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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (3): 281-288.doi: 10.3969/j.issn.1674-5671.2025.03.04

• 肝脏肿瘤专栏 • 上一篇    下一篇

合并微血管侵犯的中晚期肝细胞癌根治性切除术后经导管动脉化疗栓塞术的疗效分析：一项多中心队列研究

  

  1. 广西医科大学附属肿瘤医院肝胆胰脾外科；贵港市人民医院肝胆胰脾外科；柳州市人民医院肝胆外科；广西医科大学第一附属医院肝胆外科；南宁市第二人民医院肿瘤科
  • 出版日期:2025-06-25 发布日期:2025-07-10
  • 通讯作者: 钟鉴宏， E-mail：zhongjianhong@gxmu.edu.cn； 黎乐群， E-mail：li_lequn@263.net
  • 基金资助:
    国家自然科学基金项目（82260569）；广西重点研发计划项目（桂科AB25069099；桂科AB24010082）；广西高校人体发育与疾病研究重点实验室开放课题（广西医科大学）（RTFY202501）

Efficacy of transcatheter arterial chemoembolization following radical resection in cases of intermediate to advanced hepatocellular carcinoma with microvascular invasion: A multicenter cohort study

  • Online:2025-06-25 Published:2025-07-10

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摘要： 目的评估根治性切除术后经导管动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）对合并微血管侵犯（microvascular invasion，MVI）的中晚期肝细胞癌（hepatocellular carcinoma，HCC）患者的疗效。方法 对2019年1月14日至2024年6月20日期间，在5家医院接受手术并经病理检查确诊为合并MVI的中晚期HCC患者进行回顾性分析，比较接受术后TACE与仅接受积极监测患者之间的无复发生存期（recurrence⁃free survival，RFS）、总生存期（overall survival，OS）和安全性。 结果 最终纳入分析的335例患者中，148例接受术后TACE治疗，187例仅接受积极监测。随访期间，术后TACE组的中位RFS显著优于积极监测组（15.2个月 vs 12.0个月;HR=0.69,95%CI:0.54~0.88,P=0.003）；尽管术后TACE组的中位OS未达到，但相比于积极监测组具有显著改善的趋势（未达到 vs 33.1个月;HR=0.55,95%CI:0.40~0.77,P=0.001）。经倾向评分匹配后，术后TACE组的RFS和OS均显著优于积极监测组(均P<0.05）。肿瘤分期亚组分析显示，中期HCC患者中，两组的RFS和OS相似；但晚期HCC患者中，术后TACE组的RFS和OS较积极监测组显著提高(均P<0.05）。术后TACE相关不良事件主要表现为一过性的肝损害和恶心/呕吐等，未观察到4级或5级不良事件。 结论 根治性切除术后TACE治疗可提高部分合并MVI的中晚期HCC患者，尤其是晚期患者的RFS和OS，但需前瞻性随机对照试验对这些发现作进一步验证。

关键词: 肝细胞癌；根治性切除术, 经导管动脉化疗栓塞术；微血管侵犯

Abstract: Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) for intermediate to advanced hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) after radical resection. Methods A retrospective analysis was conducted on patients with intermediate to advanced HCC, who were postoperatively diagnosed with revealed MVI through pathological examination, across at five hospitals from January 14,2019 to June 20,2024. The study compared recurrence⁃free survival (RFS), overall survival (OS), and safety between patients who received postoperative TACE and underwent active surveillance. Results In a cohort of 335 included patients, 148 received postoperative TACE and 187 underwent active surveillance. During follow⁃up period, the postoperative TACE group demonstrated a significantly longer median RFS compared to the active surveillance group (15.2 months  vs 12.0 months; HR=0.69, 95%CI: 0.54-0.88, P=0.003). Although the median OS was not reached in the postoperative TACE group, there was a trend toward improved OS relative to the active surveillance group (not reached vs 33.1 months; HR=0.55, 95%CI: 0.40-0.77, P=0.001). Following propensity score matching, the postoperative TACE group demonstrated significantly superior RFS and OS compared to the active surveillance group (all P<0.05). Subgroup analysis based on tumor staging revealed comparable outcomes for patients with intermediate stage HCC in both groups, but significantly improved RFS and OS with advanced stage HCC patients in the postoperative TACE group (all P<0.05). Adverse events associated with postoperative TACE were primarily transient liver injury and nausea/vomiting, with no grade 4 or 5 events reported. Conclusions TACE following radical resection could improve the RFS and OS in some patients with intermediate to advanced HCC exhibiting MVI, particularly in those at advanced stages. However, further prospective randomized trials are crucial to validate these findings.

Key words: Hepatocellular carcinoma, Radical resection, Transcatheter arterial chemoembolization, Microvascular invasion

中图分类号: 

  • R735.7