Lee Yun Bin, Lee Dong Hyeon, Cho Yuri, Yu Su Jong, Lee Jeong-Hoon, Yoon Jung-Hwan, Lee Hyo-Suk, Kim Hyo-Cheol, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk, Chung Jin Wook, Kim Yoon Jun
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Vasc Interv Radiol. 2015 May;26(5):651-9. doi: 10.1016/j.jvir.2015.02.004. Epub 2015 Mar 29.
To compare long-term survival after hepatic resection and transarterial chemoembolization of large solitary hepatocellular carcinomas (HCCs).
Analysis of 91 and 68 consecutive patients with large (≥ 5 cm) solitary HCCs who underwent hepatic resection and transarterial chemoembolization, respectively, was performed. Overall survival and time to progression (TTP) were estimated using the Kaplan-Meier method and compared using the Cox proportional hazards model. To control for treatment-selection bias, matched groups of patients were selected using a propensity score matching method, and survival analysis was repeated.
During the follow-up period (median, 60.7 mo; range, 0.5-122.2 mo), 42 (46%) patients in the hepatic resection group and 35 (51%) patients in the transarterial chemoembolization group died. The 1-year, 3-year, and 5-year overall survival rates of the hepatic resection and transarterial chemoembolization groups were 91.1%, 80.0%, and 66.4% (hepatic resection group) and 89.8%, 72.8%, and 49.6% (transarterial chemoembolization group) (P = .023). TTP was significantly longer in patients who underwent hepatic resection (P < .001). Hepatitis B surface antigen positivity and the absence of portal hypertension were independent predictors for favorable overall survival. For patients with platelet counts ≤ 100,000/mm(3), Child-Pugh score of 6, smaller HCCs (≤ 7 cm), or portal hypertension, hepatic resection and transarterial chemoembolization yielded similar overall survival rates. After propensity score matching, transarterial chemoembolization was comparable to hepatic resection in overall survival (P = .293), whereas TTP remained longer in patients who underwent hepatic resection (P = .001).
Transarterial chemoembolization can lead to results comparable to hepatic resection in the treatment of large solitary HCCs, particularly in patients with clinically presumed portal hypertension.
比较大型孤立性肝细胞癌（HCC）肝切除术后和经动脉化疗栓塞后的长期生存率。
分别对91例和68例连续的大型（≥5 cm）孤立性HCC患者进行分析，这些患者分别接受了肝切除术和经动脉化疗栓塞。使用Kaplan-Meier方法估计总生存率和进展时间（TTP），并使用Cox比例风险模型进行比较。为控制治疗选择偏倚，采用倾向评分匹配方法选择匹配的患者组，并重复生存分析。
在随访期（中位数为60.7个月；范围为0.5 - 122.2个月），肝切除组42例（46%）患者和经动脉化疗栓塞组35例（51%）患者死亡。肝切除组和经动脉化疗栓塞组的1年、3年和5年总生存率分别为91.1%、80.0%和66.4%（肝切除组）以及89.8%、72.8%和49.6%（经动脉化疗栓塞组）（P = 0.023）。肝切除患者的TTP明显更长（P < 0.001）。乙肝表面抗原阳性和无门静脉高压是总生存良好的独立预测因素。对于血小板计数≤100,000/mm³、Child-Pugh评分为6分、较小的HCC（≤7 cm）或门静脉高压患者，肝切除术和经动脉化疗栓塞的总生存率相似。倾向评分匹配后，经动脉化疗栓塞在总生存方面与肝切除术相当（P = 0.293），而肝切除患者的TTP仍然更长（P = 0.001）。
经动脉化疗栓塞在治疗大型孤立性HCC方面可取得与肝切除术相当的结果，特别是在临床推测有门静脉高压的患者中。
