Kang In Koo, Kim Sung Woo, Hahn Sung Hee, Cho Seung Chul, Gham Chang Woo, Lee Dong Hoo
Institute of Digestive Diseases, Hanyang University, Seoul, Korea.
Taehan Kan Hakhoe Chi. 2002 Jun;8(2):189-200.
BACKGROUND/AIMS: Although hepatocellular carcinoma(HCC) shows poor prognosis, transcatheter hepatic arterial chemoembolization(TACE) can improve survival rate in some patient groups. This study investigated the synergy effect of the different clinical indices on the survival time in patients with HCC underwent TACE.
A retrospective study of 241 patients with HCC who underwent TACE with a mixture of lipiodol, mitomycin-C and adriamycin, alone or followed by gelfoam was conducted. Three different survival groups (A, less than 6 months; B, between between 6 and 23 months; and C, over 24 months) were compared.
Alkaline phosphatase was lowest in group C (p=0.0001). The longer the survival, the lower (p=0.027, p=0.007) the AST and AST/ALT ratio were. Albumin was higher (p=0.032), GGT and LDH were lower (p=0.003, p=0.002) in the long-term survival group. The long-term survival group revealed an absence of both ascites(p<0.002) and portal vein thrombosis(p<0.001), and lower TNM stage (P<0.0001). The single nodular type of HCC was more frequent (P<0.0001) and the size of tumor was smaller in the long-term survival group (P<0.0001). Child-Pugh class was lower in the long-term survival group (p=0.017). The higher serum albumin and elder age, the higher albumin and the lower alkaline phosphatase or alpha-fetoprotein, represented synergic effects on a long term survival. The higher albumin and the smaller size or the lower tumor stage, the higher albumin and platelet revealed similar synergy effects. Although the age or platelet is high, low albumin showed poor prognosis.
Patients with small-sized single, nodular HCC in a low Child-Pugh class without evidence of ascites and portal vein thrombosis, and the higher level of serum albumin but lower levels of alpha-fetoprotein, alkaline phosphatase, GGT, and LDH, can expect a long-term survival over 24 months by the treatment of TACE. There are meaningful synergies of the different clinical variables affecting the survival times in the patients with HCC undergoing TACE.
背景/目的：尽管肝细胞癌（HCC）预后较差，但经导管肝动脉化疗栓塞术（TACE）可提高部分患者群体的生存率。本研究探讨了不同临床指标对接受TACE治疗的HCC患者生存时间的协同作用。
对241例行TACE治疗的HCC患者进行回顾性研究，TACE使用碘油、丝裂霉素-C和阿霉素混合剂，单独使用或继以明胶海绵。比较三个不同生存组（A组，生存时间小于6个月；B组，生存时间在6至23个月之间；C组，生存时间超过24个月）。
C组碱性磷酸酶最低（p = 0.0001）。生存时间越长，AST和AST/ALT比值越低（p = 0.027，p = 0.007）。长期生存组白蛋白较高（p = 0.032），GGT和LDH较低（p = 0.003，p = 0.002）。长期生存组无腹水（p < 0.002）和门静脉血栓形成（p < 0.001），TNM分期较低（P < 0.0001）。长期生存组HCC单结节型更常见（P < 0.0001），肿瘤大小较小（P < 0.0001）。长期生存组Child-Pugh分级较低（p = 0.017）。血清白蛋白水平较高和年龄较大、白蛋白水平较高且碱性磷酸酶或甲胎蛋白水平较低，对长期生存具有协同作用。白蛋白水平较高且肿瘤大小较小或肿瘤分期较低、白蛋白水平较高且血小板水平较高显示出类似的协同作用。尽管年龄或血小板水平较高，但白蛋白水平较低预后较差。
Child-Pugh分级较低、无腹水和门静脉血栓形成证据、血清白蛋白水平较高但甲胎蛋白、碱性磷酸酶、GGT和LDH水平较低的单结节小肝癌患者，经TACE治疗有望获得超过24个月的长期生存。影响接受TACE治疗的HCC患者生存时间的不同临床变量存在有意义的协同作用。
