Dept of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Ctr, Northwestern Memorial Hosp, 676 N St Clair St, Suite 800, Chicago, IL 60611, USA.
Radiology. 2010 Jun;255(3):955-65. doi: 10.1148/radiol.10091473.
To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC).
One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems.
Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001).
The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.
确定肝癌（HCC）患者经化疗栓塞治疗后的综合影像学表现和长期生存结果。
对 172 例经化疗栓塞治疗的 HCC 患者进行回顾性研究，研究方案经机构审查委员会批准，符合 HIPAA 规定。获得患者的基线实验室和影像学特征。评估治疗后临床和实验室毒性。评估化疗栓塞后的影像学特征，以确定反应率（大小和坏死）和进展时间（TTP）。从首次化疗栓塞治疗时间计算生存时间。根据 Child-Pugh、美国器官共享联合网络（UNOS）和巴塞罗那临床肝癌（BCLC）分期系统对患者进行分层，进行亚组分析。
157 例（91%）患者存在肝硬化，139 例（81%）患者存在门静脉高压。11 例（6%）患者基线时有转移，11 例（6%）患者存在门静脉血栓形成。55%的患者治疗后出现某种形式的毒性，21%的患者出现 3 级或 4 级胆红素毒性。根据大小和坏死标准，分别有 31%和 64%的患者出现化疗栓塞后反应。中位 TTP 为 7.9 个月（95%置信区间：7.1，9.4），但分期差异很大。BCLC 分期 A、B 和 C 疾病患者的中位生存时间有显著差异（分期 A，40.0 个月；B，17.4 个月；C，6.3 个月；P<0.0001）。
HCC 患者的 TTP 和生存的确定受到肿瘤生物学和背景肝硬化的影响；化疗栓塞被证明是 HCC 患者安全有效的治疗方法。
