Majno P E, Adam R, Bismuth H, Castaing D, Ariche A, Krissat J, Perrin H, Azoulay D
Hepatobiliary Surgery and Liver Transplant Research Center, Hôpital Paul Brousse, Villejuif, France.
Ann Surg. 1997 Dec;226(6):688-701; discussion 701-3. doi: 10.1097/00000658-199712000-00006.
To investigate the impact of preoperative transarterial lipiodol chemoembolization (TACE) in the management of patients undergoing liver resection or liver transplantation for hepatocellular carcinoma.
TACE was performed before surgery in 49 of 76 patients undergoing resection and in 54 of 111 patients undergoing liver transplantation. Results were retrospectively analyzed with regard to the response to treatment, the type of procedure performed, the incidence of complications, the incidence and pattern of recurrence, and survival.
In liver resection, downstaging of the tumor by TACE (21 of 49 patients [42%]) and total necrosis (24 of 49 patients [50%]) were associated with a better disease-free survival than either no response to TACE or no TACE (downstaging, 29% vs. 10% and 11 % at 5 years, p = 0.08 and 0.10; necrosis, 22% vs. 13% and 11% at 5 years, p = 0.1 and 0.3). Five patients (10%) with previously unresectable tumors could be resected after downstaging. In liver transplantation, downstaging of tumors >3 cm (19 of 35 patients [54%]) and total necrosis (15 of 54 patients [28%]) were associated with better disease-free survival than either incomplete response to TACE or no TACE (downstaging, 71 % vs. 29% and 49% at 5 years, p = 0.01 and 0.09; necrosis, 87% vs. 47% and 60% at 5 years, p = 0.03 and 0.14). Multivariate analysis of the factors associated with response to TACE showed that downstaging occurred more frequently for tumors >5 cm.
Downstaging or total necrosis of the tumor induced by TACE occurred in 62% of the cases and was associated with improved disease-free survival both after liver resection and transplantation. In liver resection, TACE was also useful to improve the resectability of primarily unresectable tumors. In liver transplantation, downstaging in patients with tumors >3 cm was associated with survival similar to that in patients with less extensive disease.
探讨术前经动脉碘油化疗栓塞术（TACE）对接受肝细胞癌肝切除或肝移植患者治疗效果的影响。
76例接受肝切除的患者中有49例、111例接受肝移植的患者中有54例在手术前接受了TACE治疗。对治疗反应、所施行手术类型、并发症发生率、复发率及复发模式以及生存率进行回顾性分析。
在肝切除患者中，TACE使肿瘤降期（49例患者中的21例[42%]）和完全坏死（49例患者中的24例[50%]）与无TACE反应或未行TACE相比，无病生存期更佳（降期：5年时分别为29%、10%和11%，p = 0.08和0.10；坏死：5年时分别为22%、13%和11%，p = 0.1和0.3）。5例（10%）先前无法切除的肿瘤患者在降期后能够接受切除手术。在肝移植患者中，肿瘤直径>3 cm的降期（35例患者中的19例[54%]）和完全坏死（54例患者中的15例[28%]）与TACE不完全反应或未行TACE相比，无病生存期更佳（降期：5年时分别为71%、29%和49%，p = 0.01和0.09；坏死：5年时分别为87%、47%和60%，p = 0.03和0.14）。对与TACE反应相关因素的多变量分析显示，肿瘤直径>5 cm时降期更常见。
TACE诱导的肿瘤降期或完全坏死发生在62%的病例中，并且与肝切除和肝移植后的无病生存期改善相关。在肝切除中，TACE对于提高原本不可切除肿瘤的可切除性也很有用。在肝移植中，肿瘤直径>3 cm患者的降期与疾病范围较小患者的生存率相似。
