Hasegawa Izumi, Hirashima Noboru
Dept. of Gastroenterology, Chukyo Hospital.
Gan To Kagaku Ryoho. 2002 Feb;29(2):253-9.
To evaluate the effect of styrene maleic neocarzinostatin-transcatheter arterial embolization (SMANCS-TAE), 40 patients with unresectable hepatocellular carcinoma (HCC) of hypervascular radiological feature, associated with liver cirrhosis (LC), 18 in clinical stage 2 and 20 in stage 3, were treated by SMANCS-TAE. SMANCS with Lipiodol and then gelatin sponge particles were injected into the artery branch supplying HCC using selective catheterization, and its effect was evaluated by computed tomography (CT) Grade. In patients with Grade III or less (Lipiodol accumulation < 99% in the entire tumor) after the first course of therapy, SMANCS-TAE or arterial injection of SMANCS-Lipiodol was performed once or twice more. Consequently, 32 of 40 patients (80%) obtained Grade IV (100% Lipiodol accumulation in the entire tumor) after from once to thrice (median, 1.6 courses). Grade IV was maintained in 26 of 32 patients, and non-recurrence was found 16 of 40 (40%) at the primary tumor to the time at last of follow up. Severe side effects were not noted except in 10 cases with narrowness of hepatic artery and cases of 2 biloma in patients undergoing therapy two or more times. The 1-, 2-, 3-, and 5-year survival rate was 85, 64, 35, and 26%, respectively. No significant difference was noted in the survival rate between clinical stage 2 and 3 liver cirrhosis (LC). But the survival rate of patients who continued to exhibit Grade IV at the primary tumor was significantly better than in those exhibiting Grade III or less (96, 68, 56, and 43% vs 64, 29, 0, and 0%, respectively; p < 0.01). In conclusion, the HCC patients, even those with decompensated LC, who obtained and maintained Grade IV after SMANCS-TAE could reduce the courses of treatment without severe side effects and survived longer. SMANCS-TAE might be useful for the good quality of life of HCC patients.
为评估苯乙烯马来酸新制癌菌素经导管动脉栓塞术（SMANCS-TAE）的效果，对40例具有富血管影像学特征、合并肝硬化（LC）的不可切除肝细胞癌（HCC）患者进行了治疗，其中临床2期18例，3期20例。采用选择性插管将SMANCS与碘油，然后再将明胶海绵颗粒注入供应HCC的动脉分支，通过计算机断层扫描（CT）分级评估其效果。在首个疗程后CT分级为III级或更低（整个肿瘤内碘油积聚<99%）的患者中，再次进行1至2次SMANCS-TAE或动脉注射SMANCS-碘油。结果，40例患者中有32例（80%）在经过1至3次（中位数为1.6个疗程）治疗后达到IV级（整个肿瘤内碘油积聚100%）。32例患者中有26例维持在IV级，40例患者中有16例（40%）在最后一次随访时原发肿瘤未复发。除10例肝动脉狭窄患者以及接受两次或更多次治疗的患者中有2例出现胆汁瘤外，未观察到严重副作用。1年、2年、3年和5年生存率分别为85%、64%、35%和26%。临床2期和3期肝硬化（LC）患者的生存率无显著差异。但原发肿瘤持续表现为IV级的患者生存率明显高于表现为III级或更低的患者（分别为96%、68%、56%和43% 与64%、29%、0%和0%；p<0.01）。总之，即使是失代偿期LC的HCC患者，在接受SMANCS-TAE后达到并维持IV级，也可减少治疗疗程且无严重副作用，生存期更长。SMANCS-TAE可能对提高HCC患者的生活质量有用。
