Fan J, Wu Z, Tang Z
Cancer Institute, Zhongshan Hospital, Medical Center, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2001 Oct;39(10):745-8.
To study the therapeutic results of hepatic resection for shrunk hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and hepatic artery ligation and chemoembolization (HALCE) in patients with unresectable HCC, and compare the influence of the above different treatment modalities on the prognosis.
Two hundred and four patients w ith pathologically proven HCC by two stage liver resection were classified into two groups: TACE group (n = 112) and HALEC group (n = 92). The patients in the TACE group received a total of 1-7 consecutive treatment courses (average, 2.4 +/- 1.2 courses). HALCE was done in 49 patients. HALCE alternating fractionated radiotherapy was employed in 7 patients and HALCE + targeting regional internal radiotherapy in 36. Shrunk tumors were surgically removed by two-stage operation in all the patients with unresectable HCC. Seven possible factors influencing the results of two-stage resection of HCC were studied.
All the patients were followed up to June, 1999. The 1-, 3-, 5-, and 7-year survival rates were 95.7%, 69.3%, 56.5% and 44.5% after the first TACE and HALCE, respectively and 88.5%, 64.9%, 51.9% and 38.3% after resection of the shrunk HCC, respectively. The 1-, 3-, 5- and 7-year survival rates were 94.1%, 64.7%, 51.2% and 40.8% respectively in the TACE group and 96.3%, 73.9%, 61.6% and 45.2% respectively in the HALCE group. There were no statistically differences between the survival rates in the TACE and HALCE groups. The extent of cirrhotic liver and percentage of tumor necrosis were of prognostic significance. In the TACE group, the extent of cirrhotic liver, the percentage of tumor necrosis and whether capsule of shrunk tumor was complete or in complete were of prognostic significance. In the HALCE group, however, the 7 factors were not found to be statistically significant for the prognosis.
Sequential resection should be done after cytoreduction of tumor for the patients with unresectable HCC, which might improve their survival. The extent of cirrhotic liver and the percentage of tumor necrosis after TACE or HALCE are the major factors affecting the survival of patients with two-stage operation.
研究经动脉化疗栓塞术（TACE）及肝动脉结扎化疗栓塞术（HALCE）后肝切除治疗不可切除肝细胞癌（HCC）缩小后的疗效，并比较上述不同治疗方式对预后的影响。
204例经两阶段肝切除病理证实为HCC的患者分为两组：TACE组（n = 112）和HALCE组（n = 92）。TACE组患者共接受1 - 7个连续疗程（平均2.4±1.2个疗程）的治疗。49例患者接受HALCE治疗。7例患者采用HALCE交替分割放疗，36例采用HALCE + 靶向区域内放疗。所有不可切除HCC患者缩小后的肿瘤均通过两阶段手术切除。研究了影响HCC两阶段切除结果的7个可能因素。
所有患者随访至1999年6月。首次TACE和HALCE后1年、3年、5年和7年生存率分别为95.7%、69.3%、56.5%和44.5%，缩小后的HCC切除后分别为88.5%、64.9%、51.9%和38.3%。TACE组1年、3年、5年和7年生存率分别为94.1%、64.7%、51.2%和40.8%，HALCE组分别为96.3%、73.9%、61.6%和45.2%。TACE组和HALCE组生存率无统计学差异。肝硬化肝脏程度和肿瘤坏死百分比具有预后意义。在TACE组中，肝硬化肝脏程度、肿瘤坏死百分比以及缩小后肿瘤包膜是否完整具有预后意义。然而，在HALCE组中，未发现这7个因素对预后有统计学意义。
对于不可切除HCC患者，应在肿瘤细胞减灭后进行序贯切除手术，这可能会提高其生存率。TACE或HALCE后肝硬化肝脏程度和肿瘤坏死百分比是影响两阶段手术患者生存的主要因素。
