Application Of Transarterial Chemotherapy In The Treatment Of Post-Operation PLC Patients

Objective: To evaluate the clinical effectiveness of two methods for PLC: transarterial chemotherapy after surgical excision and simple surgical excision, and to explore the application value of combined therapy of TACE and surgical excision in the treatment for PLC, thus providing better treatment strategies for the comprehensive therapy of primary liver cancer(PLC). Methods: Clinical data of 362 patients who were diagnosed as primary hepatic carcinoma (HCC) in the attached tumor hospital of Guangxi Medical University during the year 2003—2007 were collected. 362 cases were divided into two groups: 104 cases were treated with post-operative TACE while 258 others just treated with surgical excision were in the controlled group. In the intervention group, all patients accept TACE in six months with the maximum of four times and minimum of twice. This procedure is repeated every 4-6 weeks. The controlled group only accepts the oral drugs after the surgical excision. We follow up all cases for 36-48 months. The 1-, 2-, 3-year post-operative survival rate and the 1-, 2-, 3-year cumulate recurrence rate of each group were compared respectively. Meanwhile, we divide the post-surgical group into four sub-groups, according to the time when patients firstly accepted the preventive TACE therapy after surgical excision and analyze 1-year recurrence rate within sub-groups. In addition, we analyzed factors that might affect the post-operative recurrence for PLC. These diameters include: age, sex, hepatic function staging and grading, HBsAg, liver cirrhosis, capsule, tumor size, portal vein thrombosis, etc. Results: The 1-, 2-, 3-year survival rate for the controlled group is 84.1%,68.2%,36.4%,respectively and the 1-, 2-, 3-year recurrence rate for it is 30.2%,47.7%,80.2% respectively. The median survival time for this group is 31.3 months. The 1-, 2-, 3-year survival rate for the post-operative group is 95.2%,87.5%,60.6% respectively and the 1-, 2-, 3-year recurrence rate for it is 17.3%,24%,46.2% respectively. The median survival time for this group is 32.1 months. There is great difference compared to the controlled group (P<0.05). The 1-year recurrence rate within the sub-groups from group one to group four are 3.7%,6.5%,27.3%,37.5%,respectively. The recurrence rate increases with time delayed when patients first accept intervention therapy. TACE within two months after surgical excision has greatly reduced the recurrence rate than two months after that(P﹤0.05). Multiple factor analysis for hepatic recurrence shows that incomplete or absence of capsule of tumor contributes largest to the recurrence, followed by relatively larger tumor size, tumor thrombosis, liver cirrhosis and HBsAg positive. Conclusion: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of recurrence significantly, especially for those with incomplete liver membrane, HBsAg positive, liver cirrhosis, relatively larger tumor size and tumor thrombosis. One or two months after hepatic carcinoma excision is the best time for the preventive TACE.