Choi Jin Woo, Chung Jin Wook, Cho Yun Ku, Kim Yoon Jun, Yoon Jung-Hwan, Kim Hyo-Cheol, Jae Hwan Jun
Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.
Cardiovasc Intervent Radiol. 2015 Aug;38(4):937-45. doi: 10.1007/s00270-014-1032-9. Epub 2014 Dec 4.
To assess the safety and effectiveness of transarterial chemoembolization (TACE) of patients who have hepatocellular carcinomas (HCCs) with central bile duct invasion.
The institutional review board approved this retrospective study and waived informed consent. Fifty-three patients, initially treated with TACE for HCCs with central bile duct invasion from January 1999 to September 2012, were included. Clinical, laboratory, and survival data were reviewed. Complications and hospitalization length were evaluated using the χ(2) test, Fisher's exact test, and logistic regression analysis. Survival was analyzed using the Kaplan-Meier method with log-rank test and Cox proportional hazard model.
Seven patients experienced TACE-related major complications (severe post-embolization syndrome in 3, non-fatal sepsis in 3, and secondary bacterial peritonitis in 1). The overall major complication rate was 13.2%, but there were no permanent adverse sequelae or deaths within 30 days. Serum total bilirubin ≥ 3.0 mg/dL was the only significant risk factor for long hospitalization [hazard ratio (HR) = 4.341, p = .022]. The median survival was 12.2 months. Extrahepatic metastasis (HR = 6.145, p < .001), international normalized ratio (PT-INR) ≥ 1.20 (HR = 4.564, p < .001), vascular invasion (HR = 3.484, p = .001), and intermediate tumor enhancement (HR = 2.417, p = .019) were significantly associated with shorter survival.
TACE can be a safe and effective treatment for patients who have HCCs with central bile duct invasion. In particular, long-term survival can be expected if patients have strongly enhancing tumors without poor prognostic factors such as extrahepatic metastasis, PT-INR prolongation, and vascular invasion.
评估经动脉化疗栓塞术（TACE）治疗伴有肝门部胆管侵犯的肝细胞癌（HCC）患者的安全性和有效性。
本机构审查委员会批准了这项回顾性研究并豁免了知情同意。纳入了1999年1月至2012年9月期间最初接受TACE治疗的53例伴有肝门部胆管侵犯的HCC患者。回顾了临床、实验室和生存数据。使用χ²检验、Fisher精确检验和逻辑回归分析评估并发症和住院时间。采用Kaplan-Meier法结合对数秩检验和Cox比例风险模型分析生存情况。
7例患者发生了与TACE相关的严重并发症（3例为严重栓塞后综合征，3例为非致命性脓毒症，1例为继发性细菌性腹膜炎）。总体严重并发症发生率为13.2%，但30天内无永久性不良后遗症或死亡。血清总胆红素≥3.0mg/dL是长期住院的唯一显著危险因素[风险比（HR）=4.341，p=0.022]。中位生存期为12.2个月。肝外转移（HR=6.145，p<0.001）、国际标准化比值（PT-INR）≥1.20（HR=4.564，p<0.001）、血管侵犯（HR=3.484，p=0.001）和肿瘤中等强化（HR=2.417，p=0.019）与较短生存期显著相关。
TACE对于伴有肝门部胆管侵犯的HCC患者可能是一种安全有效的治疗方法。特别是，如果患者的肿瘤强化明显且无肝外转移、PT-INR延长和血管侵犯等不良预后因素，则有望获得长期生存。
