Department of Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada.
HPB (Oxford). 2012 May;14(5):341-50. doi: 10.1111/j.1477-2574.2012.00455.x.
Transarterial chemoembolization (TACE) is indicated for primary hepatic tumours when resection or local ablation are not feasible. Patients undergoing TACE have a better survival than best supportive therapy. However, there is paucity of prospective studies on the quality of life (QOL) after TACE for primary hepatic malignancies, especially in the Western world.
The primary aim of the present study was to determine if TACE impacts on the QOL of patients affected by primary hepatic tumours, and to assess treatment efficacy in a prospective cohort of patients treated at a tertiary Canadian university medical centre.
From September 2005 to December 2010, 48 candidates for TACE underwent at least one TACE session. Data on their QOL, tumour response, serum alpha fetoprotein (AFP) and survival were prospectively collected every 3-4 months.
The overall QOL of patients undergoing TACE did not decline during the first 12 months after treatment. A decline was observed in the physical health domain after the third TACE that coincided with the increasing size of the largest tumour and a rise in the serum AFP levels. Psychological, social and environmental domains remained stable throughout the treatment period. Multivariate analysis revealed that tumour focality, AFP levels and model of end-stage liver disease (MELD) scores were associated with long-term survival (P= 0.001, P= 0.01, P= 0.02, respectively). The overall survival at 12, 36 and 48 months were 72%, 28% and 12%, respectively.
TACE is an effective palliative intervention for unresectable and non-ablatable primary liver tumours without affecting the QOL of patients even when repeated interventions are performed.
经动脉化疗栓塞术（TACE）适用于无法进行切除或局部消融的原发性肝肿瘤。接受 TACE 的患者比最佳支持治疗的患者具有更好的生存机会。然而，对于原发性肝恶性肿瘤 TACE 后生活质量（QOL）的前瞻性研究较少，尤其是在西方世界。
本研究的主要目的是确定 TACE 是否会影响原发性肝肿瘤患者的 QOL，并评估在加拿大一所三级大学医学中心治疗的前瞻性队列患者中的治疗效果。
从 2005 年 9 月至 2010 年 12 月，48 名 TACE 候选者至少接受了一次 TACE 治疗。前瞻性收集他们的 QOL、肿瘤反应、血清甲胎蛋白（AFP）和生存数据，每 3-4 个月收集一次。
接受 TACE 的患者在治疗后的前 12 个月内整体 QOL 并未下降。第三次 TACE 后，身体健康状况下降，此时最大肿瘤的大小增加，血清 AFP 水平升高。心理、社会和环境领域在整个治疗期间保持稳定。多变量分析显示，肿瘤局灶性、AFP 水平和终末期肝病模型（MELD）评分与长期生存相关（P=0.001、P=0.01、P=0.02）。12、36 和 48 个月的总生存率分别为 72%、28%和 12%。
TACE 是无法切除和不可消融的原发性肝肿瘤的有效姑息治疗方法，即使进行重复干预，也不会影响患者的 QOL。
