经动脉化疗栓塞术相关的肝细胞癌肺转移
Pulmonary metastasis of hepatocellular carcinoma associated with transarterial chemoembolization.
作者信息
Liou T C, Shih S C, Kao C R, Chou S Y, Lin S C, Wang H Y
机构信息
Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, Republic of China.
出版信息
J Hepatol. 1995 Nov;23(5):563-8. doi: 10.1016/0168-8278(95)80063-8.
UNLABELLED
Recent advances in both diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the subsequently increasing distant metastases. Pulmonary metastasis of hepatocellular carcinoma associated with transcatheter arterial chemoembolization has rarely been reported.
METHODS
To evaluate whether transcatheter arterial chemoembolization increases the risk of pulmonary metastasis of hepatocellular carcinoma, 230 patients were studied. Among them, 156 received transcatheter arterial chemoembolization with an interval of 12-16 weeks, the remaining 74 cases refused transcatheter arterial chemoembolization and received only conservative treatment. All patients were followed up with chest x-ray films taken before transcatheter arterial chemoembolization, during admission or in the out-patient department. The mean follow-up interval was 3.37 +/- 1.51 months.
RESULTS
Pulmonary metastasis was found in 25.6% (40/156) and 8.1% (6/74) of the patients with and without transcatheter arterial chemoembolization (p = 0.002). The median interval between initial diagnosis and pulmonary metastasis was 3.39 +/- 0.08 and 11.72 +/- 2.91 months among patients with and without transcatheter arterial chemoembolization (p = 0.001). The mean age, sex, existence of cirrhosis, severity of cirrhosis, presence of collateral arterial circulation, amount of lipiodol and agent of anti-cancer drugs were not associated with the development of lung metastasis. However, factors predisposing to lung metastasis included: solitary tumor with tumor size > 10 cm, multiple tumors with main tumor > 5 cm or diffuse hepatocellular carcinoma, intrahepatic portal vein thrombosis, arterioportal or arteriovenous shunt, and the presence of incomplete tumor necrosis after transcatheter arterial chemoembolization (especially combined with necrotic area > 50% main tumor size).
CONCLUSIONS
Pulmonary metastasis associated with transcatheter arterial chemoembolization has a strong adverse impact on patient survival.
未标注
肝细胞癌诊断和治疗方面的最新进展改善了预后，并改变了随后增加的远处转移的临床意义。经导管动脉化疗栓塞术相关的肝细胞癌肺转移鲜有报道。
方法
为评估经导管动脉化疗栓塞术是否会增加肝细胞癌肺转移风险，对230例患者进行了研究。其中，156例接受了间隔为12 - 16周的经导管动脉化疗栓塞术，其余74例拒绝经导管动脉化疗栓塞术，仅接受保守治疗。所有患者在经导管动脉化疗栓塞术前、住院期间或门诊进行胸部X光片随访。平均随访间隔为3.37±1.51个月。
结果
接受和未接受经导管动脉化疗栓塞术的患者中，肺转移发生率分别为25.6%（40/156）和8.1%（6/74）（p = 0.002）。在接受和未接受经导管动脉化疗栓塞术的患者中，初次诊断至肺转移的中位间隔时间分别为3.39±0.08个月和11.72±2.91个月（p = 0.001）。平均年龄、性别、肝硬化的存在、肝硬化的严重程度、侧支动脉循环的存在、碘油用量和抗癌药物种类与肺转移的发生无关。然而，易发生肺转移的因素包括：肿瘤大小>10 cm的孤立性肿瘤、主肿瘤>5 cm的多发肿瘤或弥漫性肝细胞癌、肝内门静脉血栓形成、动门脉或动静脉分流，以及经导管动脉化疗栓塞术后存在不完全肿瘤坏死（尤其是坏死面积>主肿瘤大小的50%）。
结论
经导管动脉化疗栓塞术相关的肺转移对患者生存有强烈的不良影响。
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