Huppert P E, Lauchart W, Duda S H, Torkler C, Kloska S P, Weinlich M, Benda N, Pereira P, Claussen C D
Abteilung für Radiologische Diagnostik, Universität Tübingen, Tuebingen.
Rofo. 2004 Mar;176(3):375-85. doi: 10.1055/s-2004-812776.
To determine independent prognostic factors influencing the survival of patients with hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE).
Ninety-one patients with unresectable HCC were treated with 269 repetitive TACE. The dosages of epirubicin (40-60 mg) and ethiodized oil (8-20 ml) were adjusted to tumor size and liver function. The impact of tumor size, macroscopic tumor type, tumor location, portal vein infiltration, capsular infiltration, tumor vascularization, uptake of ethiodized oil within the tumors, Child-Pugh-Class and Okuda-Stage on patient survival were evaluated by means of univariate and multivariate regression analysis.
The following independent prognostic factors were found: tumor type (nodular vs. infiltrating, p = 0 008), tumor size (p = 0.01), Child-Pugh-Class (A vs. B; p = 0.02) and grade of tumor vascularization (p = 0.04). In 57 patients with HCC of the nodular type, the median survival time was significant longer than in 32 patients with HCC of the infiltrating type (17.0 months vs. 7.9 months; p < 0.003; 2 tumors could not be classified). The 1-, 2- and 3-year-survival rates were significantly higher in 57 patients with Okuda-Stage I disease, compared to 34 patients with Okuda-Stage II and III disease (73%, 31% and 8% vs. 23%, 6% and 4% p < 0.0001).
Tumor type, tumor size and grade of liver cirrhosis have an independent impact on prognosis of patients with HCC treated by TACE. An appropriate selection of patients is necessary to improve patients survival.
确定影响经导管动脉化疗栓塞术（TACE）治疗的肝细胞癌（HCC）患者生存的独立预后因素。
91例不可切除的HCC患者接受了269次重复TACE治疗。表柔比星（40 - 60 mg）和碘化油（8 - 20 ml）的剂量根据肿瘤大小和肝功能进行调整。通过单因素和多因素回归分析评估肿瘤大小、宏观肿瘤类型、肿瘤位置、门静脉浸润、包膜浸润、肿瘤血管形成、肿瘤内碘化油摄取、Child-Pugh分级和奥田分期对患者生存的影响。
发现以下独立预后因素：肿瘤类型（结节型与浸润型，p = 0.008）、肿瘤大小（p = 0.01）、Child-Pugh分级（A与B；p = 0.02）和肿瘤血管形成分级（p = 0.04）。在57例结节型HCC患者中，中位生存时间显著长于32例浸润型HCC患者（17.0个月对7.9个月；p < 0.003；2个肿瘤无法分类）。与34例奥田II期和III期疾病患者相比，57例奥田I期疾病患者的1年、2年和3年生存率显著更高（73%、31%和8%对23%、6%和4%，p < 0.0001）。
肿瘤类型、肿瘤大小和肝硬化分级对TACE治疗的HCC患者的预后有独立影响。为提高患者生存率，有必要适当选择患者。
