Abstract:
Objective:To investigate the effect of microvascular invasion (MVI) on tumor recurrence of hepatocellular carcinoma (HCC) patients after hepatectomy, the efficacy of sequential transcatheter arterial chemoembolization (TACE) on positive MVI patients after hepatectomy, and the effect of comprehensive treatment on the prognosis of patients with tumor recurrence.
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 136 HCC patients who underwent hepatectomy in the First Affiliated Hospital of Air Force Medical University from February 2015 to December 2016 were collected. Patients were treated with TACE, radiofrequency ablation (RFA) and molecular-targeted drugs after hepatectomy, and patients with tumor recurrence selected 1 or 2 above treatments. The patient received postoperatively outpatient reexaminations every 3 months to detect tumor recurrence and survival. Follow-up was from the day of the surgery to death or December 2017. Observation indicators: (1) treatment after hepatectomy; (2) effect of MVI on tumor recurrence of HCC patients after hepatectomy: clinicopathological features and tumor recurrence rate between positive and negative MVI patients; (3) efficacy of TACE on positive MVI patients: clinicopathological features and tumor recurrence rate in positive MVI patients with or without TACE; (4) effect of comprehensive treatment on the prognosis of patients with tumor recurrence. Measurement data with normal distribution were represented as ±s and analyzed using the independent-samples t test. Comparisons of count data were analyzed using chi-square test or Fisher exact probalility. The tumor recurrence rate and survival rate were calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis.
Results:(1) Treatment after hepatectomy: of 136 patients undergoing hepatectomy, 117 underwent single hepatectomy and 19 combined sequential TACE; 59 had HCC recurrence, including 22 receiving comprehensive treatment. (2) Effect of MVI on tumor recurrence of HCC patients after hepatectomy: ① Clinicopathological features: of 117 patients undergoing single hepatectomy, positive MVI was detected in 49 patients, including 44 males and 5 females, with an age of (52±10)years old; 49 patients were in Child-Pugh grade A, including 36 combined with liver cirrhosis and 13 without liver cirrhosis; positive and negative alpha-fetoproteins (AFPs) were respectively detected in 34 and 15 patients. Negative MVI was detected in 68 patients, including 54 males and 14 females, with an age of (55±11)years old; 65 and 3 patients were respectively in Child-Pugh grade A and B, including 52 combined with liver cirrhosis and 16 without liver cirrhosis; positive and negative AFPs were respectively detected in 39 and 29 patients. There was no statistically significant difference in gender, age, Child-Pugh score of liver function, liver cirrhosis and comparison of AFP between positive and negative MVI patients (x
2=2.258, t=-1.626, x
2=0.804, 0.138, 1.758, P>0.05). ② Tumor recurrence rate: The 6-month and 1-year tumor recurrence rates after hepatectomy were respectively 30.77%, 30.61% in 117 patients undergoing single hepatectomy and 42.86%, 51.02% in 49 of 117 patients with positive MVI and 22.06%, 27.94% in 68 of 117 patients with negative MVI, showing statistically significant differences in 6-month and 1-year tumor recurrence rates between positive and negative MVI patients (x
2=5.738, 6.465, P<0.05). (3) Efficacy of TACE on positive MVI patients: ① Clinicopathological features of 56 patients with positive MVI, 7 received postoperatively sequential TACE, including 7 males, with an age of (50±4)years old; 56 patients were in Child-Pugh grade A, including 5 combined with liver cirrhosis and 2 without liver cirrhosis; positive and negative AFPs were respectively detected in 2 and 5 patients. Forty-nine patients didn′t combine sequential TACE, including 44 males and 5 females, with an age of (52±10)years old; 49 patients were in Child-Pugh grade A, including 36 combined with liver cirrhosis and 13 without liver cirrhosis; positive and negative AFPs were respectively detected in 34 and 15 patients. There was no statistically significant difference in gender, age, Child-Pugh score of liver function, liver cirrhosis and comparison of AFP between patients with and without sequential TACE (x
2=0.784, t=-0.512, x
2=0.013, 2.844, P>0.05). ② Tumor recurrence: the 6-month and 1-year tumor recurrence rates after hepatectomy were respectively 0, 28.57% in 7 positive MVI patients with sequential TACE and 42.86%, 51.02% in 49 positive MVI patients without sequential TACE, showing a statistically significant difference in 6-month tumor recurrence rate (x
2=4.800, P<0.05) and no statistically significant difference in 1-year tumor recurrence rate (x
2=1.236, P>0.05). (4) Effect of comprehensive treatment on the prognosis of patients with tumor recurrence: of 59 patients with tumor recurrence, 37 didn′t receive comprehensive treatment, 34 of 37 died within 1-year postoperatively, including 30 deaths within 6-month postoperatively, and 1-year survival rate was 8.10%; 22 received comprehensive treatment, including 4 deaths within 1-year postoperatively, and 1-year survival rate was 81.80%, showing a statistically significant difference in 1-year survival rate (x
2=32.698, P<0.05).
Conclusions:MVI is one of the important risk factors affecting HCC recurrence and metastasis after hepatectomy. The combined TACE after hepatectomy can reduce the HCC recurrence rate of MVI positive patients, and active comprehensive treatment after HCC recurrence can significantly prolong the survival time of patients.
±s表示，采用独立样本t检验，计数资料比较采用x2检验或Fisher确切概率法，采用Kaplan-Meier法计算肿瘤复发率和生存率，Log-rank检验进行生存分析。
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