CD4+/CD8+ T淋巴细胞在肝细胞癌组织中的浸润及与预后的相关性研究

目的 检测CD4⁺/CD8⁺ T淋巴细胞在肝细胞癌（hepatocellular carcinoma,HCC）组织中的浸润程度,并分析其与预后的相关性。方法 收集行肝切除术的HCC患者215例,采用免疫组化技术检测CD4⁺/CD8⁺ T淋巴细胞在HCC癌组织中的浸润程度,根据浸润情况比较患者肝切除术后无瘤生存率和总生存率。结果 CD4⁺ T淋巴细胞高浸润和低浸润比例分别为60.9%和39.1%。CD4⁺ T淋巴细胞高浸润组患者总生存率和无瘤生存率均显著高于低浸润组（P=0.015,P=0.038）。CD8⁺ T淋巴细胞高浸润和低浸润比例分别为34.9%和65.1%。CD8⁺ T淋巴细胞高浸润组患者的总生存率和无瘤生存率亦显著高于低浸润组患者（P=0.033,P=0.047）。结论 CD4⁺或CD8⁺ T淋巴细胞低浸润可能与HCC患者术后不良预后相关。     

术前外周血嗜酸性粒细胞升高对肝细胞癌根治术预后的影响

目的 探讨外周血嗜酸性粒细胞（eosinophils,EOS）升高对肝细胞癌（hepatocellular carcinoma,HCC）根治性切除术预后的影响。方法 回顾性分析广西医科大学附属肿瘤医院2011年1月至2013年12月初诊为HCC并接受根治性肝切除治疗患者的临床资料,共431例患者纳入研究,按EOS表达分为术前EOS升高组（≥0.5×10⁹/L）56例和EOS正常组（<0.5×10⁹/L）375例。采用倾向性评分匹配法平衡两组临床基线资料,Kaplan-Meier法进行生存分析,Cox比例风险模型评估患者死亡的独立危险因素。结果 倾向性评分匹配前EOS正常组和升高组患者1年、3年、5年生存率分别为78.9%、54.3%、38.0%和82.1%、49.9%、30.1%,两组生存曲线比较差异无统计学意义（χ²＝0.614,P=0.341）;按1：1 倾向性评分匹配后分别获得47例患者,EOS正常组和升高组1年、3年、5年生存率分别为85.1%、61.6%、31.2%和87.2%、50.0%、25.1%,两组生存曲线比较差异亦无统计学意义（χ²＝0.601,P=0.438）。结论 术前EOS升高对HCC患者总生存率无影响。     

乙型肝炎病毒相关性肝癌术后抗病毒结合胸腺肽治疗的疗效观察

目的 探讨肝癌术后抗乙型肝炎病毒（hepatitis B virus,HBV）药物拉米夫定结合胸腺肽治疗对HBV相关性肝癌术后的疗效。方法 选取合并HBV感染的肝癌患者65例,分为对照组32例,单纯接受肝癌根治性切除术;治疗组33例先行肝癌根治性切除术,术后接受拉米夫定联合胸腺肽治疗。观察并比较两组患者治疗后肝功能、乙型肝炎病毒DNA（HBV-DNA）清除率、乙型肝炎e抗原（HBeAg）转阴率和生存时间。结果 治疗后治疗组较对照组患者肝功能明显改善（P<0.05）。治疗组治疗3年后HBV-DNA 清除率和HBeAg 转阴率明显高于对照组（P<0.05）。随访期间共56 例复发,其中治疗组27 例,对照组29 例。治疗组和对照组1年、3 年总生存率分别为97.1%、44.2% vs 90.9%、27.0%,两组比较差异均有统计学意义（P均＜0.05）,且治疗组中位生存时间长于对照组（P<0.01）。结论 拉米夫定结合胸腺肽治疗合并HBV感染的肝癌术后患者可有效改善其肝功能,有利于清除病毒复制,提高生存时间,可作为HBV相关性肝癌患者术后的治疗方法。     

术前碱性磷酸酶与前白蛋白比值对肝细胞癌切除术后总体生存期的影响

 目的 探讨术前碱性磷酸酶和前白蛋白比值（alkaline phosphatase to prealbumin ratio,APR）对肝细胞癌（hepatocellular carcinoma,HCC）患者肝切除术后总生存期（overall survival,OS）的影响。方法 回顾性分析2012年1月至2016年12月广西医科大学附属肿瘤医院收治的942例接受肝切除术的HCC患者的临床资料。采用时间依赖的受试者工作特征（receiver operating characteristic,ROC）曲线确定APR的cut⁃off值,并根据cut⁃off值将患者分为高APR组（APR≥cut⁃off值）和低APR组（APRP<0.001）。多因素Cox比例风险回归模型分析结果显示,高APR是影响HCC患者肝切除术后OS的独立危险因素（HR=1.646,95%CI:1.323~2.047,P<0.001）。结论 术前高APR是HCC患者肝切除术后预后的独立危险因素,可能作为HCC患者肝切除术后不良预后的预测因子。     

急诊肝动脉栓塞联合二期肝部分切除治疗原发性肝癌破裂出血疗效Meta分析

目的 探讨急诊肝动脉栓塞（transcatheter arterial embolization, TAE）联合二期肝部分切除与急诊肝部分切除治疗原发性肝癌（hepatocellular carcinoma, HCC）破裂出血的疗效区别。方法 通过计算机及手工搜索国内外关于急诊TAE联合二期肝部分切除与急诊肝部分切除治疗HCC破裂出血效果对比的文献,按照纳入标准选择文献,提取相关数据,应用RevMan5.3软件进行统计学分析。结果 共纳入文献5篇,与急诊肝部分切除组相比,急诊TAE联合二期肝部分切除组患者并发症发生率明显降低（OR=0.27, 95%CI：0.03~0.40, P=0.008）,1、2、3年生存率无明显升高（1年生存率：OR=1.63, 95%CI：0.84~3.16, P=0.15;2年生存率：OR=1.40, 95%CI：0.63~3.11, P=0.41;3年生存率：OR=1.13, 95%CI：0.48~2.68, P=0.78）。结论 急诊TAE联合二期肝部分切除治疗HCC破裂出血,与急诊肝部分切除相比,可显著降低围手术期并发症,1、2、3年生存率组间比较差异无统计学意义,在手术后短期内使患者受益更大。     

巴塞罗那肝癌临床分期B期肝细胞性肝癌手术与TACE疗效比较

  目的  比较肝细胞性肝癌(HCC)巴塞罗那肝癌临床(BCLC)分期B期患者行肝切除术及经肝动脉化疗栓塞(TACE)治疗的疗效。  方法  回顾性分析2003年1月至2006年8月共222例BCLC B期、Child-PughA级HCC患者的生存资料, 采用t检验及秩和检验进行组间比较, 采用Cox模型分析危险因素, Kaplan-Meier曲线法分析总生存率。  结果  222例患者中, 肝切除术治疗118例, TACE治疗104例。肝切除术组患者的1、3、5年总生存率分别为76%、46%、37%, 中位生存期为29个月; TACE组患者的总生存率分别为53%、19%、7%, 中位生存期为11个月(P < 0.05)。Cox回归模型提示治疗方式TACE是影响预后的危险因素。  结论  肝切除术较TACE治疗可能更能提高BCLC B期、Child-Pugh A级HCC患者的总生存率。BCLC B期HCC的治疗方式应该按不同的亚组行更为细致的划分。      

Clp蛋白酶复合体亚基ClpX在肝细胞癌中的表达及意义

目的 探讨Clp蛋白酶复合体的ATP依赖性亚基（ATP-dependent Clp protease ATP-binding subunit，ClpX）在肝细胞癌（hepatocellular carcinoma，HCC） 组织中的表达及临床意义。方法 收集2013年1月至2014年12月于空军军医大学西京医院肝胆外科行根治性肝切除术的166例HCC患者癌组织及癌旁正常组织。采用免疫组化法检测HCC癌组织及相应癌旁正常组织中ClpX的表达，并分析ClpX蛋白表达与HCC患者临床病理特征及预后关系。在HCC癌细胞株SNU739中分别干涉或过表达ClpX后，采用MTS法检测细胞增殖能力。结果 ClpX在HCC癌组织中的表达水平低于癌旁正常组织（P＜0.001），ClpX高表达的HCC患者总生存期优于低表达患者（P=0.009）。ClpX表达水平与TNM分期相关（P=0.008），ClpX低表达是影响HCC患者总生存期的独立危险因素（P=0.046）。干涉ClpX表达后，SNU739细胞增殖能力较对照组增强（P＜0.001）；而过表达ClpX后，细胞增殖能力降低（P＜0.001）。结论 ClpX在HCC癌组织中呈低表达，且低表达患者预后更差；下调ClpX可促进细胞增殖，ClpX可作为HCC患者潜在的预后标志物。     

贝伐珠单抗联合多西他赛治疗HER-2阴性复发转移性乳腺癌的临床疗效

目的 观察贝伐珠单抗联合多西他赛治疗人表皮生长因子受体-2（human epidermal growth factor receptor-2,HER-2）阴性复发转移性乳腺癌的临床疗效。方法  79例HER-2阴性复发转移性乳腺癌患者根据不同化疗方案分为两组,观察组42例给予贝伐珠单抗联合多西他赛治疗,对照组37例给予多西他赛单药治疗,观察两组患者治疗后的临床疗效和1年、2年生存率及生存期。 结果 观察组总有效率为59.52%,对照组为37.84%,两组比较差异无统计学意义（P＞0.05）;观察组患者部分缓解率为47.62%,显著高于对照组的24.32%（P＜0.05）;观察组患者2年生存率为40.28%,高于对照组的16.22%（P＜0.05）;观察组患者贫血、血小板减少的发生率显著高于对照组（P＜0.05）。 结论 贝伐珠单抗联合多西他赛治疗HER-2阴性复发转移性乳腺癌的疗效较好,可提高患者生存率和生存期,但对患者血液系统影响较为明显,值得临床重视。     

单用双极电凝断肝法与钳夹法在肝蒂横断法肝切除术中的比较

目的 通过与经典的钳夹法断肝比较,探讨单用双极电凝断肝法在肝蒂横断法肝切除术中的临床价值。方法 收集101例行肝蒂横断法肝切除术的原发性肝癌患者的临床资料。依据术中离断肝实质方法的不同,分为钳夹法组及双极电凝组。对比分析两组患者临床资料的差异。结果 两组患者术前Child-Pugh分级、吲哚菁绿15 min清除率（indocyanine green clearance rate at 15min, ICGR15）、合并肝硬化情况及手术时间差异无统计学意义（P>0.05）。两组患者的手术出血量[（488.89±268.76）ml vs.（390.00±209.82）ml,P=0.041）]、术中输血率（25.92% vs. 8.51%, P=0.023）、术后第一日白蛋白（albumin, ALB）水平[（25.69±4.27）ml vs.（27.57±4.11）ml, P=0.026]及术后24 h腹引量[60.00（10.00, 135.00）ml vs. 50.00（30.00, 80.00）ml P=0.039]间差异有统计学意义。结论 单独使用双极电凝断肝能够减少肝蒂横断法肝切除术出血量,降低输血率,术后白蛋白水平更高,渗出更少。单用双极电凝断肝应用于肝蒂横断法肝切除术较传统钳夹法断肝更有优势,具有临床推广价值。     

单纯肝动脉化疗栓塞对中晚期肝癌患者疼痛的疗效分析

目的 观察单纯肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）对中晚期肝癌患者疼痛的治疗效果。方法 回顾性分析1 542例符合巴塞罗那肝癌分期系统的中晚期肝癌伴明显上腹部疼痛并随访半年以上患者的临床资料,根据是否采取TACE治疗,将患者分为TACE组（n=935）和对照组（n=607）,分析两组患者一般资料、治疗后6个月的疼痛缓解情况和不良反应发生率。结果 治疗前具有重度和中度疼痛的TACE组患者治疗6个月后疼痛显效率较对照组高（P<0.05）,而治疗前具有轻度疼痛的患者治疗6个月后疼痛显效率两组差异无统计学意义（P>0.05）。TACE组患者治疗后恶心呕吐发生率较对照组低（P<0.05）,但TACE相关性腹痛和骨髓抑制发生率明显增高（P<0.05）。结论 TACE可有效缓解治疗前有中重度疼痛的中晚期肝癌患者治疗后6个月的上腹部疼痛,但急性疼痛和骨髓抑制发生率较高。     

Transcatheter Arterial Chemoembolization Combined with Interferon-α is Safe and Effective for Patients with Hepatocellular Carcinoma after Curative Resection

Objectives: Intrahepatic recurrence is the major cause of death among patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative surgical resection. Several approaches have been reportedto decrease the recurrence rate. The objective of our study was to compare the clinical effects of transcatheterarterial chemoembolization (TACE) combined with interferon-alpha (IFN-α) therapy on recurrence after hepaticresection in patients with HBV-related HCC with that of TACE chemotherapy alone. Methods: We retrospectivelyanalyzed the data from 228 patients who were diagnosed with HBV-related HCC and underwent curative resectionbetween January 2001 to December 2008. The patients were divided into TACE (n = 126) and TACE-IFN-α (n= 102) groups for postoperative chemotherapy. The TACE regimen consisted of 5-fluorouracil (5-FU), cisplatin(DDP) , and the emulsion mixed with mitomycin C (MMC) and lipiodol. The recurrence rates, disease-freesurvival (DFS), overall survival (OS), and risk of recurrence were evaluated. Results: The clinicopathologicalparameters and adverse effects were similar between the 2 groups (P > 0.05). The median OS for the TACEIFN-α group (36.3 months) was significantly longer than that of the TACE group (24.5 months, P < 0.05). The3-and 5-year OS for the TACE-IFN-α group were significantly longer than those of the TACE group (P < 0.05)and the recurrence rate was significantly lower (P < 0.05). The TACE and IFN-α combination therapy, activehepatitis HBV infection, the number of tumor nodules, microvascular invasion, liver cirrhosis, and the BCLCstage were independent predictors of OS and DFS. Conclusions: The use of the TACE and IFN-α combinationchemotherapy after curative hepatic resection safely and effectively improves OS and decreases recurrencein patients with HBV-related HCC who are at high risk. Our findings can serve as a guide for the selection ofpostoperative adjuvant chemotherapy for patients with HBV-related HCC who are at high risk of recurrence.     

Efficacy of Prophylactic Entecavir for Hepatitis B Virus- Related Hepatocellular Carcinoma Receiving Transcatheter Arterial Chemoembolization

Background and Aims: Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE. Methods: A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints. Results: Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation. Conclusion: Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.     

Efficacy of Adjuvant Transarterial Chemoembolization Combined Antiviral Therapy for HBV-Related HCC with MVI after Hepatic Resection: A Multicenter Study

Background: Efficacy of transarterial chemoembolization (TACE) combined antiviral therapy (AVT) on long-term outcome in hepatitis B virus-related HCC with microvascular invasion (MVI) after hepatic resection is unclear. Methods: A multicenter retrospective study was conducted. All patients were divided into four groups according to postoperative adjuvant therapy (control group, AVT group, TACE group, and combined group). The overall survival (OS) and recurrence-free survival (RFS) were analyzed. Results: A total of 1090 patients were enrolled in this study, including control group (n=319), TACE group (n=152), AVT group (n=335) and combined group (n=284). Multivariate Cox analysis showed that postoperative adjuvant AVT and TACE were the independent protective factors for OS and RFS. The median OS among the control group, TACE group, AVT group, and the combined group were 16.44, 18.36 months, 38.88 months, and 48.24 months respectively(p<0.01). The median RFS among 4 group were 4.68, 5.40 months, 8.64 months and 10.32 months respectively(p<0.01). Conclusions: Postoperative adjuvant TACE and AVT were the independent protective factors associated with mortality and tumor recurrence in HBV-related HCC with MVI after resection. This combined treatment strategy may provide useful clinical significance in the prevention of tumor recurrence in these patients.     

The Impact of Sorafenib in Combination with Transarterial Chemoembolization on the Outcomes of Intermediate-Stage Hepatocellular Carcinoma

Background: We investigated the treatment outcomes and hepatic reserve of transarterial chemoembolization (TACE)-refractory patients with recurrent advanced hepatocellular carcinoma (HCC) treated with TACE plus sorafenib. Methods: Forty-one patients with intermediate-stage HCC defined as being TACE refractory on imaging were treated with sorafenib and TACE between 2009 and 2012 and comprised the combination treatment group. Twenty-nine patients who received repeated TACE after becoming refractory to TACE between 2005 and 2008 comprised the TACE continuation group. Results: Although the interval between successive rounds of TACE was significantly shorter before the patients developed TACE refractoriness, it was significantly longer after the development of TACE refractoriness, in the combination treatment group compared with the TACE continuation group. The appearance of extrahepatic spread and/or vascular invasion differed significantly between the two groups. The median overall survival was significantly longer in the combination treatment group than in the TACE continuation group (20.5 vs. 15.4 months, respectively; hazard ratio = 2.04; 95% confidence interval = 1.20–3.48). The 3-year overall survival rate was 33.4% in the combination treatment group and 3.5% in the TACE continuation group. Downstaging of the Child–Pugh class was significantly less frequent in the combination treatment group than in the TACE continuation group. In COX proportional hazards analyses, sorafenib plus TACE resulted in a better prognosis compared with repeated TACE. Conclusions: Treatment with sorafenib plus TACE in TACE-refractory patients with intermediate-stage HCC resulted in longer intervals between TACE rounds, better maintenance of hepatic reserve, and significantly longer OS compared with repeated TACE.     

广西肝癌高发区原发性肝细胞癌 HBV X 基因的整合及影响因素分析

目的 了解广西肝癌高发区乙型肝炎病毒（hepatitis B virus,HBV）X区基因在肝细胞癌（hepatocellular carcinoma,HCC）染色体中的整合及影响因素。方法 以30例与HBV相关的原发性肝细胞癌患者为研究对象。提取HCC组织及癌旁组织标本DNA作为模板,以HBV X基因上游序列和人类基因组Alu重复序列为引物,应用重复序列-多聚酶链反应（Alu-PCR）扩增整合的HBV X片段及两侧的人类基因组DNA片段。扩增产物进行测序,计算目的片段整合率并分析相关的影响因素。结果 18例HCC组织检测到HBV X基因的整合片段,整合率为60.00%（18/30）;26例癌旁组织检测到HBV X基因的整合片段,整合率为86.67%（26/30）。癌旁组织HBV病毒整合率高于HCC组织,差异有统计学意义（χ²=5.445,P=0.020）。不同性别、年龄、HBeAg、HBV DNA、ALT、AST的HCC癌组织及其癌旁组织HBV X基因整合率比较差异均无统计学意义（P＞0.05）。结论 广西肝癌高发区癌旁组织比HCC组织HBV整合率高,说明HBV整合发生在感染早期。HBV X基因整合与HCC患者性别、年龄、HBeAg、HBV DNA、ALT、AST无明显关系。     

直肠癌术后三维适形/调强放疗联合化疗与单纯辅助化疗的疗效比较

目的 比较直肠癌术后三维适形/调强放疗联合化疗与术后单纯化疗的疗效及不良反应。方法 回顾性分析直肠癌根治术患者226例,其中辅助化疗组116例,辅助放化疗组110例。辅助放化疗组采用三维适形放疗88例,调强放疗22例。剂量范围45～54 Gy,中位剂量50 Gy。全组患者化疗周期数为2～8周期,中位4周期。观察患者不良反应,比较三维适形/调强放疗联合化疗与单纯术后化疗两组不同辅助治疗模式对局部复发率、总生存率（OS）及无病生存率（DFS）的影响。结果 术后放化组1、2、3年局部复发率分别为3.8%、10.5%、10.5%,明显低于术后化疗组的15.5%、29.7%、33.2%（P=0.001）,术后放化组与术后化疗组1、2、3年OS分别为94.2%、76%、70.7%和95.6%、68.4%、53.5%,组间差异接近统计学意义（P=0.059）,1、2、3年DFS组间差异无统计学意义（P=0.608）。术后放化组的胃肠道、血液学不良反应发生率分别为78.2%和64.5%,高于术后化疗组的41.4%和30.2%（P=0.000;P=0.000）。亚组分析显示Ⅱ期患者术后放化组和术后化疗组1、2、3年OS、DFS差异均无统计学意义（P=0.810;P=0.067）。Ⅲ期患者术后放化组的1、2、3年OS高于术后化疗组,差异有统计学意义（P=0.047）,DFS与术后化疗组比较差异无统计学意义（P=0.201）。术后放化组中20.9%患者出现放射性肠炎;10%患者出现放射性膀胱炎。无3级以上不良反应发生。结论 直肠癌术后三维适形/调强放疗联合化疗可显著降低局部复发率,提高Ⅲ期直肠癌患者总生存率。放化联合治疗组血液学及胃肠道不良反应高于术后单纯化疗,但患者耐受性较好。盆腔照射采用三维适形或调强放疗技术,在提高局控率的同时可较常规放疗显著降低放射性膀胱炎和放射性肠炎的发生率和发生程度。     

m6A去甲基化酶ALKBH5在肝细胞癌组织中的表达及其临床意义

目的 探讨m6A去甲基化酶烷基化修复蛋白B同源物5(alkylation repair protein B homolog 5,ALKHB5)在肝细胞癌(hepatocellular carcinoma,HCC)组织中的表达及其临床意义.方法 收集2009年1月至2013年8月在桂林医学院附属医院接受肝癌切除术的80例...     

The safety and efficacy of TACE combined with apatinib on patients with advanced hepatocellular carcinoma: a retrospective study

As a novel vascular endothelial growth factor receptor-2 tyrosine kinase inhibitor (VEGFR2-TKI), apatinib has a certain anti-tumor effect for a variety of solid tumors. The present study evaluates its efficacy and safety in advanced hepatocellular carcinoma (HCC). In this study, 47 patients with advanced HCC were included. TACE monotherapy group included 22 patients that responded to TACE, while the group that received TACE and apatinib included 25 patients that progressed on TACE and were able to receive apatinib off label. Median overall survival (OS) was significantly improved in the apatinib plus TACE group compared with the TACE group. Similarly, apatinib in combination with TACE significantly prolonged median progression-free survival (PFS) compared with TACE monotherapy. Furthermore, there was a significant difference between combination therapy and monotherapy in both Barcelona clinic liver cancer (BCLC) B and BCLC C group. The combination therapy had a dramatic effect on OS and PFS for patients at both BCLC B and BCLC C level. The most common clinically adverse events of apatinib plus TACE group were fatigue, weight loss, hypertension, hand-foot syndrome and anorexia, which were manageable and tolerable. The efficacy analysis showed that there was no significant association of survival benefit with age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, hypertension and hand-foot syndrome. Patients with macrovascular invasion and extrahepatic invasion showed worse survival benefits. In conclusion, apatinib combined with TACE revealed certain survival benefits for HCC patients who experienced progression following TACE, which can provide a promising strategy for HCC treatment.     

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

目的 建立肝细胞癌（简称肝癌）根治性切除术后预防性动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）治疗的卫生经济学评价模型。方法 140例肝癌患者根治性切除术后分为TACE组和非TACE组（即门诊随访组）,收集两组治疗方案直接医疗成本和治疗效果（复发率及无瘤生存时间）,进行成本效果分析、增量成本效果分析和敏感度分析。结果 （1）40例非TACE组患者门诊总平均费用为7 121.44元/人;100例TACE组患者复发前总费用为2 8250.45元/人。（2）非TACE组和TACE组的1、2、3、4、5年复发率比较差异无统计学意义（P＞0.05）;两组无瘤生存时间比较差异无统计学意义（P=0.322）。（3）非TACE组的成本效果比为389.15元/月,TACE组为1 278.30元/月,增量成本效果比为5 560.27元/月。（4）敏感度分析中非TACE组的成本度效果比为350.84元/月,TACE组为1 215.81元/月,增量成本效果比为5 381.35元/月。结论 从卫生经济学角度,预防肝癌术后复发,预防性TACE并不是最优方案,至少不是每个患者都应该或都适合做,在相同的效果下（复发率、无瘤生存时间）门诊随访治疗可能更经济。