TACE在肝细胞癌根治性切除术后MVI阳性患者的疗效分析

doi:10.3877/cma.j.issn.1674-3946.2026.03.014

目的

本研究旨在探讨微血管侵犯（MVI）阳性肝细胞癌（HCC）患者根治性手术切除术后接受经导管动脉化疗栓塞（TACE）的临床疗效。

方法

回顾性分析2019年3月至2024年5月行根治性肝细胞癌切除术且病理报告证实为MVI阳性的130例患者临床资料，其中纳入术后TACE治疗组77例，对照组53例，采用SPSS 26.0和R Studio 4.4.3软件进行统计学分析。对正态分布的计量资料以（

x ¯

±s）表示，行t检验，对非正态正态分布的计量资料采用Mann-Whitney U检验；计数资料采用卡方检验进行分析。通过单因素及多因素COX回归分析影响MVI阳性HCC患者术后无复发生存期（DFS）的危险因素。使用Kaplan-Meier法绘制DFS生存曲线，组间差异采用Log-Rank检验。P<0.05表示差异具有统计学意义。

结果

单因素COX回归分析显示：肿瘤直径>5 cm（P=0.001）、MVI 2级（P<0.001）、AFP>400 ng/ml（P=0.001）、卫星结节（P<0.05）、脉管癌栓（P<0.05）、BCLC B期（P<0.05）是DFS潜在危险因素。多因素COX回归分析显示：MVI 2级、肿瘤直径>5 cm、AFP>400 ng/ml、脉管癌栓是影响MVI阳性肝细胞癌患者DFS的独立危险因素，而术后辅助TACE治疗是患者DFS的独立保护因素。Kaplan-Meier分析显示，TACE组患者中位DFS 19.8月（95%CI：13.4-26.8月），对照组患者中位DFS 10.5月（95%CI：9.0-16.6月），TACE组中位DFS显著优于对照组，差异具有统计学意义（P<0.05）。

结论

MVI阳性肝细胞癌患者根治性切除术后辅以TACE治疗可改善患者DFS。

关键词: 癌，肝细胞, 根治性切除术, 微血管侵犯, 经导管动脉化疗栓塞, 无复发生存期

Objective

The optimal adjuvant therapy for patients with microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC) after radical resection remains highly controversial. This study aimed to investigate the clinical efficacy of postoperative transcatheter arterial chemoembolization (TACE) in patients with MVI-positive HCC.

Methods

Clinical data of 130 patients who underwent radical resection for HCC and were pathologically confirmed as M-positive between March 2019 and May 2024 were retrospectively analyzed. Among them, 77 patients were included in the postoperative TACE group and 53 in the control group. Statistical analyses were performed using SPSS 26.0 and R Studio 4.4.3. Normally distributed continuous data were presented as (mean ± standard deviation) and analyzed by independent samples t test; non-normally distributed continuous data were analyzed by Mann-Whitney U test. Categorical data were analyzed by chi-square test. Univariate and multivariate COX regression analyses were used to identify risk factors affecting disease-free survival (DFS) after surgery in MVI-positive HCC patients. The Kaplan-Meier method was used to plot DFS curves, and differences between groups were analyzed by the Log-Rank test. A P-value <0.05 was considered statistically significant.

Results

Univariate COX regression analysis showed that tumor diameter >5 cm (P=0.001), MVI grade 2 (P<0.001), AFP >400 ng/ml (P=0.001), satellite nodules (P<0.05), vascular tumor thrombus (P<0.05), and BCLC stage B (P<0.05) were potential risk factors for DFS. Multivariate COX regression analysis demonstrated that MVI grade 2, tumor diameter >5 cm, AFP >400 ng/ml, and vascular tumor thrombus were independent risk factors for DFS in MVI-positive HCC patients, whereas postoperative adjuvant TACE was an independent protective factor for DFS. Kaplan-Meier analysis showed that the median DFS was 19.8 months in the TACE group (95%CI: 13.4-26.8 months) and 10.5 months in the control group (95%CI: 9.0-16.6 months). The median DFS was significantly better in the TACE group than in the control group (P<0.05).

Conclusion

Postoperative adjuvant TACE can improve DFS in patients with MVI-positive HCC after radical resection.

Key words: Carcinoma, Hepatocellular, Microvascular Invasion, Radical Resection, Transcatheter Arterial Chemoembolization, Disease-Free Survival

表1 肝细胞癌根治性切除术两组患者基线资料对比

变量	总数（n=130）	TACE组（n=77）	对照组（n=53）	P值
年龄（岁， $x ˉ$ ±s）	55.8±11.5	54.5±11.5	57.7±11.3	0.120
身高[m，M(P₂₅，P₇₅)]	1.7 (1.6, 1.7)	1.7 (1.6, 1.7)	1.7 (1.6, 1.7)	0.172
体重[kg，M(P₂₅，P₇₅)]	60.0 (54.0, 66.0)	61.0 (55.0, 67.0)	59.0 (53.0, 65.0)	0.216
BMI[kg/m²，M(P₂₅，P₇₅)]	21.6 (20.3, 23.3)	21.7 (20.3, 23.4)	21.5 (20.1, 23.1)	0.557
ALT[Ul/L，M(P₂₅，P₇₅)]	28.8 (19.1, 40.0)	30.0 (19.0, 43.4)	27.0 (20.1, 35.0)	0.247
AST[Ul/L，M(P₂₅，P₇₅)]	34.9 (26.5, 51.9)	40.1 (27.0, 54.9)	32.0 (25.3, 42.5)	0.073
ALB[g/L，M(P₂₅，P₇₅)]	39.2 (37.0, 42.2)	39.5 (37.4, 42.3)	38.9 (36.9, 41.8)	0.259
TBIL[μmol/L，M(P₂₅，P₇₅)]	14.1 (10.1, 18.4)	14.6 (10.6, 18.6)	13.1 (9.4, 18.2)	0.576
NLR[M(P₂₅，P₇₅)]	2.2 (1.7, 3.3)	2.2 (1.6, 3.2)	2.2 (1.8, 3.5)	0.460
甲胎蛋白[ng/ml，M(P₂₅，P₇₅)]	173.0 (13.4, 1,210.0)	168.0 (11.6, 1,199.0)	178.0 (17.0, 1,210.0)	0.574
HBV-DNA[IU/ml，M(P₂₅，P₇₅)]	592.9 (30.0, 38,100.0)	3,130.0 (76.3, 184,000.0)	100.0 (30.0, 4,090.0)	0.011
肿瘤最大直径[cm，M(P₂₅，P₇₅)]	4.9 (3.2, 7.6)	5.1 (3.5, 8.0)	4.4 (3.1, 7.1)	0.286
性别[例(%)]
女	12 (9.2)	7 (9.1)	5 (9.4)	>0.999
男	118 (90.8)	70 (90.9)	48 (90.6)	>0.999
饮酒史[例(%)]
无	83 (63.8)	51 (66.2)	32 (60.4)	0.495
有	47 (36.2)	26 (33.8)	21 (39.6)	0.495
MVI[例(%)]
M1	96 (73.8)	56 (72.7)	40 (75.5)	0.726
M2	34 (26.2)	21 (27.3)	13 (24.5)	0.726
乙肝[例(%)]
无	18 (13.8)	5 (6.5)	13 (24.5)	0.003
有	112 (86.2)	72 (93.5)	40 (75.5)	0.003
丙肝[例(%)]
无	128 (98.5)	76 (98.7)	52 (98.1)	>0.999
有	2 (1.5)	1 (1.3)	1 (1.9)	>0.999
Child分级[例(%)]
A	127 (97.7)	76 (98.7)	51 (96.2)	0.567
B	3 (2.3)	1 (1.3)	2 (3.8)	0.567
BCLC分期[例(%)]
0	6 (4.6)	5 (6.5)	1 (1.9)	0.543
A	117 (90.0)	68 (88.3)	49 (92.5)
B	7 (5.4)	4 (5.2)	3 (5.7)
肿瘤数量[例(%)]
1	119 (91.5)	71 (92.2)	48 (90.6)	0.297
2	9 (6.9)	6 (7.8)	3 (5.7)
3	2 (1.5)	0 (0.0)	2 (3.8)
肝硬化[例(%)]
无	42 (32.3)	26 (33.8)	16 (30.2)	0.668
有	88 (67.7)	51 (66.2)	37 (69.8)	0.668
Edmonson分级[例(%)]
1	3 (2.3)	3 (3.9)	0 (0.0)	0.274
2	80 (61.5)	49 (63.6)	31 (58.5)
3	47 (36.2)	25 (32.5)	22 (41.5)
脉管癌栓[例(%)]
无	110 (84.6)	65 (84.4)	45 (84.9)	0.939
有	20 (15.4)	12 (15.6)	8 (15.1)	0.939
卫星结节[例(%)]
无	97 (74.6)	58 (75.3)	39 (73.6)	0.823
有	33 (25.4)	19 (24.7)	14 (26.4)	0.823

表1 肝细胞癌根治性切除术两组患者基线资料对比

变量	总数（n=130）	TACE组（n=77）	对照组（n=53）	P值
年龄（岁， $x ˉ$ ±s）	55.8±11.5	54.5±11.5	57.7±11.3	0.120
身高[m，M(P₂₅，P₇₅)]	1.7 (1.6, 1.7)	1.7 (1.6, 1.7)	1.7 (1.6, 1.7)	0.172
体重[kg，M(P₂₅，P₇₅)]	60.0 (54.0, 66.0)	61.0 (55.0, 67.0)	59.0 (53.0, 65.0)	0.216
BMI[kg/m²，M(P₂₅，P₇₅)]	21.6 (20.3, 23.3)	21.7 (20.3, 23.4)	21.5 (20.1, 23.1)	0.557
ALT[Ul/L，M(P₂₅，P₇₅)]	28.8 (19.1, 40.0)	30.0 (19.0, 43.4)	27.0 (20.1, 35.0)	0.247
AST[Ul/L，M(P₂₅，P₇₅)]	34.9 (26.5, 51.9)	40.1 (27.0, 54.9)	32.0 (25.3, 42.5)	0.073
ALB[g/L，M(P₂₅，P₇₅)]	39.2 (37.0, 42.2)	39.5 (37.4, 42.3)	38.9 (36.9, 41.8)	0.259
TBIL[μmol/L，M(P₂₅，P₇₅)]	14.1 (10.1, 18.4)	14.6 (10.6, 18.6)	13.1 (9.4, 18.2)	0.576
NLR[M(P₂₅，P₇₅)]	2.2 (1.7, 3.3)	2.2 (1.6, 3.2)	2.2 (1.8, 3.5)	0.460
甲胎蛋白[ng/ml，M(P₂₅，P₇₅)]	173.0 (13.4, 1,210.0)	168.0 (11.6, 1,199.0)	178.0 (17.0, 1,210.0)	0.574
HBV-DNA[IU/ml，M(P₂₅，P₇₅)]	592.9 (30.0, 38,100.0)	3,130.0 (76.3, 184,000.0)	100.0 (30.0, 4,090.0)	0.011
肿瘤最大直径[cm，M(P₂₅，P₇₅)]	4.9 (3.2, 7.6)	5.1 (3.5, 8.0)	4.4 (3.1, 7.1)	0.286
性别[例(%)]
女	12 (9.2)	7 (9.1)	5 (9.4)	>0.999
男	118 (90.8)	70 (90.9)	48 (90.6)	>0.999
饮酒史[例(%)]
无	83 (63.8)	51 (66.2)	32 (60.4)	0.495
有	47 (36.2)	26 (33.8)	21 (39.6)	0.495
MVI[例(%)]
M1	96 (73.8)	56 (72.7)	40 (75.5)	0.726
M2	34 (26.2)	21 (27.3)	13 (24.5)	0.726
乙肝[例(%)]
无	18 (13.8)	5 (6.5)	13 (24.5)	0.003
有	112 (86.2)	72 (93.5)	40 (75.5)	0.003
丙肝[例(%)]
无	128 (98.5)	76 (98.7)	52 (98.1)	>0.999
有	2 (1.5)	1 (1.3)	1 (1.9)	>0.999
Child分级[例(%)]
A	127 (97.7)	76 (98.7)	51 (96.2)	0.567
B	3 (2.3)	1 (1.3)	2 (3.8)	0.567
BCLC分期[例(%)]
0	6 (4.6)	5 (6.5)	1 (1.9)	0.543
A	117 (90.0)	68 (88.3)	49 (92.5)
B	7 (5.4)	4 (5.2)	3 (5.7)
肿瘤数量[例(%)]
1	119 (91.5)	71 (92.2)	48 (90.6)	0.297
2	9 (6.9)	6 (7.8)	3 (5.7)
3	2 (1.5)	0 (0.0)	2 (3.8)
肝硬化[例(%)]
无	42 (32.3)	26 (33.8)	16 (30.2)	0.668
有	88 (67.7)	51 (66.2)	37 (69.8)	0.668
Edmonson分级[例(%)]
1	3 (2.3)	3 (3.9)	0 (0.0)	0.274
2	80 (61.5)	49 (63.6)	31 (58.5)
3	47 (36.2)	25 (32.5)	22 (41.5)
脉管癌栓[例(%)]
无	110 (84.6)	65 (84.4)	45 (84.9)	0.939
有	20 (15.4)	12 (15.6)	8 (15.1)	0.939
卫星结节[例(%)]
无	97 (74.6)	58 (75.3)	39 (73.6)	0.823
有	33 (25.4)	19 (24.7)	14 (26.4)	0.823

表2 肝细胞癌根治性切除术患者DFS单因素及多因素COX回归分析

变量	单因素分析			多因素分析
变量	HR	95%CI	P值	HR	95%CI	P值
年龄	0.999	0.984−1.015	0.900
性别（男）	1.115	0.562−2.212	0.755
身高	0.407	0.022−7.580	0.547
体重	1.001	0.977−1.026	0.913
BMI	1.022	0.939−1.112	0.612
ALT	0.998	0.993−1.003	0.484
AST	1.000	0.995−1.004	0.841
ALB	0.967	0.920−1.016	0.182
TBIL	0.995	0.970−1.020	0.677
NLR	1.036	0.959−1.120	0.370
HBV-DNA	1.000	1.000−1.000	0.271
饮酒史（有）	1.310	0.882−1.946	0.181
乙肝病史（有）	0.576	0.337−0.984	0.044	0.429	0.241−0.762	0.004
丙肝病史（有）	0.561	0.078−4.029	0.565
肝硬化（有）	0.925	0.613−1.396	0.710
肿瘤直径（>5 cm）	1.906	1.290−2.817	0.001	2.063	1.347−3.159	0.001
AFP（>400 ng/ml）	1.928	1.306−2.846	0.001	1.796	1.177−2.740	0.007
卫星结节（有）	1.788	1.168−2.739	0.008	1.528	0.943−2.476	0.085
脉管癌栓（有）	1.832	1.084−3.099	0.024	1.915	1.078−3.401	0.027
MVI 2级	2.702	1.754−4.162	<0.001	2.641	1.647−4.235	<0.001
辅助TACE治疗	0.617	0.417−0.911	0.015	0.472	0.309−0.722	0.001
Child B期	2.747	0.857−8.801	0.089
BCLC分期
A	4.744	1.166−19.303	0.030	2.076	0.487−8.849	0.323
B	8.750	1.798−42.578	0.007	2.644	0.512−13.654	0.246
Edmonson分级
1	ref	ref	ref
2	0.730	0.229−2.329	0.595
3	0.763	0.235−2.477	0.652
肿瘤数量
1	ref	ref	ref
2	0.985	0.457−2.125	0.970
3	0.534	0.074−3.850	0.533

表2 肝细胞癌根治性切除术患者DFS单因素及多因素COX回归分析

变量	单因素分析			多因素分析
变量	HR	95%CI	P值	HR	95%CI	P值
年龄	0.999	0.984−1.015	0.900
性别（男）	1.115	0.562−2.212	0.755
身高	0.407	0.022−7.580	0.547
体重	1.001	0.977−1.026	0.913
BMI	1.022	0.939−1.112	0.612
ALT	0.998	0.993−1.003	0.484
AST	1.000	0.995−1.004	0.841
ALB	0.967	0.920−1.016	0.182
TBIL	0.995	0.970−1.020	0.677
NLR	1.036	0.959−1.120	0.370
HBV-DNA	1.000	1.000−1.000	0.271
饮酒史（有）	1.310	0.882−1.946	0.181
乙肝病史（有）	0.576	0.337−0.984	0.044	0.429	0.241−0.762	0.004
丙肝病史（有）	0.561	0.078−4.029	0.565
肝硬化（有）	0.925	0.613−1.396	0.710
肿瘤直径（>5 cm）	1.906	1.290−2.817	0.001	2.063	1.347−3.159	0.001
AFP（>400 ng/ml）	1.928	1.306−2.846	0.001	1.796	1.177−2.740	0.007
卫星结节（有）	1.788	1.168−2.739	0.008	1.528	0.943−2.476	0.085
脉管癌栓（有）	1.832	1.084−3.099	0.024	1.915	1.078−3.401	0.027
MVI 2级	2.702	1.754−4.162	<0.001	2.641	1.647−4.235	<0.001
辅助TACE治疗	0.617	0.417−0.911	0.015	0.472	0.309−0.722	0.001
Child B期	2.747	0.857−8.801	0.089
BCLC分期
A	4.744	1.166−19.303	0.030	2.076	0.487−8.849	0.323
B	8.750	1.798−42.578	0.007	2.644	0.512−13.654	0.246
Edmonson分级
1	ref	ref	ref
2	0.730	0.229−2.329	0.595
3	0.763	0.235−2.477	0.652
肿瘤数量
1	ref	ref	ref
2	0.985	0.457−2.125	0.970
3	0.534	0.074−3.850	0.533

图1 肝细胞癌根治性切除术两组患者DFS生存分析曲线

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Efficacy analysis of TACE in MVI-Positive patients after radical resection of hepatocellular carcinoma

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Efficacy analysis of TACE in MVI-Positive patients after radical resection of hepatocellular carcinoma