| Background:Hepatocellular carcinoma（HCC）is one of the most common tumors in the world.According to the 2018 Global Cancer Statistics report,the global incidence of liver cancer is 841000,accounting for 4.7%of the global number of cancer cases,782000 deaths,accounting for 8.2%of the global cancer mortality rate.The number of liver cancer cases in China is 393000,accounting for 46.7%of the world,and 369000 deaths,accounting for 47.2%of the world.Liver cancer occupies the fourth place in the incidence of cancer in China,and the fatality rate occupies the third place.For patients with early liver cancer,radical resection and liver transplantation may have a therapeutic effect.However,recurrence is common after surgical treatment,with a recurrence rate of 70%after surgical resection and 35%after liver transplantation in 5 years.Due to the high recurrence rate and metastasis rate after operation,the long-term survival rate of patients with liver cancer is still very low.Vascular invasion of HCC is the main factor leading to recurrence of HCC,including macrovascular invasion and microvascular invasion（MVI）.Macrovascular invasion and microvascular invasion of hepatocellular carcinoma can increase the risk of tumor recurrence by 15 times and 4.4 times,respectively.Macrovascular invasion means that the tumor invades the blood vessels,and the common macrovascular invasions are portal vein tumor thrombus,hepatic vein or inferior vena cava tumor thrombus.Generally,the diagnosis can be confirmed by preoperative imaging examination.At present,the prediction method of preoperative diagnosis of microvascular invasion is limited,which is mainly found according to the postoperative pathological report.Microvascular invasion is a high risk factor indicating poor prognosis of postoperative recurrence of primary hepatocellular carcinoma.According to the 2019 Standard for diagnosis and treatment of Primary liver Cancer microvascular invasion refers to the microscopic appearance of cancer cell nests in the vascular lumen lined with endothelial cells,mainly in the portal vein（including intracapsular vessels）.Pathological grading method:M0:no MVI;M1（low risk group）:≤5 MVI/per high magnification and occurred in adjacent liver tissue（≤1cm）,M2（high risk group）:>5 MVI/per high magnification,or MVI occurred in distant paracancerous liver tissue（>1cm）.A number of studies have shown that MVI is an independent risk factor for recurrence and metastasis of hepatocellular carcinoma.In a study[9],the data of 661patients with HCC showed that the total incidence of MVI was about 31.6%.Another study[10]showed that the incidence of MVI was about 46.8%.It can be concluded that the incidence of MVI in patients with primary hepatocellular carcinoma is higher,which is an important factor leading to postoperative tumor recurrence and metastasis.However,there are still few reports on how to reduce the tumor recurrence rate and prolong the overall survival rate of primary hepatocellular carcinoma with microvascular invasion.Therefore,it has become an important topic to explore how to reduce the tumor recurrence rate and prolong the survival time of primary hepatocellular carcinoma patients with microvascular invasion.Objective:To observe the effects of different treatments on the postoperative recurrence rate and survival rate of patients with primary hepatocellular carcinoma complicated with microvascular invasion,so as to provide theoretical basis for improving the postoperative survival rate.Methods:A total of 244 patients with HCC who underwent radical resection from March 2016to March 2019 in the second affiliated Hospital of Guangzhou Medical University were collected.A total of 138 patients with primary hepatocellular carcinoma with microvascular invasion confirmed by pathology were randomly divided into transcatheter arterial chemoembolization+sorafenib group（n=33）,simple TACE group（n=35）,simple sorafenib group（n=29）and control group（n=41）.The related clinical data,tumor size,operation time,operative blood loss,degree of microvascular invasion,tumor recurrence time and survival time were recorded.Using SPSS25.0 statistical software,the tumor-free survival time and survival time of each group were compared by Kaplan-Meier method and Log-Rank test,and the therapeutic effect of each group on patients with primary hepatocellular carcinoma complicated with microvascular invasion was evaluated.Results:1.Among the 244 patients with HCC after radical resection,there were 192 males and 52females.The male-to-female ratio was 3.69.There were 138 patients with MVI and 106patients without MVI.The total incidence of MVI was 56.56%.2.There was no significant difference in sex ratio,average age,hepatitis B surfaceantigen,preoperative tumor index,tumor size,operation time,intraoperative bleeding and other related clinical data among the treatment groups（P>0.05）.3.The postoperative tumor-free survival time of each treatment group was as follows:（1）The median tumor-free survival time of TACE+sorafenib group was 10.0months（95%CI:5.6～14.4 months）;（2）The median tumor-free survival time of TACE group was 6.0 months（95%CI:1.2～10.8 months）;（3）The median tumor-free survival time of sorafenib group was 4.0 months（95%CI:2.5～5.5 months）;（4）The median tumor-free survival time in the control group was 3.0 months（95%CI:1.9～4.0 months）.There was significant difference in median tumor-free survival time among the above treatment groups（P<0.05）.4.The postoperative survival rates of each treatment group were as follows:（1）The 1-and 2-year survival rates of the TACE+sorafenib group were 89.0%and26.1%,and the median survival time was 20.0 months（95%CI:19.3～20.7 months）;（2）In the simple TACE treatment group,the 1-and 2-year postoperative survival rates were 72.2%and 16.2%,and the median survival time was 15.0 months（95%CI:12.7～17.3 months）.（3）The 1-and 2-year survival rates of the simple sorafenib group were 63.6%and0%,and the median survival time was 12.0 months（95%CI:9.5～14.5 months）;（4）In the control group,the 1-and 2-year survival rates were 31.2%and 0%,and the median survival time was 9.0 months（95%CI:7.7～10.3 months）.There were significant differences in 1-and 2-year postoperative survival time among the above treatment groups（P<0.05）.5.TACE+sorafenib group compared with simple TACE group:（1）The median tumor-free survival time of TACE+sorafenib group was 10.0months（95%CI:5.6～14.4 months）,and that of simple TACE group was 6.0months （95%CI:1.2～10.8 months）.There was no significant difference between the two groups.（2）The 1-and 2-year survival rates in the TACE+sorafenib group were 89.0%and26.1%,and the median survival time was 20.0 months（95%CI:19.3～20.7 months）.In the simple TACE group,the 1-and 2-year survival rates were 72.2%and 16.2%,and the median survival time was 15.0 months（95%CI:12.7～17.3 months）.There was significant difference between the two groups（P<0.05）.6.TACE++sorafenib treatment group compared with simple sorafenib group:（1）The median tumor-free survival time of TACE+sorafenib group was 10.0months（95%CI:2.5～5.5 months）,and that of simple sorafenib group was 4.0 months（95%CI:5.6～14.4 months）.There was significant difference between the two groups.（2）The 1-and 2-year survival rates of TACE+sorafenib group were 89.0%and26.1%,and the median survival time was 20.0 months（95%CI:19.3～20.7 months）.In sorafenib alone group,the 1-and 2-year survival rates were 63.6%and 0%,and the median survival time was 12.0 months（95%CI:9.5～14.5 months）.There was significant difference between the two groups（P<0.05）.7.The treatment group compared with the control group:7.1 Postoperative tumor-free survival time:（1）The median tumor-free survival time of TACE+sorafenib group was 10.0months（95%CI:5.6～14.4 months）,and that of the control group was 3.0 months（95%CI:1.9～4.0months）.The difference between the two groups was statistically significant.（2）The median tumor-free survival time of the TACE group was 6.0 months（95%CI:1.2～10.8 months）,while that of the control group was 3.0months（95%CI:1.9～4.0 months）.There was significant difference between the two groups.（3）The median tumor-free survival time of sorafenib group was 4.0 months（95%CI:2.5～5.5 months）,while that of the control group was 3.0 months（95%CI:1.9～4.0 months）.There was significant difference between the two groups.7.2 postoperative 1-and 2-year survival rates:（1）In the TACE+sorafenib group,the 1-and 2-year survival rates were 89.0%and26.1%,and the median survival time was 20.0 months（95%CI:19.3～20.7 months）.In the control group,the 1-and 2-year survival rates were 31.2%and 0%,and the median survival time was 9.0 months（95%CI:7.7～10.3 months）.There was significant difference between the two groups（P<0.05）.（2）The 1-and 2-year survival rates of the simple TACE treatment group were 72.2%and 16.2%,and the median survival time was 15.0 months（95%CI:12.7～17.3 months）.In the control group,the 1-and 2-year survival rates were 31.2%and 0%,and the median survival time was 9.0 months（95%CI:7.7～10.3 months）.There was significant difference between the two groups（P<0.05）.（3）The 1-and 2-year survival rates of the simple sorafenib group were 63.6%and0%,and the median survival time was 12.0 months（95%CI:9.5～14.5 months）.In the control group,the 1-and 2-year survival rates were 31.2%and 0%,and the median survival time was 9.0 months（95%CI:7.7～10.3 months）.There was significant difference between the two groups（P<0.05）.8.Comparison of M1 patients with M2 patients in each treatment group:8.1 postoperative tumor-free survival time:（1）In TACE+sorafenib group,the median tumor-free survival time of M1 patients was 15.0 months（95%CI:9.9～20.1 months）;The median tumor-free survival time of M2patients was 8.0 months（95%CI:3.4～12.6 months）,and there was significant difference between the two groups.（2）In the simple TACE group,the median tumor-free survival time of patients with M1 type was 12.0 months（95%CI:3.8～20.2 months）,and that of patients with M2 type was 4.0 months（95%CI:3.0～5.0 months）,there was significant difference between the two groups.（3）In sorafenib alone group,the median tumor-free survival time of M1 type patients was 10.0 months（95%CI:6.7～13.2 months）,and that of M2 type patients was 2.0months（95%CI:1.2～2.8 months）,there was significant difference between the two groups.8.2 postoperative 1-and 2-year survival rates:（1）In the TACE+sorafenib group,the 1-and 2-year postoperative survival rates of M1 patients were 90.9%and 51.9%,respectively,and the median survival time was 28.0months（95%CI:19.0～37.0 months）.The 1-and 2-year survival rates of M2 patients were80.0%and 0%,and the median survival time was 19.0 months（95%CI:15.2～22.8 months）.There was significant difference between the two groups（P<0.05）.（2）In the simple TACE treatment group,the 1-and 2-year survival rates of M1patients were 80.0%and 20.0%,respectively,and the median survival time was 17.0 months（95%CI:9.3～24.7 months）.The 1-and 2-year survival rates of M2 patients were38.7%and 0%,and the median survival time was 11.0 months（95%CI:8.7～13.3 months）.There was significant difference between the two groups（P<0.05）.（3）In the simple sorafenib treatment group,the 1-and 2-year survival rates of M1patients in the simple sorafenib treatment group were 83.3%and 0%,respectively,and the median survival time was 14.0 months（95%CI:13.2～14.8 months）.The 1-and 2-year survival rates of M2 patients treated with sorafenib alone were 20.6%and 0%, respectively,and the median survival time was 10.0 months（95%CI:7.6～12.4 months）.There was significant difference between the two groups（P<0.05）.Conclusions:1.The disease-free survival time and overall survival rate of the three treatment groups were better than those of the control group.TACE and sorafenib can effectively prolong the tumor-free survival time and overall survival time of patients with hepatocellular carcinoma after radical resection.2.For patients with hepatocellular carcinoma complicated with microvascular invasion,TACE+sorafenib treatment group compared with simple TACE treatment group, although the former can’t prolong the tumor recurrence time,but can prolong the postoperative tumor survival time and increase the total survival time.3.For patients with hepatocellular carcinoma complicated with microvascular invasion,TACE+sorafenib treatment group can not only prolong the time of tumor recurrence,but also improve the overall survival rate compared with sorafenib alone treatment group.4.The tumor-free survival time of M2 patients in each treatment group was shorter than that of M1 patients,and the total postoperative survival time was less.The higher the MVI pathological grade,the greater the possibility of tumor recurrence and metastasis,and the lower the disease-free survival rate and the overall survival rate. |
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