Marchiori L, Mansueto G C, Nifosi F, Bortolasi L, Dal Dosso I, Facci E, Perus G, Nicoli N
Istituto di Patologia Chirurgica, Università degli Studi di Verona.
Chir Ital. 1994;46(1):17-22.
One hundred and fourteen consecutive patients with unresectable hepatocellular carcinoma were treated by chemoembolization using ethiodized oil (Lipiodol), anticancer agents. Ninety patients had concomitant chronic liver disease. Hepatocellular carcinoma (HCC) was diagnosed by US, contrast enhanced CT, fine needle biopsy and alpha-feto-protein level. Admission criteria were as follows: tumor confined to the liver with or without hilar nodal involvement, Child class A or B, white blood cell count above 2.000/mmc and platelet count above 75,000/mmc. All the patients underwent angiographic chemoembolization with Lipiodol and anticancer agents. In 98 patients we performed transcatheter hepatic arterial embolization (TAE) with Gelfoam or for Ivalon sponge. In 16 patients TAE was not performed because of portal thrombosis (7 cases) or technical reasons (9 cases). Mitomycin was used in 40 patients and dihydroxyanthracenedione (DADH) in 58 patients. In the TAE group 83 patients were Child A and 15 Child B. In 27 patients HCC was mononodular whereas in 71 it was multinodular. In 41 patients the tumor was more than 5 cm in diameter (in multinodular tumors only the larger lesion was taken into account). In 56 patients chemoembolization plus TAE was repeated. Seven patients died within one month after treatment: two from myocardial infarction, two from liver failure, two from digestive haemorrhage and one from necrotizing pancreatitis. Long-term survival rates were investigated in relation to prognostic factors: anti-cancer agent, number of nodes, tumor size and Child stage using Kaplan-Meier method. Survival rate at 12, 24 and 36 months are 64%, 38%, and 30% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
114例连续性不可切除肝细胞癌患者接受了使用乙碘油（碘油）和抗癌药物的化疗栓塞治疗。90例患者伴有慢性肝病。肝细胞癌（HCC）通过超声、增强CT、细针活检及甲胎蛋白水平进行诊断。纳入标准如下：肿瘤局限于肝脏，有或无肝门淋巴结受累，Child A或B级，白细胞计数高于2000/mmc且血小板计数高于75000/mmc。所有患者均接受了碘油和抗癌药物的血管造影化疗栓塞。98例患者使用明胶海绵或Ivalon海绵进行了经导管肝动脉栓塞（TAE）。16例患者因门静脉血栓形成（7例）或技术原因（9例）未进行TAE。40例患者使用丝裂霉素，58例患者使用二羟基蒽二酮（DADH）。TAE组中，83例患者为Child A级，15例为Child B级。27例患者的HCC为单结节，71例为多结节。41例患者肿瘤直径超过5 cm（多结节肿瘤仅考虑较大病灶）。56例患者重复进行了化疗栓塞加TAE。7例患者在治疗后1个月内死亡：2例死于心肌梗死，2例死于肝功能衰竭，2例死于消化道出血，1例死于坏死性胰腺炎。使用Kaplan-Meier方法根据预后因素（抗癌药物、淋巴结数量、肿瘤大小和Child分期）研究长期生存率。12、24和36个月时的生存率分别为64%、38%和30%。（摘要截断于250字）
