| The first choice of treatment on HCC is hepatectomy. But the recurrence is higher, especially within 1 or 2 years, it's the peak of recurrence after hepatectomy. It's the vital treatment to fight recurrence after hepatectomy. In recent years, it's the best treatment widely used to fight recurrence by using postoperative adjuvant TACE on HCC patients, but actually, this kind of treatment is better or not, till now, we can't draw a conclusion. There is a great debate or there are many points of view on it, in the meantime ,there is no authoritative public criterion of evaluation about it. It's not reported that multivariate analysis on effective factors of postoperative adjuvant TACE on HCC patients. Objective:By means of analyzing the clinical, pathological, treating factors of postoperative adjuvant TACE on HCC patients, we research the effective factors of postoperative TACE on HCC patients, in order to evaluate the affection of postoperative TACE on HCC patients actually, then we can take a correct choice to treat the liver cancer patients after hepatectomy.Methods:1. From January 1995 to December 1999, 385 patients who underwent hepatectomy for HCC were enrolled to my hospital for reviewing their clinical characteristics, treatment and prognosis, among them 190 patients underwent adjuvant TACE after hepatectomy and 195 patients didn't undergo adjuvant TACE after hepatectomy. Over 5 years averagely, 10 parameters contributing to survival rate (SR) were analyzed for the 190 patients.2. The patients were classified into intervention group (the 190 patients with adjuvant TACE) and control group (the 195 patients without adjuvant TACE).All patients were further stratified to two groups with high risk factors (patients with single tumor >5cm in diameter, or with multiple tumors, or with portal tumor thrombi) and low risk factors(patients with single tumor = 5cm,without portal tumor thrombi). To the low risk with residual tumor or high risk patients with residual tumor, the intervention group and the control group were studied by using case-control study.3 .All patients were classified to three groups with different curative resection, including complete resection, incomplete resection and temporary resection. To every group, the intervention group and control group were studied by using case control study.4. To deal with it by SPSS 10.0 software package on computer based on statistics , a value less than 0.05 was considered as significance.. Results:1. To the intervention group, univariate analysis showed that tumor size, portal tumor thrombi, satellite nodule, cirrhosis type, recurrent and treatment, curative resection (CR) and immunodepressive or not were significant prognostic factors (P=0-0.0199).2.To the intervention group, the use of Cox's multivariate proportional hazard model showed that tumor size, curative resection, portal tumor thrombi, recurrent andtreatment were significant prognostic factors for survival rate(P=0-0.002).3.To the low risk patients with residual tumor, the l-,2-,3-,4-,5-year survival rate (SR) was 96.6%,79.7%,67.8%, 62.7%,50.8% in the intervention group, and the l-,2-,3-,4-,5-year SR was 93.3%,81.7%, 70.0%,56.3% and 55.0% in the control group. There was no statistical difference between the two groups in survival (log-rank P=0.6607).To the high risk patients with residual tumor, the l-,2-,3-,4-,5-year SR was 87.8%,77.1%,61.1%,51.1% and 42.0% in the intervention group, and the l-,2-,3-,4-,5-year SR was83.0%,66.7%,54.1%,37.8% and 27.4% in the control group. There was statistical difference between the two groups in survival rate(log-rank P=0.0101).4.To the patients after hepatectomy with pathological CR, the l-,2-,3-,4-,5-year SR was 98.0%,93.9%,86.7%, 83.7% and 76.5% in the intervention group, and the l-,2-,3-,4-,5-year SR was 97.9%,92.9%, 86.9%,81.8% and 70.7% in the control group. There was no statistical difference between the two groups in survival rate(log-rank P=0.1317).To the patients after hepatectomy with clinical CR, the l-,2-,3-,4-,5-year SR was 87.1%,66.1%,46.8%,33.9% and 17.8% in the intervention group, and the l-,2-,3-,4-,5-year SR was 82.8%,64.1%,40.6%,6.3% and 0% in the control group. There was statistical difference between the two groups in survival rate(log-rank P=0.0016).To the patients with temporary resection, the l-,2-,3-,4-,5-year SR was 70.0%,46..7%,20.0%, 3.3% and 0% in the intervention group, and the l-,2-,3-,4-,5-year SR was 56.3%, 18.8%, 6.3%,0% and 0% in the control group. There was statistical difference between the two groups in survival rate(log-rank P=0.0196). Conclusions:l.The tumor size, curative resection, recurrent and treatment, portal tumor thrombi are important factors for prognosis for the patients with postoperative adjuvant TACE. 2. Postoperative adjuvant TACE can't prolong surving time for the low riskpatients with residual tumor, but it can prolong surving time for the high risk patients with residual tumor.3. Postoperative adjuvant TACE can't prolong surving time for the patients with pathological curative resection, but it can prolong surving time for the patients with clinical curative resection or temporary resection. |
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