Irie Toshiyuki, Kuramochi Masashi, Kamoshida Toshiro, Takahashi Nobuyuki
Department of Radiology, Hitachi General Hospital.
Department of Radiology, Tsukuba Memorial Hospital.
Hepatol Res. 2016 Feb;46(2):209-14. doi: 10.1111/hepr.12564. Epub 2015 Sep 2.
Selective balloon-occluded transarterial chemoembolization (B-TACE) enables strong TACE; infusion of more volume of lipiodol emulsion and forceful injection of embolization materials. The aim of this study is to analyze the efficacy of B-TACE for patients with one or two hepatocellular carcinoma (HCC) nodules compared with conventional super-selective TACE using a microcatheter (C-TACE).
We retrospectively selected patients without previous history of TACE, with one or two HCC nodules, with performance status 0/1, and with liver function of Child-Pugh score A/B. Between 2008 and 2010, a 3-Fr microballoon catheter was used for targeted TACE (B-TACE group). Between 2005 and 2008, a 2-Fr microcatheter was used (C-TACE group). Control rates of primary nodule, overall survival rates and tumor-free rates in the liver were calculated for each group using the Kaplan-Meier method. Univariate analysis was performed to compare between the groups using the log-rank test. Multivariate analysis was performed for analysis of prognostic factors using Cox's proportional hazard model. The factors were B-TACE versus C-TACE, Child-Pugh score A versus B, single nodule versus double, large nodule versus small , elder versus not, and prior radiofrequency ablation treatment versus not.
Control rates of the primary nodule were improved by B-TACE. B-TACE was an independent factor to improve both control rates of the primary nodule and overall survival rates. Child-Pugh score A was an independent factor to increase overall survival rates. There was no statistically significant difference in overall survival or tumor-free survival rates between the groups.
B-TACE was an independent factor to improve overall survival rates on multivariate analysis, but there was no significant difference in overall survival rates between B-TACE and C-TACE groups on univariate analysis.
选择性球囊闭塞经动脉化疗栓塞术（B-TACE）可实现强效经动脉化疗栓塞术；注入更多量的碘油乳剂并强力注射栓塞材料。本研究的目的是分析与使用微导管的传统超选择性经动脉化疗栓塞术（C-TACE）相比，B-TACE 对有一个或两个肝细胞癌（HCC）结节患者的疗效。
我们回顾性选择了既往无 TACE 病史、有一个或两个 HCC 结节、体能状态为 0/1 且肝功能为 Child-Pugh 评分 A/B 的患者。在 2008 年至 2010 年期间，使用 3Fr 微球囊导管进行靶向 TACE（B-TACE 组）。在 2005 年至 2008 年期间，使用 2Fr 微导管（C-TACE 组）。使用 Kaplan-Meier 方法计算每组的原发结节控制率、总生存率和肝脏无瘤率。使用对数秩检验进行单因素分析以比较两组之间的差异。使用 Cox 比例风险模型进行多因素分析以分析预后因素。这些因素包括 B-TACE 与 C-TACE、Child-Pugh 评分 A 与 B、单结节与双结节、大结节与小结节、年龄大与年龄不大以及既往是否接受过射频消融治疗。
B-TACE 提高了原发结节的控制率。B-TACE 是提高原发结节控制率和总生存率的独立因素。Child-Pugh 评分 A 是提高总生存率的独立因素。两组之间的总生存率或无瘤生存率无统计学显著差异。
在多因素分析中，B-TACE 是提高总生存率的独立因素，但在单因素分析中，B-TACE 组和 C-TACE 组之间的总生存率无显著差异。
