Yu C-Y, Ou H-Y, Weng C-C, Huang T-L, Chen T-Y, Leung-Chit L, Hsu H-W, Chen C-L, Cheng Y-F
Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2016 May;48(4):1045-8. doi: 10.1016/j.transproceed.2015.12.078.
The majority of hepatocellular carcinoma (HCC) patients is diagnosed in late stages and therefore becomes ineligible for potentially curative treatment such as resection or liver transplantation. Transarterial chemoembolization (TACE) with drug-eluting beads (DC beads, Biocompatibles, Farnham, United Kingdom) has been proven with less side effects and better efficacy than conventional TACE, especially among patients with poor liver function.
The aim of this study is to evaluate outcomes of HCC patients who received TACE with DC beads, which resulted to eligibility for liver transplantation.
From January 2012 to June 2015, 60 patients with HCC received pre-liver transplantation evaluation whose cases were managed with TACE using DC beads at Kaohsiung Chang Gung Memorial Hospital were included in the study. DC beads loaded with doxorubicin were used.
Forty percent of the patients had complete tumor response. Thirty-three percent of the patients had partial tumor response, of which 15% showed stable disease, 11.7% exhibited disease progression including 3 with portal vein thrombosis, 1 with both hepatic vein and portal vein thrombosis, and 3 with increase in tumor size. Twenty-three patients were beyond University of California, San Francisco (UCSF) criteria initially. The successful downstage rate was 73.9% (17 of 23). Thirty-seven patients fit the USCF criteria initially. The 3-, 6- and 12-month drop rates of these patients were 0%, 3.9%, and 16.8%, respectively. Twenty-four (40%) patients successfully underwent liver transplantation. Three patients (12.5%) demonstrated recurrent HCC after liver transplantation.
TACE with DC bead can effectively induce tumor necrosis and appears to be a successful approach as bridge therapy for patients with advanced HCC and poor liver function.
大多数肝细胞癌（HCC）患者在晚期才被诊断出来，因此没有资格接受诸如切除或肝移植等可能治愈性的治疗。使用载药微球（DC微球，英国法纳姆的生物相容性公司）的经动脉化疗栓塞术（TACE）已被证明与传统TACE相比副作用更少、疗效更好，尤其是在肝功能较差的患者中。
本研究的目的是评估接受DC微球TACE治疗后符合肝移植条件的HCC患者的预后。
2012年1月至2015年6月，高雄长庚纪念医院60例接受肝移植术前评估且采用DC微球进行TACE治疗的HCC患者纳入本研究。使用负载阿霉素的DC微球。
40%的患者肿瘤完全缓解。33%的患者肿瘤部分缓解，其中15%病情稳定，11.7%病情进展，包括3例门静脉血栓形成、1例肝静脉和门静脉血栓形成以及3例肿瘤大小增加。23例患者最初不符合加利福尼亚大学旧金山分校（UCSF）标准。成功降期率为73.9%（23例中的17例）。37例患者最初符合UCSF标准。这些患者3个月、6个月和12个月的降级率分别为0%、3.9%和16.8%。24例（40%）患者成功接受了肝移植。3例患者（12.5%）肝移植后出现复发性HCC。
DC微球TACE能有效诱导肿瘤坏死，似乎是晚期HCC和肝功能差的患者作为桥接治疗的一种成功方法。
