Yip W M, Hung H G, Lok K H, Li K F, Li K K, Szeto M L
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Hong Kong Med J. 2009 Oct;15(5):339-45.
To evaluate survival and prognostic factors in patients with advanced hepatocellular carcinoma treated by transarterial chemoembolisation in a real-life clinical practice setting.
Retrospective study.
Regional hospital, Hong Kong.
Patients with inoperable hepatocellular carcinoma diagnosed from January 1998 to December 2003 who received transarterial chemoembolisation.
A total of 74 patients were identified, and had a median survival of 214 days. The cumulative survival rates at 1, 2, and 3 years were 28%, 12%, and 7%, respectively. By multivariate analysis, superselective cannulation performed in transarterial chemoembolisation (hazard ratio=0.47; 95% confidence interval, 0.23-0.95; P=0.034), embolisation with gelfoam (0.30; 0.11-0.80; P=0.017), and treatment intervals of more than 45 days (0.33; 0.15-0.72; P=0.006) were independent predictors of good survival. Child-Pugh grade B cirrhosis (hazard ratio=5.62; 95% confidence interval, 2.11-14.97; P=0.001), and high pre-treatment serum alpha-fetoprotein level (2.93; 1.50-5.73; P=0.002) were independent predictors of poor survival.
In real-life clinical practice, survival of patients with inoperable hepatocellular carcinoma remains grave despite treatment. Patients with Child-Pugh grade A cirrhosis or with low pretreatment alpha-fetoprotein level are more suitable for this form of treatment. The procedure should be performed with superselective cannulation and embolisation with gelfoam.
在实际临床实践环境中评估经动脉化疗栓塞治疗晚期肝细胞癌患者的生存率及预后因素。
回顾性研究。
香港地区医院。
1998年1月至2003年12月期间诊断为无法手术切除的肝细胞癌且接受经动脉化疗栓塞治疗的患者。
共纳入74例患者，中位生存期为214天。1年、2年和3年的累积生存率分别为28%、12%和7%。多因素分析显示，经动脉化疗栓塞术中进行超选择性插管（风险比=0.47；95%置信区间，0.23 - 0.95；P = 0.034）、使用明胶海绵栓塞（0.30；0.11 - 0.80；P = 0.017）以及治疗间隔超过45天（0.33；0.15 - 0.72；P = 0.006）是生存良好的独立预测因素。Child-Pugh B级肝硬化（风险比=5.62；95%置信区间，2.11 - 14.97；P = 0.001）和治疗前血清甲胎蛋白水平高（2.93；1.50 - 5.73；P = 0.002）是生存不良的独立预测因素。
在实际临床实践中，无法手术切除的肝细胞癌患者尽管接受了治疗，生存率仍然很低。Child-Pugh A级肝硬化或治疗前甲胎蛋白水平低的患者更适合这种治疗方式。该操作应采用超选择性插管并用明胶海绵栓塞。
