Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Aliment Pharmacol Ther. 2012 Jun;35(11):1343-50. doi: 10.1111/j.1365-2036.2012.05089.x. Epub 2012 Apr 8.
It remains unclear whether initial compact lipiodol uptake after transarterial chemoembolisation (TACE) is associated with improved survival in patients with hepatocellular carcinoma (HCC).
To reveal the clinical relevance of compact lipiodolisation after TACE.
We studied 490 patients with unresectable HCC who had first been treated with TACE. Compact lipiodolisation was defined as the absence of an arterial enhancing lesion, reflecting complete lipiodol uptake, as assessed by dynamic computed tomography (CT) 1 month after treatment. The rate of initial compact lipiodolisation was analysed according to multiplicity and size of tumour, and survival of patients who achieved compact lipiodolisation was compared to that of patients who did not.
Of the 490 patients, 409 (83.5%) were in Child-Pugh class A and 81 (16.5%) in class B. The rate of initial compact lipiodolisation in single HCCs was higher than that in multinodular HCCs (33.7% vs. 14.6%, P < 0.001). Among single HCCs, the rate of compact lipiodolisation in tumours ≤5, 5-10 and >10 cm was 46.6%, 13.6%, and 0% respectively. The 1-, 3- and 5-year survival rates of patients with compact uptake were 92.7%, 70.7% and 52.4% compared to 60.8%, 28.0% and 16.9% in patients with noncompact lipiodolisation. Multivariate analysis revealed that Child-Pugh class, alpha-fetoprotein level, tumour node metastasis stage, portal vein thrombosis and initial compact lipiodolisation were independent predictors of survival.
Initial compact lipiodol uptake after transarterial chemoembolisation is associated with improved survival in patients with unresectable hepatocellular carcinoma. Accordingly, initial complete lipiodolisation should be considered a relevant therapeutic target.
经动脉化疗栓塞（TACE）后初始致密碘油沉积是否与肝癌（HCC）患者的生存改善相关仍不清楚。
揭示 TACE 后致密碘油沉积的临床相关性。
我们研究了 490 例不可切除 HCC 患者，这些患者首先接受了 TACE 治疗。致密碘油沉积定义为治疗后 1 个月动态 CT 评估时无动脉增强病变，提示完全碘油摄取。根据肿瘤的多发性和大小分析初始致密碘油沉积的发生率，并比较达到致密碘油沉积的患者和未达到致密碘油沉积的患者的生存情况。
490 例患者中，Child-Pugh 分级 A 级 409 例（83.5%），B 级 81 例（16.5%）。单发 HCC 的初始致密碘油沉积率高于多结节 HCC（33.7% vs. 14.6%，P<0.001）。单发 HCC 中，肿瘤直径≤5cm、5-10cm 和>10cm 的致密碘油沉积率分别为 46.6%、13.6%和 0%。致密碘油摄取患者的 1 年、3 年和 5 年生存率分别为 92.7%、70.7%和 52.4%，而非致密碘油摄取患者的生存率分别为 60.8%、28.0%和 16.9%。多变量分析显示，Child-Pugh 分级、甲胎蛋白水平、肿瘤淋巴结转移分期、门静脉血栓形成和初始致密碘油沉积是生存的独立预测因素。
经动脉化疗栓塞后初始致密碘油摄取与不可切除肝癌患者的生存改善相关。因此，初始完全碘油沉积应被视为一个相关的治疗目标。
