Akamatsu Masatoshi, Yoshida Haruhiko, Obi Shuntaro, Sato Shinpei, Koike Yukihiro, Fujishima Tomonori, Tateishi Ryosuke, Imamura Masatoshi, Hamamura Keisuke, Teratani Takuma, Shiina Shuichiro, Ishikawa Takashi, Omata Masao
Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan.
Liver Int. 2004 Dec;24(6):625-9. doi: 10.1111/j.1478-3231.2004.0963.x.
Transcatheter arterial embolization (TAE) may reduce the risk of hepatocellular carcinoma (HCC) recurrence when performed before percutaneous tumor ablation (PTA), either percutaneous ethanol injection therapy (PEIT) or radiofrequency ablation (RFA). We conducted a randomized, controlled trial comparing the use of TAE combined with percutaneous ethanol injection therapy (TAE/PEIT) to the use of PEIT only to assess the effects on HCC recurrence and survival. We continued the study after the introduction of RFA and compared TAE combined with RFA (TAE/RFA) with RFA only.
Between March 1997 and April 2001, 42 HCC patients were enrolled who satisfied the following inclusion criteria: (1) uninodular HCC as determined by angiography under computed tomography, (2) arterial hypervascularity, and (3) no prior history of HCC treatment. Twenty-two patients were treated with TAE/PTA (PEIT, 12; RFA, 10) and 20 patients with PTA only (PEIT, 14; RFA, 6).
There were four cases of local recurrence in the PTA-only group and none in the TAE/PTA group (P=0.043). The four patients with local recurrence were treated with PEIT. None of the patients treated with RFA showed local recurrence. The effect of TAE on overall recurrence was not significant (P=0.4179). In the multivariate analysis, prior TAE was not significant for survival (P=0.514).
TAE has a limited use in suppressing local recurrence when performed before PEIT but not before RFA.
经导管动脉栓塞术（TAE）在经皮肿瘤消融术（PTA），即经皮乙醇注射疗法（PEIT）或射频消融术（RFA）之前进行，可能会降低肝细胞癌（HCC）复发的风险。我们进行了一项随机对照试验，比较TAE联合经皮乙醇注射疗法（TAE/PEIT）与单纯使用PEIT，以评估对HCC复发和生存的影响。在引入RFA后，我们继续该研究，并比较TAE联合RFA（TAE/RFA）与单纯RFA。
1997年3月至2001年4月，纳入42例符合以下纳入标准的HCC患者：（1）经计算机断层扫描血管造影确定为单结节HCC，（2）动脉血管增多，（3）无HCC治疗史。22例患者接受TAE/PTA治疗（PEIT，12例；RFA，10例），20例患者仅接受PTA治疗（PEIT，14例；RFA，6例）。
单纯PTA组有4例局部复发，TAE/PTA组无局部复发（P = 0.043）。4例局部复发患者接受了PEIT治疗。接受RFA治疗的患者均未出现局部复发。TAE对总体复发率的影响不显著（P = 0.4179）。在多变量分析中，既往TAE对生存率无显著影响（P = 0.514）。
TAE在PEIT之前进行时，对抑制局部复发的作用有限，但在RFA之前进行时并非如此。
