Miraglia Roberto, Pietrosi Giada, Maruzzelli Luigi, Petridis Ioannis, Caruso Settimo, Marrone Gianluca, Mamone Giuseppe, Vizzini Giovanni, Luca Angelo, Gridelli Bruno
Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Italy.
World J Gastroenterol. 2007 Jun 7;13(21):2952-5. doi: 10.3748/wjg.v13.i21.2952.
To investigate the efficacy of transcatheter embolization/chemoembolization (TAE/TACE) in cirrhotic patients with single hepatocellular carcinoma (HCC) not suitable for surgical resection and percutaneous ablation therapy.
A cohort of 176 consecutive cirrhotic patients with single HCC undergoing TAE/TACE was reviewed; 162 patients had at least one image examination (helical CT scan or triphasic contrast-enhanced MRI) after treatment and were included into the study. TAE was performed with Lipiodol followed by Gelfoam embolization; TACE was performed with Farmorubicin prepared in sterile drip at a dose of 50 mg/m(2), infused over 30 min using a peristaltic pump, and followed by Lipiodol and Gelfoam embolization.
Patients characteristics were: mean age, 62 years; male/female 117/45; Child-Pugh score 6.2 +/- 1.1; MELD 8.7 +/- 2.3; mean HCC size, 3.6 (range 1.0-12.0) cm. HCC size class was <or= 2.0 cm, n = 51; 2.1-3.0 cm, n = 35; 3.1-4.0 cm, n = 29; 4.1-5.0 cm, n = 22; 5.1-6.0 cm, n = 11; and > 6.0 cm, n = 14. Patients received a total of 368 TAE/TACE (mean 2.4 +/- 1.7). Complete tumor necrosis was obtained in 94 patients (58%), massive (90%-99%) necrosis in 16 patients (10%), partial (50%-89%) necrosis in 18 patients (11%) and poor (< 50%) necrosis in the remaining 34 patients (21%). The rate of complete necrosis according to the HCC size class was: 69%, 69%, 52%, 68%, 50% and, 13% for lesions of <or= 2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, 5.1-6.0, and > 6.0 cm, respectively. Kaplan-Mayer survival at 24-mo was 88%, 68%, 59%, 59%, 45%, and 53% for lesions of <or= 2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, 5.1-6.0, and > 6.0 cm, respectively.
Our study showed that in cirrhotic patients with single HCC smaller than 6.0 cm, TAE/TACE produces complete local control of tumor in a significant proportion of patients. TAE/TACE is an effective therapeutic option in patients with single HCC not suitable for surgical resection or percutaneous ablation therapies. Further studies should investigate if the new available embolization agents or drug eluting beads may improve the effect on tumor necrosis.
探讨经导管栓塞术/化疗栓塞术（TAE/TACE）对不适合手术切除及经皮消融治疗的肝硬化单发性肝细胞癌（HCC）患者的疗效。
回顾性分析176例连续接受TAE/TACE治疗的肝硬化单发性HCC患者；162例患者在治疗后至少接受了一次影像检查（螺旋CT扫描或三相对比增强MRI）并纳入研究。TAE采用碘油栓塞，继以明胶海绵栓塞；TACE采用将表柔比星用无菌滴液配制成50mg/m²的剂量，用蠕动泵在30分钟内输注完毕，然后采用碘油及明胶海绵栓塞。
患者特征如下：平均年龄62岁；男/女为117/45；Child-Pugh评分6.2±1.1；终末期肝病模型（MELD）评分8.7±2.3；平均HCC大小为3.6（范围1.0 - 12.0）cm。HCC大小分级为：≤2.0cm，51例；2.1 - 3.0cm，35例；3.1 - 4.0cm，29例；4.1 - 5.0cm，22例；5.1 - 6.0cm，11例；＞6.0cm，14例。患者共接受368次TAE/TACE治疗（平均2.4±1.7次）。94例患者（58%）实现完全肿瘤坏死，16例患者（10%）出现大片（90% - 99%）坏死，18例患者（11%）出现部分（50% - 89%）坏死，其余34例患者（21%）坏死程度差（＜50%）。根据HCC大小分级的完全坏死率分别为：≤2.0cm病变为69%，2.1 - 3.0cm病变为69%，3.1 - 4.0cm病变为52%，4.1 - 5.0cm病变为68%，5.1 - 6.0cm病变为50%，＞6.0cm病变为13%。24个月时，≤2.0cm、2.1 - 3.0cm、3.1 - 4.0cm、4.1 - 5.0cm、5.1 - 6.0cm及＞6.0cm病变的Kaplan - Meier生存率分别为88%、68%、59%、59%、45%和53%。
我们的研究表明，对于小于6.0cm的肝硬化单发性HCC患者，TAE/TACE可使相当一部分患者实现肿瘤的完全局部控制。TAE/TACE是不适合手术切除或经皮消融治疗的单发性HCC患者的一种有效治疗选择。进一步研究应探讨新型栓塞剂或药物洗脱微球是否可提高对肿瘤坏死的效果。
