Dettmer Arne, Kirchhoff Timm-D, Gebel Michael, Zender Lars, Malek Nisar-P, Panning Bernhard, Chavan Ajay, Rosenthal Herbert, Kubicka Stefan, Krusche Susanne, Merkesdal Sonja, Galanski Michael, Manns Michael-P, Bleck Joerg-S
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany.
World J Gastroenterol. 2006 Jun 21;12(23):3707-15. doi: 10.3748/wjg.v12.i23.3707.
To evaluate the treatment effect of percutaneous ethanol injection (PEI) for patients with advanced, non-resectable HCC compared with combination of transarterial chemoembolisation (TACE) and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care.
All patients who received PEI treatment during the study period were included and stratified to one of the following treatment modalities according to physical status and tumor extent: combination of TACE and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. Prognostic value of clinical parameters including Okuda-classification, presence of portal vein thrombosis, presence of ascites, number of tumors, maximum tumor diameter, and serum cholinesterase (CHE), as well as Child-Pugh stage, alpha-fetoprotein (AFP), fever, incidence of complications were assessed and compared between the groups. Survival was determined using Kaplan-Meier and multivariate regression analyses.
The 1- and 3-year survival of all patients was 73% and 47%. In the subgroup analyses, the combination of TACE and PEI (1) was associated with a longer survival (1-, 3-, 5-year survival: 90%, 52%, and 43%) compared to PEI treatment alone (2) (1-, 3-, 5-year survival: 65%, 50%, and 37%). Secondary PEI after initial stratification to TACE (3) yielded comparable results (1-, 3-, 5-year survival: 91%, 40%, and 30%) while PEI after stratification to best supportive care (4) was associated with decreased survival (1-, 3-, 5-year survival: 50%, 23%, 12%). Apart from the chosen treatment modalities, predictors for better survival were tumor number (n < 5), tumor size (< 5 cm), no ascites before PEI, and stable serum cholinesterase after PEI (P < 0.05). The mortality within 2 wk after PEI was 2.8% (n = 3). There were 24 (8.9%) major complications after PEI including segmental liver infarction, focal liver necrosis, and liver abscess. All complications could be managed non-surgically.
Repeated single-session PEI is effective in patients with advanced HCC at an acceptable and manageable complication rate. Patients stratified to a combination of TACE and PEI can expect longer survival than those stratified to repeated PEI alone. Furthermore, patients with large or multiple tumors in good clinical status may also profit from a combination of TACE and reconsideration for secondary PEI.
评估经皮乙醇注射（PEI）与经动脉化疗栓塞（TACE）联合重复单次PEI、单纯重复单次PEI、单纯重复TACE或最佳支持治疗相比，对晚期不可切除肝细胞癌（HCC）患者的治疗效果。
纳入研究期间接受PEI治疗的所有患者，并根据身体状况和肿瘤范围将其分层至以下治疗方式之一：TACE与重复单次PEI联合、单纯重复单次PEI、单纯重复TACE或最佳支持治疗。评估并比较各组间包括奥田分期、门静脉血栓形成、腹水、肿瘤数量、最大肿瘤直径和血清胆碱酯酶（CHE）等临床参数以及Child-Pugh分级、甲胎蛋白（AFP）、发热、并发症发生率的预后价值。采用Kaplan-Meier法和多因素回归分析确定生存率。
所有患者的1年和3年生存率分别为73%和47%。在亚组分析中，与单纯PEI治疗（1年、3年、5年生存率分别为65%、50%和37%）相比，TACE与PEI联合（1年、3年、5年生存率分别为90%、52%和43%）生存期更长。初始分层至TACE后进行二次PEI（1年、3年、5年生存率分别为91%、40%和30%）结果相当，而分层至最佳支持治疗后进行PEI（1年、3年、5年生存率分别为50%、23%、12%）生存期缩短。除所选治疗方式外，生存期较好的预测因素为肿瘤数量（n<5）、肿瘤大小（<5cm）、PEI前无腹水以及PEI后血清胆碱酯酶稳定（P<0.05）。PEI后2周内死亡率为2.8%（n=3）。PEI后有24例（8.9%）发生严重并发症，包括节段性肝梗死、局灶性肝坏死和肝脓肿。所有并发症均可通过非手术方式处理。
重复单次PEI对晚期HCC患者有效，并发症发生率可接受且可控。分层至TACE与PEI联合治疗的患者比分层至单纯重复PEI的患者生存期更长。此外，临床状态良好的大肿瘤或多肿瘤患者也可能从TACE联合二次PEI治疗中获益。
