Ando Eiji, Tanaka Masatoshi, Yamashita Fumihiko, Kuromatsu Ryoko, Yutani Shigeru, Fukumori Kazuta, Sumie Shuji, Yano Yoichi, Okuda Koji, Sata Michio
Department of Medicine II, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-shi, Fukuoka-ken 830-0011, Japan.
Cancer. 2002 Aug 1;95(3):588-95. doi: 10.1002/cncr.10694.
The prognosis of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is extremely poor. The aim of this study was to elucidate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with advanced HCCs.
Forty-eight HCC patients with PVTT were treated by HAIC via a subcutaneously implanted injection port. Of these, 14 had PVTT in the second portal branch and 34 patients had PVTT in the first portal branch or in the main portal trunk. One course of chemotherapy consisted of daily cisplatin (7 mg/m(2) for 1 hour on Days 1-5) followed by 5-fluorouracil (170 mg/m(2) for 5 hours on Days 1-5). Patients were scheduled to receive four serial courses of HAIC. Responders were defined as having either a complete response (CR) or partial response (PR) and nonresponders were defined as exhibiting stable disease or progressive disease. The prognosis after HAIC and factors related to survival were analyzed.
Following HAIC, 4 and 19 patients exhibited a CR and PR, respectively (response rate = 48%). The 1, 2, 3, and 5-year cumulative survival rates of 48 patients treated with HAIC were 45%, 31%, 25%, and 11%, respectively. Median survival periods for 23 responders and 25 nonresponders were 31.6 (range, 8.3-76.9) months and 5.4 (1.9-29.0) months, respectively. Therapeutic effect (P < 0.001) and hepatic reserve capacity (P = 0.021) were identified as significant prognostic factors by univariate analysis. Multivariate analysis identified only therapeutic effect as being significantly related to survival.
HAIC using low-dose cisplatin and 5-fluorouracil may be a useful therapeutic option for patients with advanced HCC with PVTT. HCC patients with PVTT who respond to HAIC could certainly have survival benefits.
伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者预后极差。本研究旨在阐明肝动脉灌注化疗（HAIC）对晚期HCC患者的疗效。
48例伴有PVTT的HCC患者通过皮下植入注射端口接受HAIC治疗。其中，14例患者的癌栓位于门静脉二级分支，34例患者的癌栓位于门静脉一级分支或门静脉主干。一个化疗疗程包括每日给予顺铂（第1 - 5天，7 mg/m²，持续1小时），随后给予5 - 氟尿嘧啶（第1 - 5天，170 mg/m²，持续5小时）。患者计划接受四个连续疗程的HAIC。缓解者定义为完全缓解（CR）或部分缓解（PR），无缓解者定义为疾病稳定或疾病进展。分析了HAIC后的预后及生存相关因素。
HAIC治疗后，分别有4例和19例患者出现CR和PR（缓解率 = 48%）。48例接受HAIC治疗的患者1年、2年、3年和5年累积生存率分别为45%、31%、25%和11%。23例缓解者和25例无缓解者的中位生存期分别为31.6（范围8.3 - 76.9）个月和5.4（1.9 - 29.0）个月。单因素分析确定治疗效果（P < 0.001）和肝储备功能（P = 0.021）为显著的预后因素。多因素分析仅确定治疗效果与生存显著相关。
使用低剂量顺铂和5 - 氟尿嘧啶的HAIC可能是伴有PVTT的晚期HCC患者的一种有效治疗选择。对HAIC有反应的伴有PVTT的HCC患者肯定能从生存中获益。
