目的: 评估经肝动脉化疗栓塞（TACE）在超“UCSF标准”肝细胞癌（HCC）肝移植术前治疗的安全性及疗效。方法: 回顾性分析2003年1月至2013年3月在本院行肝移植治疗的83例超“UCSF标准”的成年HCC病人临床资料,根据术前是否采取TACE治疗分为TACE治疗组（63例）与对照组（20例）。比较两组病人术后急性排异、胆道并发症和血管并发症发生率、无瘤生存率及总生存率。结果: TACE治疗组在肝移植术前平均进行了（2.0±1.3）次TACE疗程,末次治疗至肝移植的平均时间为（15.7±8.4） d。TACE治疗组与对照组相比,在肝移植术后急性排异、肝动脉栓塞和胆道并发症发生率差异无统计学意义（P>0.05）。TACE治疗组无瘤生存率及总生存率明显优于对照组（P<0.05）。分层分析表明,TACE治疗后获得完全反应或部分反应的HCC病人行肝移植1、3、5年无瘤生存率及总生存率明显高于TACE治疗后无反应组（P<0.05）。TACE治疗后肿瘤降期至“UCSF标准”的HCC病人行肝移植1、3、5年无瘤生存率及总生存率明显高于降期治疗后未达到“UCSF标准”的病人（P<0.05）。结论: 肝移植术前TACE治疗可延长病人无瘤生存及总生存时间。肝移植术前TACE降期治疗安全,仅1例发生肝动脉栓塞并发症。
Objective: To assess the safety and effectiveness of preliver transplantation transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) beyond UCSF criteria. Methods: We retrospectively analyzed the clinical data of 83 patients with HCC beyond UCSF criteria, who were divided into TACE group and control group. The postoperative acute rejection, biliary complications, vascular complications, tumor free survival rate and overall survival rate between two groups were compared. Results: There were (2.0±1.3) preliver transplantation TACE procedures with the period of (15.7±8.4) d between final TACE treatment and liver transplantation. There was no significant difference in postoperative acute rejection, biliary complications and hepatic artery embolism between TACE group and control group(P>0.05). The tumor free survival rate and overall survival rate in TACE group were significantly higher than those in control group (P<0.05). Stratification analysis revealed that the 1-, 3-, 5-year tumor free survival rate and overall survival rate of the patients with complete response or partial response were much higher than those of the patients without response(P<0.05). The 1-, 3-, 5-year tumor free survival rate and overall survival rate were significantly higher in the patients with HCC which satisfied UCSF criteria after TACE than those in the patients with HCC still beyond UCSF criteria(P<0.05). Conclusions: Preliver transplantation TACE can prolong tumor free survival time and overall survival time, and is safe with only one case of hepatic artery embolism.
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