Departments of SurgeryDiagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto UniversityDepartment of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan.
Hepatol Res. 2011 Apr;41(4):303-9. doi: 10.1111/j.1872-034X.2010.00770.x. Epub 2011 Jan 30.
Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable hepatocellular carcinoma (HCC). However, it is unclear which chemotherapeutic agent should be selected for TACE. The aim of this study was to compare the efficacy of cisplatin (CDDP) with that of epirubicin (EPI) in TACE for patients with unresectable or relapsed HCC.
We performed a historical cohort study involving 131 patients treated with a first TACE, defined as either an initial treatment for previously untreated HCC or a first treatment for relapsed HCC after curative resections or ablations. Efficacy was estimated as the response rate (RR) and it was adjusted for the confounding factors that were defined in this study.
The RR were 62.5% (20/32) for the first TACE with CDDP and 51.5% (51/99) for that with EPI. In the adjusted analysis for a history of hepatectomy, percutaneous treatment combined with TACE and tumor factors, the odds ratio was 1.72 (95% confidence interval [CI] = 0.70-4.48). However, a test for interaction between the number of tumors and the chemotherapeutic agent was statistically significant (P = 0.016). In multiple HCC, the RR were 66.7% (10/17) for CDDP and 39.6% (30/46) for EPI. The odds ratio was 4.11 (95% CI = 1.14-17.2).
CDDP may be more effective than EPI in TACE for multiple HCC. A randomized controlled study is needed to clarify the efficacy of CDDP in TACE in patients with multiple HCC.
经导管动脉化疗栓塞术（TACE）是治疗不可切除肝细胞癌（HCC）的一种既定方法。然而，尚不清楚 TACE 应选择哪种化疗药物。本研究旨在比较顺铂（CDDP）与表柔比星（EPI）在不可切除或复发性 HCC 患者 TACE 中的疗效。
我们进行了一项历史队列研究，共纳入 131 例接受首次 TACE 治疗的患者，定义为初治或根治性切除或消融后复发的 HCC 患者。采用调整后的疗效评估指标，包括反应率（RR）。并对本研究中定义的混杂因素进行了调整。
CDDP 组的 RR 为 62.5%（20/32），EPI 组为 51.5%（51/99）。在调整了肝切除术史、经皮治疗联合 TACE 及肿瘤因素后，OR 值为 1.72（95%CI=0.70-4.48）。但是，两种化疗药物与肿瘤数量之间的交互作用检验具有统计学意义（P=0.016）。在多发性 HCC 中，CDDP 组的 RR 为 66.7%（10/17），EPI 组为 39.6%（30/46）。OR 值为 4.11（95%CI=1.14-17.2）。
在多发性 HCC 的 TACE 中，CDDP 可能比 EPI 更有效。需要进行随机对照研究以明确 CDDP 在多发性 HCC 患者 TACE 中的疗效。
