Yeh Ming-Lun, Huang Ching-I, Huang Chung-Feng, Hsieh Ming-Yen, Huang Jee-Fu, Dai Chia-Yen, Lin Zu-Yau, Chen Shinn-Cherng, Yu Ming-Lung, Chuang Wan-Long
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2015 Feb;31(2):77-82. doi: 10.1016/j.kjms.2014.11.003. Epub 2014 Dec 23.
The role of transcatheter arterial chemoembolization (TACE) prior to curative therapy is still unclear. The aim of our study was to elucidate the survival of single hepatocellular carcinoma (HCC) and also to clarify whether TACE plus sequential curative therapy provides benefits in single HCC. A total of 470 patients with a diagnosis of single HCC between 2005 and 2010 were studied. The factors associated with clinical outcomes were analyzed. The outcomes between patients who underwent neoadjuvant TACE and those who did not were also compared. The 1-, 3-, and 5-year overall survival (OS) rates of all patients were 92.6%, 73.3%, and 59.6%, respectively. Child-Pugh class A [HR: 2.04, 95% confidence interval (CI): 1.277-3.254, p = 0.003], very early stage Barcelona Clinic Liver Cancer (BCLC) (HR: 2.03, 95% CI: 1.021-4.025, p = 0.043), tumor size < 5 cm (HR: 1.75, 95% CI: 1.115-2.751, p = 0.015), alpha fetoprotein (AFP) level < 200 ng/mL (HR: 2.07, 95% CI: 1.346-3.182, p = 0.001), and curative-based therapy (HR: 2.16, 95% CI: 1.442-3.224, p < 0.001) were factors associated with better OS. The 1-, 3-, and 5-year disease-free survival (DFS) rates of all the patients were 75.4%, 53.7%, and 36.3%, respectively. Only Child-Pugh class A (HR: 1.57, 95% CI: 1.068-2.294, p = 0.022) and curative-based therapy (HR: 1.51, 95% CI: 1.128-2.028, p = 0.006) were significantly associated with better DFS. Neoadjuvant TACE did not provide benefit compared with curative therapy alone in subgroup analysis. In conclusion, neoadjuvant TACE is not recommended in single HCC patients who may indicate for curative therapy.
在根治性治疗之前进行经动脉化疗栓塞术（TACE）的作用仍不明确。我们研究的目的是阐明单个肝细胞癌（HCC）的生存率，并明确TACE联合序贯根治性治疗对单个HCC是否有益。对2005年至2010年间共470例诊断为单个HCC的患者进行了研究。分析了与临床结局相关的因素。还比较了接受新辅助TACE治疗的患者和未接受新辅助TACE治疗的患者之间的结局。所有患者的1年、3年和5年总生存率（OS）分别为92.6%、73.3%和59.6%。Child-Pugh A级[风险比（HR）：2.04，95%置信区间（CI）：1.277 - 3.254，p = 0.003]、巴塞罗那临床肝癌（BCLC）极早期（HR：2.03，95% CI：1.021 - 4.025，p = 0.043）、肿瘤大小<5 cm（HR：1.75，95% CI：1.115 - 2.751，p = 0.015）、甲胎蛋白（AFP）水平<200 ng/mL（HR：2.07，95% CI：1.346 - 3.182，p = 0.001）以及基于根治性的治疗（HR：2.16，95% CI：1.442 - 3.224，p < 0.001）是与更好的总生存率相关的因素。所有患者的1年、3年和5年无病生存率（DFS）分别为75.4%、53.7%和36.3%。只有Child-Pugh A级（HR：1.57，95% CI：1.068 - 2.294，p = 0.022）和基于根治性的治疗（HR：1.51，95% CI：1.128 - 2.028，p = 0.006）与更好的无病生存率显著相关。在亚组分析中，与单纯根治性治疗相比，新辅助TACE未显示出益处。总之，对于可能适合根治性治疗的单个HCC患者，不推荐进行新辅助TACE。
