Hiraoka Atsushi, Kumada Takashi, Michitaka Kojiro, Toyoda Hidenori, Tada Toshifumi, Ishikawa Toru, Itobayashi Ei, Shimada Noritomo, Takaguchi Koichi, Takizawa Daichi, Tsuji Kunihiko
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
Hepatol Res. 2016 May;46(6):521-8. doi: 10.1111/hepr.12583. Epub 2015 Oct 2.
A lack of donors in liver transplantation (LT) for hepatocellular carcinoma (HCC) has become a big issue. There is no consensus regarding whether interventional radiology for HCC in patients with Child-Pugh C liver cirrhosis will improve prognosis. To elucidate the effectiveness of such treatment, we evaluated the clinical features of affected patients.
Patients with naive HCC of Child-Pugh C (n = 236) were enrolled. Two of them were treated with LT after transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) were used as bridging treatments. After exclusion of a total of three patients who received LT, we evaluated clinical factors related to improved prognosis.
The percentage of all patients with total bilirubin of less than 3 mg/dL was 41.1%. The prognosis of patients who were received treatments (n = 30; ablative therapy 10, TACE 20) was better than non-treated patients (n = 18; mean survival time [MST] 22.2 vs 13.8 months, P = 0.021, respectively) in patients with up to 7 criteria and total bilirubin of less than 3 mg/dL (n = 48). On the other hand, there was no difference in prognosis between those who underwent ablative therapies (n = 10) and those who received TACE (n = 20) (MST 22.2 vs 16.9 months, P = 0.390).
Therapy for HCC may prolong survival in patients with naive HCC, with up to 7 criteria and total bilirubin of less than 3 mg/dL.
肝细胞癌（HCC）肝移植（LT）供体短缺已成为一个大问题。对于Child-Pugh C级肝硬化患者的HCC进行介入放射治疗是否能改善预后，目前尚无共识。为阐明这种治疗的有效性，我们评估了受影响患者的临床特征。
纳入Child-Pugh C级初治HCC患者（n = 236）。其中2例在经动脉化疗栓塞术（TACE）和射频消融术（RFA）作为桥接治疗后接受了LT。在排除总共3例接受LT的患者后，我们评估了与预后改善相关的临床因素。
总胆红素低于3mg/dL的所有患者的比例为41.1%。在符合多达7项标准且总胆红素低于3mg/dL的患者（n = 48）中，接受治疗的患者（n = 30；消融治疗10例，TACE 20例）的预后优于未接受治疗的患者（n = 18；平均生存时间[MST]分别为22.2个月和13.8个月，P = 0.021）。另一方面，接受消融治疗的患者（n = 10）和接受TACE的患者（n = 20）的预后没有差异（MST分别为22.2个月和16.9个月，P = 0.390）。
对于符合多达7项标准且总胆红素低于3mg/dL的初治HCC患者，HCC治疗可能会延长其生存期。
