Suh C H, Shin J H, Yoon H M, Yoon H-K, Ko G-Y, Gwon D-I, Kim J-H, Sung K-B
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2014 Sep;87(1041):20140054. doi: 10.1259/bjr.20140054. Epub 2014 Jun 27.
To evaluate the overall and cumulative incidence, degree, interval change and predictors of hepatic arterial injury (HAI) after cisplatin and Gelfoam® (Upjohn, Kalamazoo, MI)-based transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
A total of 205 patients with HCC who underwent three or more sessions of TACE without additional surgical or local treatment were included. HAI was evaluated at each segment of the hepatic artery using a three-grade scale: 1 (slight wall irregularity), 2 (overt stenosis) and 3 (occlusion). HAI interval change was categorized into three groups: progression, stable state and improvement. Cumulative incidence of HAI was analysed using Kaplan- Meier method, and predictors of HAI (patient age, sex, portal vein thrombosis and Child-Pugh classification) were analysed by univariate logistic regression.
HAI occurred in 50 of the 205 study patients (24.4%). The cumulative incidence of HAI was 16.0% [95% confidence interval (CI), 10.21-21.77] during 5 sessions of TACE, 52.1% (95% CI, 37.83-66.29) during 10 sessions and 68.0% (95% CI, 67.62-88.46) during 15 sessions. Initial HAI was interpreted as grades 1, 2 and 3 in 11 (22.0%), 17 (34.0%) and 22 (44.0%) patients, respectively. When the interval change was assessed in 48 patients with available follow-up TACE, 40 (83.3%) were included in the progression, 2 (4.2%) in the stable state and 6 (12.5%) in the improvement groups. The univariate analysis used to determine the predictors of HAI revealed no significant predictors.
In three or more sessions of TACE, the incidence of HAI was 24%. Increasing TACE causes increased incidence of HAI. The initial presentation was most commonly grade 3, and 12.5% of the patients with HAI showed improvement of the HAI grade during follow-up TACE.
In patients who underwent three or more sessions of cisplatin and Gelfoam-based TACE, the overall incidence of HAI was 24.4%, and increasing TACE causes increased incidence of HAI.
评估基于顺铂和明胶海绵（美国优普强公司，密歇根州卡拉马祖）的经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）后肝动脉损伤（HAI）的总体和累积发生率、程度、间隔期变化及预测因素。
纳入205例接受了3次或更多次TACE且未接受额外手术或局部治疗的HCC患者。采用三级评分法评估肝动脉各节段的HAI：1级（管壁轻度不规则）、2级（明显狭窄）和3级（闭塞）。HAI间隔期变化分为三组：进展、稳定和改善。采用Kaplan-Meier法分析HAI的累积发生率，通过单因素逻辑回归分析HAI的预测因素（患者年龄、性别、门静脉血栓形成和Child-Pugh分级）。
205例研究患者中有50例发生HAI（24.4%）。在5次TACE期间，HAI的累积发生率为16.0%[95%置信区间（CI），10.21 - 21.77]；10次TACE期间为52.1%（95%CI，37.83 - 66.29）；15次TACE期间为68.0%（95%CI，67.62 - 88.46）。初始HAI分别被判定为1级、2级和3级的患者有11例（22.0%）、17例（34.0%）和22例（44.0%）。在48例有可用随访TACE结果的患者中评估间隔期变化时，40例（83.3%）属于进展组，2例（4.2%）属于稳定组，6例（12.5%）属于改善组。用于确定HAI预测因素的单因素分析未发现显著的预测因素。
在3次或更多次TACE中，HAI的发生率为24%。TACE次数增加会导致HAI发生率升高。初始表现最常见为3级，12.5%的HAI患者在随访TACE期间HAI分级有所改善。
在接受3次或更多次基于顺铂和明胶海绵的TACE的患者中，HAI的总体发生率为24.4%，TACE次数增加会导致HAI发生率升高。
