Saito Natsuhiko, Tanaka Toshihiro, Nishiohuku Hideyuki, Sato Takeshi, Masada Tetsuya, Matsumoto Takeshi, Anai Hiroshi, Sakaguchi Hiroshi, Sueyoshi Satoru, Marugami Nagaaki, Kichikawa Kimihiko
Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan.
Department of Radiology, Nara City Hospital, Nara, Japan.
Hepatol Res. 2020 Oct;50(10):1176-1185. doi: 10.1111/hepr.13550. Epub 2020 Aug 14.
To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE.
Of 158 treatment-naïve patients with intermediate-stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria: no combined therapy within 4 weeks after initial TACE, and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analyses using Cox proportional hazards models. The deterioration of liver function after repeated TACE was also evaluated.
The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2 months. Survival rates at 1, 2, and 3 years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75 years (P = 0.022), serum α-fetoprotein level ≥ 200 ng/mL (P = .010), tumor number ≥ 11 (P = 0.008), and heterogeneous enhancement on dynamic computed tomography (P = 0.024) were poor prognostic factors. The deterioration rate of Child-Pugh score and albumin-bilirubin grade was 18.5% and 12.3%, respectively, after the first TACE, 15.6% and 5.1%, respectively, after the second TACE, and 14.5% and 11.1%, respectively, after the third TACE.
Superselective TACE can achieve high tumor response rates with prolonged overall survival for patients with intermediate-stage HCC with preserved liver function. Age, serum α-fetoprotein level, tumor number ≥ 11, and heterogeneous enhancement on dynamic computed tomography indicated significantly poor prognosis.
评估经动脉化疗栓塞术（TACE）对肝功能良好的中期肝细胞癌（HCC）患者的治疗效果及预后因素，以明确TACE的定位。
2007年2月至2016年1月期间，158例初治的中期HCC患者接受了首次TACE治疗，其中113例患者符合以下纳入标准：首次TACE后4周内未接受联合治疗，且Child-Pugh评分低于7分。评估了缓解率和总生存期。使用Cox比例风险模型进行单因素和多因素分析，以研究预后因素。还评估了重复TACE后肝功能的恶化情况。
缓解率为92.7%（完全缓解63.3%；部分缓解29.4%）。中位生存时间为45.2个月。1年、2年和3年生存率分别为90.4%、77.0%和60.8%。年龄≥75岁（P = 0.022）、血清甲胎蛋白水平≥200 ng/mL（P = 0.010）、肿瘤数量≥11个（P = 0.008）以及动态计算机断层扫描显示不均匀强化（P = 0.024）是不良预后因素。首次TACE后，Child-Pugh评分和白蛋白-胆红素分级的恶化率分别为18.5%和12.3%，第二次TACE后分别为15.6%和5.1%，第三次TACE后分别为14.5%和11.1%。
对于肝功能良好的中期HCC患者，超选择性TACE可实现较高的肿瘤缓解率，并延长总生存期。年龄、血清甲胎蛋白水平、肿瘤数量≥11个以及动态计算机断层扫描显示不均匀强化提示预后明显较差。
