经载多柔比星微球化疗栓塞治疗不可切除肝细胞癌：5 年生存分析。

Chemoembolization with doxorubicin-eluting beads for unresectable hepatocellular carcinoma: five-year survival analysis.

机构信息

Second Department of Radiology, University of Athens, Athens, Greece.

出版信息

Cardiovasc Intervent Radiol. 2012 Oct;35(5):1119-28. doi: 10.1007/s00270-012-0394-0. Epub 2012 May 22.

DOI:10.1007/s00270-012-0394-0

PMID:22614031

Abstract

PURPOSE

The purpose of this study was to report on the 5-year survival of hepatocellular carcinoma (HCC) patients treated with DC Bead loaded with doxorubicin (DEB-DOX) in a scheduled scheme in up to three treatments and thereafter on demand.

MATERIALS AND METHODS

173 HCC patients not suitable for curable treatments were prospectively enrolled (mean age 70.4 ± 7.4 years). Child-Pugh (Child) class was A/B (102/71 [59/41 %]), Okuda stage was 0/1/2 (91/61/19 [53.2/35.7/11.1 %]), and mean lesion diameter was 7.6 ± 2.1 cm. Lesion morphology was one dominant ≤5 cm (22 %), one dominant >5 cm (41.6 %), multifocal ≤5 (26 %), and multifocal >5 (10.4 %).

RESULTS

Overall survival at 1, 2, 3, 4, and 5 years was 93.6, 83.8, 62, 41.04, and 22.5 %, with higher rates achieved in Child class A compared with Child class B patients (95, 88.2, 61.7, 45, and 29.4 % vs. 91.5, 75, 50.7, 35.2, and 12.8 %). Mean overall survival was 43.8 months (range 1.2-64.8). Cumulative survival was better for Child class A compared with Child class B patients (p = 0.029). For patients with dominant lesions ≤5 cm 1-, 2-, 3-, 4-, and 5-year survival rates were 100, 95.2, 71.4, 66.6, and 47.6 % for Child class A and 94.1, 88.2, 58.8, 41.2, 29.4, and 23.5 % for Child class B patients. Regarding DEB-DOX treatment, multivariate analysis identified number of lesions (p = 0.033), lesion vascularity (p < 0.0001), initially achieved complete response (p < 0.0001), and objective response (p = 0.046) as significant and independent determinants of 5-year survival.

CONCLUSION

DEB-DOX results, with high rates of 5-year survival for patients, not amenable to curative treatments. Number of lesions, lesion vascularity, and local response were significant independent determinants of 5-year survival.

摘要

目的

本研究旨在报告接受载多柔比星 DC 微球（DEB-DOX）治疗的肝细胞癌（HCC）患者的 5 年生存率，这些患者接受了最多 3 次预定方案治疗，之后按需进行治疗。

材料和方法

173 名不适合根治性治疗的 HCC 患者前瞻性入组（平均年龄 70.4 ± 7.4 岁）。Child-Pugh（Child）分级为 A/B（102/71 [59/41%]），Okuda 分期为 0/1/2（91/61/19 [53.2/35.7/11.1%]），平均肿瘤直径为 7.6 ± 2.1cm。肿瘤形态为单发≤5cm（22%）、单发＞5cm（41.6%）、多发≤5cm（26%）和多发＞5cm（10.4%）。

结果

总体生存率在 1、2、3、4 和 5 年时分别为 93.6%、83.8%、62%、41.04%和 22.5%，Child A 级患者的生存率高于 Child B 级患者（95%、88.2%、61.7%、45%和 29.4%比 91.5%、75%、50.7%、35.2%和 12.8%）。平均总生存时间为 43.8 个月（范围为 1.2-64.8）。Child A 级患者的累积生存率优于 Child B 级患者（p=0.029）。对于肿瘤直径≤5cm 的患者，Child A 级患者的 1、2、3、4 和 5 年生存率分别为 100%、95.2%、71.4%、66.6%和 47.6%，Child B 级患者分别为 94.1%、88.2%、58.8%、41.2%、29.4%和 23.5%。关于 DEB-DOX 治疗，多变量分析发现肿瘤数量（p=0.033）、肿瘤血管性（p＜0.0001）、最初达到完全缓解（p＜0.0001）和客观缓解（p=0.046）是 5 年生存率的显著独立决定因素。