Ueki Toshiharu, Sakaguchi Seigo, Miyajima Yasushi, Hatono Nagafusa, Tohara Keiji, Nakabayashi Shoichi, Yao Tsuneyoshi, Kokawa Hiroshi, Hirano Motoi, Okumura Makoto
Department of Gastroenterology, Chikushi Hospital, Fukuoka University, 377-1 Ohaza-Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan.
Cancer. 2002 Aug 1;95(3):596-604. doi: 10.1002/cncr.10690.
The current study was designed to determine the usefulness of pretreatment tumor pressure as a new prognostic factor in patients with small hepatocellular carcinoma (HCC; 3 cm or smaller in diameter).
The study included 39 patients with small HCC in whom tumor pressure was determined. They underwent percutaneous ethanol (with Lipiodol) injection therapy (Lp-PEI) or transcatheter arterial embolization (TAE) of the hepatic artery. Tumor pressure was determined percutaneously under ultrasonographic guidance. The factors analyzed were age, gender, mean blood pressure, the presence/absence of antibody to hepatitis C virus (anti-HCV), alcohol abuse, Child's classification, the presence/absence of esophagogastric varices, serum alpha-fetoprotein (AFP) level, tumor size, number of tumors, degree of tumor differentiation, the presence/absence of tumor capsule, tumor pressure, and the method of treatment. Multivariate analysis using Cox proportional hazards model was conducted on the factors that may have affected prognosis (P < 0.25) according to the univariate analysis using a proportional hazards model.
The rates of local and distant recurrence were higher (P < 0.01, P < 0.01, respectively) and the survival rate was lower (P = 0.03) in patients with high tumor pressure than in those with low tumor pressure. Multivariate analysis revealed that tumor pressure (P < 0.01), AFP level (P = 0.01), and age (P = 0.01) were significant predictive factors associated with local recurrence. Tumor pressure (P < 0.01) and AFP level (P < 0.01) were both significantly associated with distant recurrence. The only significant predictive factor associated with survival rate was tumor pressure (P < 0.04).
The current study revealed that tumor pressure was associated significantly with survival rates after Lp-PEI or TAE in patients with small HCC. There were also significant predictive factors associated with local recurrence, these being tumor pressure, AFP level, and age, and with distant recurrence, namely, tumor pressure and AFP level. Tumor pressure measured before the initial treatment of patients with small HCC may be a useful new prognostic factor.
本研究旨在确定治疗前肿瘤压力作为小肝细胞癌（HCC；直径3cm或更小）患者新的预后因素的有用性。
本研究纳入了39例测定了肿瘤压力的小HCC患者。他们接受了经皮乙醇（联合碘油）注射治疗（Lp-PEI）或肝动脉经导管动脉栓塞术（TAE）。在超声引导下经皮测定肿瘤压力。分析的因素包括年龄、性别、平均血压、丙型肝炎病毒抗体（抗-HCV）的有无、酗酒、Child分级、食管胃静脉曲张的有无、血清甲胎蛋白（AFP）水平、肿瘤大小、肿瘤数量、肿瘤分化程度、肿瘤包膜的有无、肿瘤压力以及治疗方法。根据使用比例风险模型的单变量分析，对可能影响预后（P<0.25）的因素进行了使用Cox比例风险模型的多变量分析。
肿瘤压力高的患者局部复发率和远处复发率均较高（分别为P<0.01，P<0.01），生存率较低（P=0.03）。多变量分析显示，肿瘤压力（P<0.01）、AFP水平（P=0.01）和年龄（P=0.01）是与局部复发相关的显著预测因素。肿瘤压力（P<0.01）和AFP水平（P<0.01）均与远处复发显著相关。与生存率相关的唯一显著预测因素是肿瘤压力（P<0.04）。
本研究表明，肿瘤压力与小HCC患者接受Lp-PEI或TAE后的生存率显著相关。也有与局部复发相关的显著预测因素，即肿瘤压力、AFP水平和年龄，以及与远处复发相关的因素，即肿瘤压力和AFP水平。小HCC患者初始治疗前测定的肿瘤压力可能是一个有用的新预后因素。
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