Takayasu K, Wakao F, Moriyama N, Muramatsu Y, Sakamoto M, Hirohashi S, Makuuchi M, Kosuge T, Takayama T, Yamazaki S
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
AJR Am J Roentgenol. 1993 Feb;160(2):301-6. doi: 10.2214/ajr.160.2.8380949.
In Japan, borderline lesions and early-stage hepatocellular carcinoma (HCC) are now histopathologically divided into two subgroups; one includes adenomatous hyperplasia and atypical adenomatous hyperplasia, and the other includes early HCC and early advanced HCC. In order to evaluate the efficacy of transcatheter arterial embolization for treating such lesions, histopathologic studies were done after embolization and resection in 27 patients.
The lesions consisted of two adenomatous hyperplasias, one atypical adenomatous hyperplasia, 22 early HCCs, and 13 early advanced HCCs. All patients had chronic liver diseases in nontumorous parenchyma in addition to HCC. For transcatheter arterial embolization, one of the following embolizing materials was used: iodized oil (Lipiodol) alone (n = 4), an emulsion of doxorubicin in Lipiodol (n = 8), and the same emulsion followed by gelatin sponge particles (n = 15).
The frequencies of tumor stain on the angiogram and retention of Lipiodol within the tumor were 84% and 94% in overt HCC, 23% and 69% in early advanced HCC, and 9% and 9% in early HCC, respectively. The average size of overt HCC was significantly (p < .01) larger than that of early advanced HCC and early HCC. The amount of necrosis induced by embolization relative to the size of the mass was 56% on average in overt HCCs, 14% in early advanced HCCs, and 0% in early HCCs, atypical adenomatous hyperplasias, and adenomatous hyperplasias. Significant differences (p < .01) in mean necrosis rate were seen between overt HCCs and early advanced HCCs, between early advanced HCCs and early HCCs, and between overt HCCs and early HCCs. The frequency of Lipiodol retention correlated with mean necrosis rate for tumor. With reference to therapeutic techniques, only for the overt HCCs was a significant difference (p < .01) in the mean necrosis rate found between the group that received the emulsion of doxorubicin in Lipiodol and the group that received the emulsion and then particles of gelatin.
This study suggests that transcatheter arterial embolization has limited efficacy for treating early-stage HCC and borderline lesions compared with its efficacy for treating overt HCC.
在日本，目前组织病理学将交界性病变和早期肝细胞癌（HCC）分为两个亚组；一组包括腺瘤样增生和非典型腺瘤样增生，另一组包括早期HCC和早期进展期HCC。为评估经导管动脉栓塞术治疗此类病变的疗效，对27例患者在栓塞及切除术后进行了组织病理学研究。
病变包括2例腺瘤样增生、1例非典型腺瘤样增生、22例早期HCC和13例早期进展期HCC。所有患者除HCC外，非肿瘤实质均存在慢性肝病。对于经导管动脉栓塞术，使用了以下栓塞材料之一：单纯碘化油（碘油）（n = 4）、阿霉素碘油乳剂（n = 8）以及该乳剂后加明胶海绵颗粒（n = 15）。
在显性HCC中，血管造影上肿瘤染色频率和碘油在肿瘤内的滞留率分别为84%和94%；在早期进展期HCC中分别为23%和69%；在早期HCC中分别为9%和9%。显性HCC的平均大小显著（p <.01）大于早期进展期HCC和早期HCC。相对于肿块大小，栓塞诱导的坏死量在显性HCC中平均为56%，在早期进展期HCC中为14%，在早期HCC、非典型腺瘤样增生和腺瘤样增生中为0%。显性HCC与早期进展期HCC之间、早期进展期HCC与早期HCC之间以及显性HCC与早期HCC之间的平均坏死率存在显著差异（p <.01）。碘油滞留频率与肿瘤平均坏死率相关。关于治疗技术，仅在显性HCC中，接受阿霉素碘油乳剂的组与接受该乳剂后加明胶颗粒的组之间平均坏死率存在显著差异（p <.01）。
本研究表明，与治疗显性HCC相比，经导管动脉栓塞术治疗早期HCC和交界性病变的疗效有限。
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