Rou Woo Sun, Lee Byung Seok, Moon Hee Seok, Lee Eaum Seok, Kim Seok Hyun, Lee Heon Young
Woo Sun Rou, Byung Seok Lee, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Heon Young Lee, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 301-721, South Korea.
World J Gastroenterol. 2014 Jun 14;20(22):6995-7004. doi: 10.3748/wjg.v20.i22.6995.
To identify factors affecting early local recurrence after transcatheter arterial chemoembolization (TACE) and investigate treatments and outcomes for local recurrence.
Early local recurrence and no early local recurrence groups drawn from 134 patients who were initially diagnosed with hepatocellular carcinoma (HCC) and showed a complete response (CR) to TACE treatment between January 1, 2006, and January 31, 2012, were analyzed by univariate and multivariate analyses. Additionally, the subsequent treatment for patients with recurrence was analyzed, and in cases in which TACE had been performed, the cumulative recurrence rates were calculated using the Kaplan-Meier method and compared with those of the primary lesion.
The 1-, 2-, and 3-year survival rates were 92.3%, 60.2%, and 39.8%, respectively, in the early local recurrence group, which were significantly lower than those in both the late local and no local recurrence groups (P < 0.001). On multivariate analyses, non-compact lipiodol uptake, large tumor size, and an alpha-fetoprotein > 20 ng/mL after achieving a CR were significant predictors. When TACE was performed for early and late locally recurrent lesions, a CR was observed in 15 patients (41.7%) and 11 patients (78.6%), and the cumulative recurrence rates at 6, 12, and 24 mo were 17.9%, 43.3%, and 71.2%, respectively, which did not differ significantly from those after the first CR of 20.5%, 44.0%, and 58.6%, respectively (P = 0.639).
Closer monitoring and active treatments must be provided to patients with risk factors for early local recurrence of HCC.
确定经动脉化疗栓塞术（TACE）后影响早期局部复发的因素，并研究局部复发的治疗方法及预后。
对2006年1月1日至2012年1月31日期间最初诊断为肝细胞癌（HCC）且对TACE治疗呈现完全缓解（CR）的134例患者，分为早期局部复发组和无早期局部复发组，进行单因素和多因素分析。此外，分析复发患者的后续治疗情况，对于接受过TACE治疗的病例，采用Kaplan-Meier法计算累积复发率，并与原发灶的累积复发率进行比较。
早期局部复发组的1年、2年和3年生存率分别为92.3%、60.2%和39.8%，显著低于晚期局部复发组和无局部复发组（P<0.001）。多因素分析显示，碘油摄取不致密、肿瘤体积大以及达到CR后甲胎蛋白>20 ng/mL是显著的预测因素。对早期和晚期局部复发病灶进行TACE治疗时，分别有15例（41.7%）和11例（78.6%）观察到CR，6个月、12个月和24个月时的累积复发率分别为17.9%、43.3%和71.2%，与首次CR后的累积复发率分别为20.5%、44.0%和58.6%相比，差异无统计学意义（P = 0.639）。
对于有HCC早期局部复发危险因素的患者，必须进行密切监测并积极治疗。
