Takayasu Kenichi, Arii Shigeki, Ikai Iwao, Omata Masao, Okita Kiwamu, Ichida Takafumi, Matsuyama Yutaka, Nakanuma Yasuni, Kojiro Masamichi, Makuuchi Masatoshi, Yamaoka Yoshio
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
Gastroenterology. 2006 Aug;131(2):461-9. doi: 10.1053/j.gastro.2006.05.021.
BACKGROUND & AIMS: To elucidate the survival of the patients with unresectable hepatocellular carcinoma (HCC) who underwent transcatheter arterial lipiodol chemoembolization (TACE) and to analyze the factors affecting the survivals.
During the last 8 years, a nationwide prospective cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment. Exclusion criteria were extrahepatic metastases and/or any previous treatment prior to the present TACE. The primary end point was survival. The survival rates were calculated by the Kaplan-Meier method. The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model. The mean follow-up period was 1.77 years.
For overall survival rates by TACE, median and 1-, 3-, 5-, and 7-year survivals were 34 months, 82%, 47%, 26%, and 16%, respectively. Both the degree of liver damage and the tumor-node-metastasis (TNM) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals (P = .0001). The multivariate analyses showed significant difference in degree of liver damage (P = .0001), alpha-fetoprotein value (P = .0001), maximum tumor size (P = .0001), number of lesions (P = .0001), and portal vein invasion (P = .0001). The last 3 factors could be replaced by TNM stage. The TACE-related mortality rate after the initial therapy was .5%.
TACE showed safe therapeutic modality with a 5-year survival of 26% for unresectable HCC patients. The degrees of liver damage, TNM stage, and alpha-fetoprotein values were independent risk factors for patient survival.
阐明接受经动脉碘油化疗栓塞术（TACE）的不可切除肝细胞癌（HCC）患者的生存情况，并分析影响生存的因素。
在过去8年中，对8510例不可切除HCC患者进行了一项全国性前瞻性队列研究，这些患者接受了以碘油与抗癌药物乳剂随后加明胶海绵颗粒作为初始治疗的TACE。排除标准为肝外转移和/或本次TACE之前的任何先前治疗。主要终点为生存。生存率采用Kaplan-Meier法计算。通过Cox比例风险模型评估影响生存因素的多因素分析。平均随访期为1.77年。
对于TACE后的总生存率，中位生存期以及1年、3年、5年和7年生存率分别为34个月、82%、47%、26%和16%。日本肝癌研究组提出的肝损伤程度和肿瘤-淋巴结-转移（TNM）系统均显示出良好的生存分层（P = .0001）。多因素分析显示肝损伤程度（P = .0001）、甲胎蛋白值（P = .0001）、最大肿瘤大小（P = .0001）、病灶数量（P = .0001）和门静脉侵犯（P = .0001）存在显著差异。最后3个因素可用TNM分期替代。初始治疗后TACE相关死亡率为.5%。
TACE对不可切除HCC患者而言是一种安全的治疗方式，5年生存率为26%。肝损伤程度、TNM分期和甲胎蛋白值是患者生存的独立危险因素。
