TACE联合肝切除术对BCLC B期肝癌患者疗效及安全性的影响

Influence of TACE combined with hepatectomy on clinical efficacy and safety of patients with BCLC-B stage hepatocellular carcinoma

摘要:

目的 探讨肝动脉化疗栓塞（TACE）联合肝切除术对巴塞罗那临床肝癌（BCLC）分期B期肝癌患者疗效及安全性的影响。方法 选取河南省平顶山市第五人民医院普外科和云南省楚雄州人民医院肝胆外一科2012年1月至2020年5月收治BCLC B期肝癌患者92例，均行TACE联合肝切除术治疗，比较手术前后肝功能血清学指标和凝血酶原时间（PT），记录总生存时间和无进展时间，同时分析基线肝功能、术前TACE次数、末次TACE后甲胎蛋白（AFP）下降及mRECIST评价结果对无进展生存时间的影响。结果 入选患者术后l周谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素（TBil）及PT水平均高于基线、术前（P<0.05）；术后l周和1个月白蛋白（Alb）水平均低于基线（P<0.05）；术前AFP下降患者中位无进展生存时间长于AFP未见显著改变患者（P<0.05）；术前CR+PR患者中位无进展生存时间长于SD+PD患者（P<0.05）。结论 TACE联合肝切除术治疗BCLC B期肝癌安全有效；其中末次TACE后AFP下降和术前mRECIST评价达CR+PR患者中位无进展生存时间更长。

关键词:肝癌;经动脉灌注化疗栓塞（TACE）;肝切除术;巴塞罗那临床肝癌（BCLC）分期;疗效;安全性

Abstract:

Objective To investigate the influence of TACE combined with hepatectomy on clinical efficacy and safety of patients with BCLC-B stage hepatocellular carcinoma.Methods Ninety-two patients with BCLC stage B liver cancer admitted to the Department of General Surgery of the Fifth People's Hospital of Pingdingshan in Henan Province from January 2012 to May 2020 were treated with TACE combined with hepatectomy. The serum indexes of liver function and prothrombin time (PT) before and after operation were compared, and the overall survival time and progression free time were recorded. The effects of baseline liver function, preoperative TACE times, AFP decline after the last TACE and mRECIST evaluation results on progression free survival time were analyzed.Results The levels of AST, ALT, TBil and PT in 1 week after operation of all patients were significantly higher than base line and before treatment (P<0.05). The levels of Alb in 1 week and 1 month after treatment of all patients were significantly lower than base line (P<0.05). The PFS of patients with AFP decrease before operation were significantly longer than patients without AFP decrease (P<0.05). The PFS of patients with CR+PR before operation were significantly longer than patients with SD+PD (P<0.05).Conclusion TACE combined with hepatectomy in the treatment of patients with BCLC-B stage hepatocellular carcinoma possess the good clinical effects and safety, and the patients with decreased AFP after the last TACE and CR+PR before operation evaluated by mRECIST have longer median progression-free survival time.

Key words:liver cancer;TACE;hepatectomy;BCLC staging;clinical efficacy;safety