肝细胞肝癌术后辅助性 TACE 治疗可降低肺转移风险

摘要

Objective:To investigate the risk factors for the early occurrence of lung metastasis after surgery in HCC patients.Methods:A total of 284 patients that were diagnosed with hepatocellular carcinoma in the postoperative pathology and detected lung metastasis during the follow -up were analyzed respectively.Calculate the cumulative in-cidence of lung metastasis for different risk factors by the Kaplan -Meier method.21 possible risk factors were entered into the COX regression model for univariate analysis and followed by multivariate analysis,including preoperative la-boratory tests,imaging findings,and postoperative pathology,then compared the difference of the time to lung metasta-sis between patients with or without adjuvant TACE by the Log -Rank test.Results:Maximum diameter of tumor≥10cm,multifocal lesions and merging tumor thrombosis in preoperative imaging findings,and incomplete or absent tumor capsular,larger necrosis and merging satellite lesions in postoperative pathology were significant high risk fac-tors for lung metastasis in patients with HCC after surgery by COX univariate and multivariate analysis.The median time to lung metastasis in high -risk patients with adjuvant TACE treatment after surgery was significantly longer than those without adjuvant TACE (P =0.010),while there was no significant difference between those patients.Conclu-sion:Lung metastasis tended to occur significantly earlier in patients with tumor maximum diameter≥10cm,multifocal lesions and merging tumor thrombosis in preoperative imaging findings,and incomplete or absent tumor capsular,lar-ger necrosis and merging satellite lesions in postoperative pathology.Postoperative adjuvant TACE can prevent the ear-ly occurrence of lung metastasis in high -risk patients that indicated by preoperative imaging and postoperative pa-thology.%目的：探讨肝细胞肝癌（HCC）患者手术治疗后发生肺转移的危险因素。方法：回顾性分析284例行手术治疗后发生肺转移的 HCC 患者，以手术时间至发现肺转移为肺转移时间。分析患者手术前的实验室检查、影像学表现、术后病理及患者出现肺转移的时间。采用 Kaplan －Meier 法计算不同危险因素肺转移的累积发生率，并以 Log －Rank 检验比较组间差异。将21项可能的影响因素纳入 COX 回归模型依次进行单因素及多因素分析，得出肺转移的独立危险因素。结果：综合患者术前及病理资料，经 COX 单因素及多因素分析，术前影像学检查中肿瘤的最大径、数目、有无癌栓及术后病理学检查中包膜是否完整、有无坏死、卫星灶是影响 HCC 患者手术后肺转移发生的独立危险因素。对于肺转移高危患者，术后辅助性 TACE 治疗可明显延长肺转移出现的时间（P ＝0．010），而对非高危患者无明显影响。结论：术前影像学检查发现肿瘤最大径≥10cm、病灶多发和合并癌栓及术后病理学检查发现瘤灶无包膜或包膜不完整、坏死成分较多和有卫星灶，是HCC 患者手术后发生肺转移的独立危险因素；肺转移高危患者术后1个月接受辅助性 TACE，可降低肺转移发生的风险。