Guo Wei-Jian, Yu Er-Xin, Liu Lu-Ming, Li Jie, Chen Zhen, Lin Jun-Hua, Meng Zhi-Qiang, Feng Yi
Department of Oncology, Xinhua Hospital of Shanghai Second Medical University, 1665 Kongjiang Road, Shanghai 200092, China.
World J Gastroenterol. 2003 Aug;9(8):1697-701. doi: 10.3748/wjg.v9.i8.1697.
To investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiotherapy for unresectable large hepatocellular carcinoma (HCC).
From June 1994 to June 1999, a total of 76 patients with large unresectable HCC were treated with TACE followed by external-beam irradiation. 89 patients with large HCC, who underwent TACE alone during the same period, served as the control group. Clinical features, therapeutic modalities, acute effects and survival rates were analyzed and compared between TACE plus irradiation group and TACE alone group. A multivariate analysis of nine clinical variables and one treatment variable (irradiation) was performed by the Cox proportional hazards model.
The clinical features and therapeutic modalities except irradiation between the two groups were comparable (P>0.05). The objective response rate (RR) in TACE plus irradiation group was higher than that in TACE alone group (47.4 % vs 28.1 %, P<0.05). The overall survival rates in TACE plus irradiation group (64.0 %, 28.6 %, and 19.3 % at 1, 3, 5 years, respectively) were significantly higher than those in TACE alone group (39.9 %, 9.5 %, and 7.2 %, respectively, P=0.0001). Cox proportional hazards model analysis showed that tumor extension and Child grade were significant and were independent negative predictors of survival, while irradiation was an independent positive predictor of survival.
TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.
探讨经动脉化疗栓塞术（TACE）联合放疗治疗不可切除的大肝癌（HCC）的疗效。
1994年6月至1999年6月，共有76例不可切除的大肝癌患者接受了TACE治疗，随后进行外照射。同期89例仅接受TACE治疗的大肝癌患者作为对照组。分析比较TACE联合放疗组和单纯TACE组的临床特征、治疗方式、急性效应和生存率。采用Cox比例风险模型对9个临床变量和1个治疗变量（放疗）进行多因素分析。
两组除放疗外的临床特征和治疗方式具有可比性（P>0.05）。TACE联合放疗组的客观缓解率（RR）高于单纯TACE组（47.4%对28.1%，P<0.05）。TACE联合放疗组的总生存率（1年、3年和5年分别为64.0%、28.6%和19.3%）显著高于单纯TACE组（分别为39.9%、9.5%和7.2%，P=0.0001）。Cox比例风险模型分析显示，肿瘤扩展和Child分级是显著的，且是生存的独立负性预测因素，而放疗是生存的独立正性预测因素。
TACE联合放疗比单纯TACE更有效，是治疗不可切除大肝癌的一种有前景的治疗方法。
