辅助性肝动脉化疗栓塞治疗肝细胞癌微血管浸润的疗效

田波彦; 杨勤玲; 张胶琼; 韩娜; 刘少华

辅助性肝动脉化疗栓塞治疗肝细胞癌微血管浸润的疗效

西安交通大学第一附属医院肝胆外科

基金项目:

基金：陕西省自然科学基金资助项目 (2017JM8019);

计量
- 文章访问数: 2669
- HTML全文浏览量: 973
- PDF下载量: 46
- 被引次数: 0
出版历程
- 收稿日期: 2018-02-21

The Curative Effect of Auxiliary Hepatic Arterial Chemoembolization in the Treatment of Microvascular Invasion of Hepatocellular Carcinoma

Funds:

基金：陕西省自然科学基金资助项目 (2017JM8019);

摘要

摘要: 目的研究辅助性肝动脉化疗栓塞治疗肝细胞癌微血管浸润 (MVI) 后的复发率等, 探讨治疗的有效性与安全性.方法收集2010年1月至2016年12月间在西安交通大学第一附属医院肝胆外科的临床分期早中期肝细胞癌患者590例, 进行肝切除术治疗并进行随访, 采用回顾性分析的方法进行研究.采用单变量和多变量分析方法, 患者均分4组.用Kaplan-Meier方法比较4组术后RFS和OS的发生率, 并采用Log-rank分析方法确定显著差异.结果肝细胞癌患者中, 经TACE和无TACE 2组间性别、乙肝病毒表面抗原、总胆红素、凝血酶原时间、AFP、HBV-DNA、最大肿瘤直径、包膜、手术类型、肝门阻断、Child-Pugh分级等比较, 差异无统计学意义 (P>0.05) ;而年龄、肝硬化结节、肿瘤细胞异型性、BCLC等在无微血管浸润组中比较, 差异有统计学意义 (P<0.05) .脾功能亢进、复发率等在微血管浸润组中比较, 差异有统计学意义 (P<0.05) .单因素与多因素分析, AFP (>400 ng/m L) 、肿瘤直径、包膜完整性、MVI、肝大部分切除等与总体生存率有相关 (P<0.05) , AFP (>400ng/m L) 、Child-Pugh分级B、肿瘤直径、肝细胞癌异型程度、包膜完整性、MVI等与无瘤生存率有相关 (P<0.05) .多个逻辑回归确定血清AFP水平>400 ng/L, 肿瘤大小>5 cm, 和不完整的肿瘤包膜是独立的相关因子 (P<0.05) .在存在微血管浸润的肝细胞癌患者中, 辅助性肝动脉化疗栓塞的总体生存率和无瘤生存率相较于未进行辅助性肝动脉化疗栓塞有明显的改善 (P<0.05) , 而不存在微血管浸润的肝细胞癌患者中无显著影响 (P>0.05) .结论微血管浸润与肝细胞癌复发率和生存率存在一定相关性, 利用辅助性肝动脉化疗栓塞的方法有助于降低复发率延长生存期.
- 肝动脉化疗栓塞 /
- 肝细胞癌 /
- 微血管浸润 /
- 疗效
Abstract: Objective To investigate the recurrence rate, the efficacy and safety of auxiliary hepatic arterial chemoembolization after the treatment of microvascular invasion (MIV) of hepatocellular carcinoma. Methods A total of 104 patients with hepatocellular carcinoma clinical staging of early metaphase were collected from the First Affiliated Hospital of Xi'an Jiaotong University in Jan.2010 to Dec.2016, all treated with liver resection and follow-ups. Adopting the method of retrospective analysis, univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival (RFS) and overall survival (OS) . Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE. Results In HCC patients, the gender HBs Ag, total bilirubin, and prothrombin time, AFP, HBV-DNA, the size of largest tumor, capsule, operation type, hepatic door block, Child-Pugh grade, classification comparison differences had no statistical significance between the two groups of with or without TACE (P>0.05) ; Age, nodules, tumor cell resection, and BCLC were statistically significant in the non-MIV infiltration group (P<0.05) .Hypersplenism and recurrence rate were statistically significant in MIV group (P<0.05) .Univariate and multivariate analyses demonstrated that AFP (> 400 ng/m L) , tumor diameter, membrane integrity, MVI, and most liver resection were significantly associated with overall survival rates (P<0.05) , the AFP (>400 ng/m L) , Child-Pugh, grade B, tumor diameter, hepatocellular carcinoma (HCC) and other abnormal degree, membrane integrity, MVI have significant correlation with disease-free survival rate (P<0.05) . Multiple logistic regression identified serum AFP level > 400 ng/L, tumor size > 5 cm, and incomplete tumor envelope was independent correlation factor (P>0.05) . In the HCC patients with MIV, both OS and DFS were significantly improved in patients who received PA-TACE as compared to those who underwent liver resection alone (P> 0.05) , but no significant effect in HCC patients wieh no MIV invasion (P> 0.05) .Conclusions There is a certain correlation between microvascular infiltration and the recurrence rate and survival rate of hepatocellular carcinoma, and the method of using adjuvant hepatic arterial chemoembolization is helpful to reduce the recurrence rate and prolong the survival period.
- Hepatocellular carcinoma /
- Transcatheter arterial chemoembolization /
- Microvascular invasion /
- Efficacy

HTML全文

参考文献(21)

[1]	[1] MCGUIRE S.World Cancer Report 2014.Geneva, Switzerland:World Health Organization, International Agency for Research on Cancer, WHO Press, 2015[J].Adv Nutr, 2016, 7 (2) :418-419.
[2]王宁, 陈腾祥, 刘振华, 等.Calpain-1及Calpain-2在不同迁移能力肝癌细胞系中的表达[J].贵州医科大学学报, 2016, 58 (06) :649-652.
[3]	[3]ELSEGOOD C L, TIRNITZ-PARKER J E, OLYNYK J K, et al.Immune checkpoint inhibition:prospects for prevention and therapy of hepatocellular carcinoma[J].Clin Transl Immunology, 2017, 6 (11) :e161.
[4]龙云铸, 李丹, 谭英征, 等.恩替卡韦联合水飞蓟宾葡甲胺片在乙肝相关性肝癌术后治疗的临床研究[J].新疆医科大学学报, 2017, 40 (01) :35-37.
[5]王晶晶, 刘伟华, 李丹, 等.砷剂治疗消化系统恶性肿瘤的临床进展[J].国外医学 (医学地理分册) , 2016, 37 (01) :40-43.
[6]	[6]YE J Z, CHEN J Z, LI Z H, et al.Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion[J].World J Gastroenterol, 2017, 23 (41) :7415-7424.
[7]	[7]HUO T I, LIU P H, HSU C Y.Detecting microvascular invasion in HCC with contrast-enhanced MRI:Is it a good idea[J].J Hepatol, 2017, 6 (34) :398-401.
[8]	[8]IMURA S, TERAOKU H, YOSHIKAWA M, et al.Potential predictive factors for microvascular invasion in hepatocellular carcinoma classified within the Milan criteria[J].Int J Clin Oncol, 2017, 97 (55) :56-64.
[9]	[9]ZHENG J, SEIER K, GONEN M, et al.Utility of Serum Inflammatory Markers for Predicting Microvascular Invasion and Survival for Patients with Hepatocellular Carcinoma[J].Ann Surg Oncol, 2017, 24 (12) :3706-3714.
[10]戴峰, 朱西琪.索拉非尼在中晚期肝细胞肝癌治疗中的临床价值[J].东南大学学报 (医学版) , 2016, 37 (01) :106-108.
[11]陈洁, 黎乐群.术前预测肝细胞癌并微血管侵犯的研究进展[J].中国普通外科杂志, 2017, 26 (07) :921-925.
[12]段婷, 黄子星, 宋彬.磁共振评价肝细胞癌微血管侵犯的研究进展[J].中国普外基础与临床杂志, 2017, 1 (07) :880-884.
[13]陈炜.经动脉免疫化疗栓塞对肝癌患者免疫功能及血清肿瘤标志物水平的影响[J].新乡医学院学报, 2016, 33 (04) :315-317.
[14]	[14]POTE N, CAUCHY F, ALBUQUERQUE M, et al.Contribution of virtual biopsy to the screening of microvascular invasion in hepatocellular carcinoma:A pilot study[J].Liver Int, 2017, 20 (1) :215-217.
[15]张杰, 段伯焕, 朱功兵.肝细胞癌患者外科手术根治术后生存分析[J].实用肝脏病杂志, 2017, 20 (01) :93-96.
[16]赵盛, 苏刚, 杨文柯, 等.不同临床分期肝细胞肝癌的蛋白质组学研究进展[J].兰州大学学报 (医学版) , 2016, 42 (1) :66-71.
[17]	[17]DAI K, HUANG Y, CHEN Z, et al.Kbtbd2 inhibits the cytotoxic activity of immortalized NK cells through down-regulating m TOR signaling in a mouse hepatocellular carcinoma model[J].Eur J Immunol, 2018, 4 (56) :932-937.
[18]	[18]LI S, LI X, XU A, et al.Screening and clinical evaluation of dominant peptides of centromere protein F antigen for early diagnosis of hepatocellular carcinoma[J].Mol Med Rep, 2018, 17 (3) :14-19.
[19]	[19]XING M, KOKABI N, CAMACHO J C, et al.Prospective longitudinal quality of life and survival outcomes in patients with advanced infiltrative hepatocellular carcinoma and portal vein thrombosis treated with Yttrium-90 radioembolization[J].BMC Cancer, 2018, 18 (1) :75.
[20]	[20]HUBER A R, GONZALEZ R S, ORLOFF M S, et al.Accuracy of vascular invasion reporting in hepatocellular carcinoma before and after implementation of subspecialty surgical pathology sign-out[J].Indian J Pathol Microbiol, 2017, 60 (4) :501-504.
[21]	[21]YUAN G, ZENG CL, ZHU DD, et al.Influences of RFA combined with TACE on the HIF-1alpha and EGR level of patients with primary hepatic carcinoma[J].Eur Rev Med Pharmacol Sci, 2017, 21 (8) :1738-1745.

相关文章(20)

[1]	陆小华, 袁洪新. BTLA、CTLA-4基因多态性与肝癌TACE联合靶向治疗疗效及预后相关性, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230927
[2]	陈怡璇, 王琳, 夏秀宏, 彭在坤, 丁奕, 史润娇, 雷学芬. 自噬在肝细胞癌中的作用机制研究进展, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230416
[3]	张明, 于成龙, 曹锦鹏. ZNF384调控GCLM对肝细胞癌转移的机制研究, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20231108
[4]	段茜婷, 王关顺, 丁荣, 王娜, 寸红丽, 杨泠. CT影像组学在肝细胞癌联合治疗后短期疗效的应用, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220818
[5]	张天红, 杨红菊. 外泌体miRNA在肝细胞癌中的研究进展, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220221
[6]	王燕, 丁荣, 张吕玲, 王若花, 赵晓玲, 马娜. 输血治疗联合放化疗在结直肠癌患者中的疗效及对肿瘤标志物和T淋巴细胞水平的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220809
[7]	付海艳, 闫俊芳, 李红娟, 王霖, 张洁, 周宇君, 徐斌, 罗煜. 时间间隔对肝动脉化疗栓塞术序贯微波消融治疗肝细胞癌的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221127
[8]	曹凡, 刘阳文, 魏雷, 谢楠, 杨裔坚, 钱程, 李春满, 付必莽, 胥江品, 阎容稷, 曾汪. 乙型肝炎病毒与肝细胞癌微血管侵犯的相关性, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210331
[9]	杨金江, 李留江, 沈仕俊, 李兆祥, 杨镛, 李国剑. 利伐沙班用于股腘动脉粥样硬化闭塞支架植入术后的临床观察, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20201122
[10]	谭骅, 仁虹, 赵玲, 游顶云, 杨亚琛. 行TACE治疗后原发性肝细胞癌患者预后的影响因素, 昆明医科大学学报.
[11]	雷喜锋, 侯峰强, 刘韬, 张伟. FOXP2抑制人肝细胞癌增殖及其机制, 昆明医科大学学报.
[12]	雷喜锋, 侯峰强, 杨少华, 张伟. miR-373在人肝细胞癌中的表达及其作用, 昆明医科大学学报.
[13]	高靖琰, 陈富坤, 鄢佳文, 王家平. 肝动脉化疗栓塞联合调强放疗治疗原发性肝癌的临床疗效, 昆明医科大学学报.
[14]	邱建武. P38MAPK特异性抑制剂SB203580对肝癌细胞增殖的影响, 昆明医科大学学报.
[15]	尚学琴. 高剂量表柔比星TEC方案新辅助化疗三阴乳腺癌的近期疗效及耐受性, 昆明医科大学学报.
[16]	任宏轩. 培美曲塞治疗45例复治晚期非小细胞肺癌的临床观察, 昆明医科大学学报.
[17]	杨文举. 角膜缘干细胞移植术治疗翼状胬肉临床疗效观察, 昆明医科大学学报.
[18]	李恒. 非小细胞肺癌XRCC1Arg399Gln基因分析与顺铂疗效的关系, 昆明医科大学学报.
[19]	朱丽仙. 双侧髂内动脉栓塞术和结扎术对产后大出血的临床疗效比较, 昆明医科大学学报.
[20]	张兰凤. 易瑞沙治疗晚期非小细胞肺癌的临床观察, 昆明医科大学学报.