Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy.
Aliment Pharmacol Ther. 2010 Feb 15;31(4):493-501. doi: 10.1111/j.1365-2036.2009.04198.x. Epub 2009 Nov 14.
A randomized controlled trial performed by the Barcelona Clinic Liver Cancer (BCLC) published in 2002 demonstrated that transcatheter arterial chemoembolisation (TACE) is an effective treatment for well-selected patients with unresectable hepatocellular carcinoma (HCC).
To access whether this information has modified the use of TACE in clinical practice.
From 2042 HCC patients included in the Italian Liver Cancer database, we selected 336 cases diagnosed over two 4-year periods (1999-2002, n = 161 and 2003-2006, n = 175), fulfilling the inclusion criteria of the BCLC study. These groups were compared for TACE application rate, patient characteristics and survival.
Patients undergoing TACE increased in the 2003-2006 period (from 62% to 73%, P = 0.035), with an increase in of Child-Pugh class A (from 64% to 77%, P = 0.048) and advanced HCC patients (from 54% to 69%, P = 0.041). In the 1999-2002 period, there was no significant difference in survival between TACE-treated and untreated patients, while in the 2003-2006 period, TACE-treated patients survived longer (P < 0.0001).
Following the publication of studies providing evidence of a survival benefit of TACE in selected patients with unresectable HCC, significantly more patients with well-compensated cirrhosis underwent TACE within this very homogenous population, leading to an increased survival despite a more advanced tumour stage.
巴塞罗那临床肝癌（BCLC）于 2002 年发表的一项随机对照试验表明，经导管动脉化疗栓塞（TACE）是治疗不可切除肝细胞癌（HCC）的有效方法。
评估该研究结果是否改变了 TACE 在临床实践中的应用。
我们从意大利肝癌数据库中选择了 336 例符合 BCLC 研究纳入标准的 HCC 患者，这些患者被分为两组：1999-2002 年诊断的 161 例（第 1 组）和 2003-2006 年诊断的 175 例（第 2 组）。比较两组 TACE 应用率、患者特征和生存情况。
第 2 组 TACE 治疗比例（从 62%增加至 73%，P = 0.035）、Child-Pugh 分级为 A 级的患者比例（从 64%增加至 77%，P = 0.048）和晚期 HCC 患者比例（从 54%增加至 69%，P = 0.041）均高于第 1 组。第 1 组 TACE 治疗与未治疗患者的生存无显著差异，而第 2 组 TACE 治疗患者的生存时间更长（P < 0.0001）。
在发表了 TACE 治疗可使选择的不可切除 HCC 患者获益的研究后，该治疗方法在代偿良好的肝硬化患者中得到了更广泛的应用，尽管肿瘤分期更晚，但生存率仍得到提高。
