目的 探讨不可一期切除肝细胞肝癌(hepatocellular carcinoma,HCC)经导管肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)联合索拉非尼(Sorafenib)降期治疗后,二期再行根治性切除的可行性.方法 回顾性分析2010年3月至2015年1月在南方医科大学南方医院肝胆外科经TACE及口服分子靶向药物索拉非尼治疗、成功降期后再行二期切除的21例HCC病人的临床资料.该组病人平均年龄45.5岁(20~67岁),肝切除手术后持续服用索拉非尼.结果 该组病人经TACE联合口服索拉非尼成功降期,降期治疗所需时间平均为52.3 d.降期后实施左、右半肝切除分别为5例和3例,扩大左半肝切除1例,扩大右半肝切除1例,肝脏区段切除11例.术中平均出血量为356.3 ml(150~1 200 ml),平均手术时间为243.3 min(145~365 min).经过12~62个月随访(中位随访时间为30.1个月),1、2、3年的无瘤存活率分别为76.2%、52.4%、43.6%,复发后病人再次接受TACE、放疗、射频消融等综合治疗者5例,接受再次手术切除的病人3例,1、2、3年总生存率分别为85.7%、71.4%、57.1%.结论 TACE联合口服索拉非尼全身治疗,可使部分初期不可切除肝癌成功降期,降期后接受外科根治性切除手术,初步效果令人鼓舞.%Objective To investigate the feasibility of radical liver resection following downstaging of hepatocellular carcinoma (HCC) by transcatheter hepatic arterial chemoembolization (TACE) combined with sorafenib.Methods A retrospective study was conducted.Twenty-one patients with unresectable HCC from March 2010 to January 2015 underwent successful liver resection (LR) after TACE combined with sorafenib in Department of Hepatic Surgery,Nanfang Hospital.The average age of the patients was 45.5 years (20-67 years).Results The average period of downstaging was 52.3 days.Five patients underwent left hemihepatectomy,3 right hemihepatectomy,one extended left hemihepaectomy,1 extended right hemihepaectomy and 11 segmental liver resections.The mean blood loss was 356.3 mL (150-1 200 mL),and the mean operating time was 243.3 min (145-365 min).The median follow-up period of 21 cases was 30.1 months (range: 12-62 months).The1-,2-,3-year recurrence-free survival (RFS) rate after LR was 76.2%,52.4%,and 43.6% respectively.After recurrence,5 patients underwent TACE,radiotherapy,or radiofrequency ablation (RFA),and 3 patients underwent secondary surgical resection.The1-,2-,and 3-year overall survival (OS) rate after LR was 85.7%,71.4% and 57.1% respectively.Conclusions Radical liver resection after downstaging of HCC by TACE combined with sorafenib is safe and feasible.
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