Cox regression was used for multivariate analysis.Log-rank test was used to compare the median survival time of different influencing factors.X2 and t-test were used to depict clinical data distribution between the two groups.P value<0.05 was considered to have significantly statistical differenceResults:In our retrospective analysis,all the 100 patients with large liver cancer or giant liver cancer,whether they received TACE treatment or surgical resection,their liver function were grade A and B(Child-Pugh grades),and most of them were grade A,which indicated that we strictly grasped the indications and contraindications in the treatment of related patients.It is directly related to the high postoperative survival rate of the patients.The overall 6-month,12-month and 24-month survival rates of 100 patients were 96%,70%,43%,respectively,and the overall median survival time was 18 months.The median survival time of patients in TACE group was 26 months,which was longer than that of 18 months in operation group.This difference was related to the fact that TACE treatment could be performed many times.Patients with longer postoperative survival time always received TACE treatments many times(often more than 6 times).However,due to the small sample size,P value is 0.397,there is no statistical difference.We analyzed the risk factors affecting the prognosis of the two groups separately.Log-Rank method was performed to test the difference of median survival time between male and female patients,HBsAg positive and negative patients,patients with different liver function grades,patients with different number of tumors and patients with or without portal vein tumor thrombus in TACE group and operation group.The median survival time of patients with different liver function grades,patients with different number of tumors and patients with or without portal vein tumor thrombus were significantly different(P<0.05),which indicated that they were risk factors affecting prognosis of large hepatocellular carcinoma and giant hepatocellular carcinoma.Cox regression analysis showed that portal vein tumor thrombus had the greatest influence on the prognosis of large and giant hepatocellular carcinoma compared with the other three factors.At the same time,it was found that the treatment time and the amount of intraoperative blood loss of TACE group was much less than that of operation group.Because of superselective embolization of tumor feeding artery,the incidence of postoperative liver failure was lower,and there was no wound infection,pleural effusion and bile leakage after operation.Because of the use of chemotherapeutic drugs,patients had more gastrointestinal reactions and high fever symptoms after operation.The patients of operation group underwent tumorectomy,which means longer operation time and larger amount of intraoperative bleeding,and some patients had postoperative liver failure,pleural and peritoneal effusion,bile leakage and knife edge infection.2.Blood tests were performed two and five days after TACE or operation.The results were showed as mean±standard.TACE group:(the second day)glutamic pyruvic transaminase(ALT):97.12±46.08 U/L,glutamic oxaloacetic transaminase(AST):107.06±67.47 U/L;(the fifth day)glutamic pyruvic transaminase(ALT):56.58±26.73 U/L;Glutamic oxaloacetic transaminase(AST):64.64±46.73 U/L.Operation group:(the second day)glutamic pyruvic transaminase(ALT):433.36±64.15 U/L,glutamic oxaloacetic transaminase(AST):346.04±87.90 U/L;(the fifth day)glutamic pyruvic transaminase(ALT):130.94±95.03 U/L,glutamic oxaloacetic transaminase(AST):78.96±96.73 U/L.There were significant differences in ALT(D2),AST(D2)and ALT(D5)between the two groups,indicating that the liver function of patients in TACE group had less damage and recovered more quickly after operationConclusions:Patients underwent TACE has longer median survival time than patients with surgical resection for large liver cancer and giant liver cancer with portal vein tumor thrombus,intrahepatic metastasis,liver function Child-Pugh A grade.TACE treatment has the advantages of less trauma,faster recovery,less liver function injury and less complications.On the premise of being in line with the treatment indications,TACE has advantages in the treatment of large liver cancer and giant liver cancer patients with intrahepatic metastasis.