Curative Effect And Prognostic Risk Factor Of Surgical Resection Combined With TACE In The Treatment Of Advanced Hepatocellular Carcinoma

Backgroud and Objective: Hepatectomy is considered to be the first choice for liver cancer and the only possible cure.However,even after surgical resection,the recurrence rate of postoperative residual liver cancer is as high as 36% to 66%.With the development of interventional radiotherapy technology,it has opened up a new therapeutic approach for the treatment of liver cancer.Among them,transcatheter arterial chemoembolization(TACE)is a widely used and effective method.It has been reported in the literature that hepatectomy combined with postoperative TACE for liver cancer can improve the survival time of patients.However,there is no research on the efficacy and prognostic risk factors of surgical resection combined with postoperative TACE in the treatment of advanced hepatocellular carcinoma(HCC).Therefore,this study compares the efficacy of these two different treatments for advanced HCC,and analyzes the risk factors affecting the prognosis of advanced HCC,providing a basis for clinical treatment of advanced HCC.method A retrospective analysis of 156 patients with advanced HCC who were hospitalized in the Department of Hepatobiliary Surgery,Southwestern Medical University Hospital from June 2013 to June 2016(all met the inclusion criteria),divided into two groups according to treatment measures,namely the operation group and The operation + TACE group,the operation group was only patients who underwent hepatectomy,a total of 95 cases,surgery + TACE group for hepatectomy and postoperative TACE treatment,a total of 61 cases.Overall survival(OS),disease free survival(DFS),and complications were compared between the two groups.Kaplan-Meier(KM)survival analysis was performed by univariate analysis,and the Cox risk ratio model was used to comprehensively evaluate the risk factors affecting the prognosis of patients undergoing surgery+TACE.Results: 1 General information of the two groups: age,body mass index(BMI),total bilirubin(TBIL),alanine aminotransferase(ALT),serum albumin(albumin,ALB),serum ?-glutamyltranspeptidase(?-GT),PLT,AFP,prothrombin time(PT),tumor size,history of viral hepatitis,history of schistosomiasis infection,intact capsule,gross vascular cancer There were no significant differences in thrombus,cirrhosis,multiple intrahepatic tumors,satellite foci,and Child-Pugh classification(P>0.05).2 Intraoperative conditions and postoperative complications in the two groups: intraoperative bleeding in the two groups.There were no significant differences in hepatic occlusion time,postoperative bleeding,wound infection,pleural effusion,and bile leakage(P>0.05).3 OS: OS group: 95 patients with median survival time of 23 patients The survival rates of months,1,3,and 5 years were 88.4%,40.0%,and 6.3%,respectively.The median survival time of 61 patients in the surgical+TACE group was 29 months,and the survival rates at 1,3,and 5 years were 93.4%.44.3%,11.5%.According to the KM curve,OS was higher in the surgical + TACE group compared with the surgery group(P < 0.05).4 Overall DFS in the two groups: 95 patients in the operation group had 64.2%,25.3%,and 2.1% DFS in 1,3,and 5 years;respectively,61 patients in the surgery+TACE group had 72.1%,31.1% and 6.6% DFS in 1,3,and 5 years,According to the KM curve,the overall DFS was higher in the surgery+TACE group than in the surgery group(P<0.05).5 Univariate analysis showed that portal vein tumor thrombus,tumor pseudocapsule,alpha fetoprotein and tumor recurrence were associated with hepatectomy combined with postoperative TACE in the treatment of advanced HCC(P<0.05);multivariate analysis showed that there was a tumor thrombus in the portal vein.Elevated alpha-fetoprotein and tumor recurrence were independent risk factors for hepatic resection combined with postoperative TACE in the treatment of advanced HCC(P<0.05).Conclusion: For patients with advanced HCC,hepatectomy combined with postoperative TACE can prolong survival and tumor-free survival.The presence of tumor thrombus and tumor recurrence is important for hepatic resection combined with postoperative TACE for poor prognosis of advanced HCC.