1 Department of Radiological Sciences, Interventional Radiology, and Department of Medicine, The David Geffen School of Medicine at the University of California at Los Angeles, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095.
2 The UCLA Jonathan and Karin Fielding School of Public Health at the University of California at Los Angeles, Los Angeles, CA.
AJR Am J Roentgenol. 2017 Oct;209(4):722-732. doi: 10.2214/AJR.17.18219. Epub 2017 Jul 13.
OBJECTIVE: We compared survival outcomes in 313 patients with unresectable hepatocellular carcinoma (HCC) treated with two different transcatheter arterial chemoembolization (TACE) regimens: triple-drug TACE or single-drug TACE using drug-eluting beads. MATERIALS AND METHODS: In this retrospective study, patient selection criteria were uniform. The triple-drug group (n = 166) underwent TACE using ethiodized oil with doxorubicin, cisplatin, and mitomycin-C with a microsphere embolic. The single-drug group (n = 147) underwent TACE using doxorubicin-eluting beads. Group characteristics were classified and analyzed, and survival was calculated using standard statistical methods. All patients were followed until death. Those undergoing orthotopic liver transplant (OLT) were also followed. RESULTS: There were no significant differences between the two groups in terms of demographics, Child-Pugh class, or Okuda stage. With patients undergoing OLT censored (n = 73), the mean (± standard error) survival in the triple-drug group was 23.49 ± 2.38 months, and the median survival was 16.00 ± 1.51 months. Mean survival in the single-drug bead group was 28.16 ± 2.75 months, and the median survival was 15.00 ± 1.50 months (p = 0.168). With patients undergoing OLT censored, the mean and median survival for the total cohort were 26.25 ± 1.97 and 15.00 ± 1.08 months, respectively. In the entire cohort that did not undergo OLT, patients with Child-Pugh class A disease survived significantly longer than did patients with Child-Pugh class B disease. Elevated α-fetoprotein levels were associated with shorter survival, and patients undergoing TACE with drug-eluting beads had shorter hospital stays. Although a greater percentage annual survival was observed in patients undergoing drug-eluting bead TACE who had Child-Pugh class A, Okuda stage I, and Barcelona Clinic Liver Cancer classes A and B disease starting at 36 months, this suggested survival advantage did not reach statistical significance. CONCLUSION: We found no significant survival difference in patients with unresectable HCC treated with triple-drug TACE compared with single-drug TACE using doxorubicin-eluting beads.
目的：我们比较了 313 例不可切除肝细胞癌（HCC）患者的生存结果，这些患者接受了两种不同的经导管动脉化疗栓塞（TACE）治疗方案：三药 TACE 或使用载药微球的单药 TACE。
材料和方法：在这项回顾性研究中，患者选择标准是统一的。三药组（n=166）接受经碘化油、多柔比星、顺铂和丝裂霉素 C 联合微球栓塞的 TACE 治疗。单药组（n=147）接受载多柔比星微球的 TACE 治疗。对组间特征进行分类分析，并采用标准统计方法计算生存。所有患者均随访至死亡。接受原位肝移植（OLT）的患者也进行了随访。
结果：两组在人口统计学、Child-Pugh 分级或 Okuda 分期方面无显著差异。对接受 OLT 患者进行删失（n=73），三药组的平均（±标准误差）生存时间为 23.49±2.38 个月，中位生存时间为 16.00±1.51 个月。单药微球组的平均生存时间为 28.16±2.75 个月，中位生存时间为 15.00±1.50 个月（p=0.168）。对接受 OLT 患者进行删失，总队列的平均和中位生存时间分别为 26.25±1.97 和 15.00±1.08 个月。在未接受 OLT 的整个队列中，Child-Pugh 分级为 A 的患者的生存时间明显长于 Child-Pugh 分级为 B 的患者。甲胎蛋白水平升高与生存时间缩短相关，使用载药微球行 TACE 的患者住院时间更短。尽管在接受载药微球 TACE 的 Child-Pugh 分级为 A、Okuda 分期为 I、巴塞罗那临床肝癌分级为 A 和 B 的患者中，第 36 个月时观察到更高的年度生存率，但这种生存优势并未达到统计学意义。
结论：我们发现，与使用载多柔比星微球的单药 TACE 相比，接受三药 TACE 治疗的不可切除 HCC 患者的生存无显著差异。
Front Oncol. 2022-8-18
J Hepatocell Carcinoma. 2022-8-15
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