Bartolozzi C, Lencioni R, Armillotta N
Dipartimento di Oncologia, Cattedra di Radiologia, Università degli Studi di Pisa.
Radiol Med. 1997 Jul-Aug;94(1-2):19-23.
We investigated the long-term outcome of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). A series of 86 patients with biopsy-proved HCC were treated at our Institution January, 1991, to June, 1996. All patients had a single primary tumor bigger than 3 cm, occurring solitary or associated with no more than 2 daughter nodules. Forty-eight patients were in Child class A and 38 patients were in Child class B. The diameter of the lesions ranged 3 to 8 cm (mean: 5.3 cm). The treatment schedule included a single TACE performed via a segmental approach by injecting an emulsion of 20-70 mg adriblastin or farmorubicin and 5-20 ml Lipiodol followed by gelatin sponge particles. Four weeks later, CT and MR follow-up studies were performed and PEI was subsequently started. PEI included 4-16 treatment sessions (mean: 6.8 sessions) performed under US guidance. The total amount of alcohol administered ranged 16 to 215 ml (mean: 69 ml). All patients were followed after therapy with clinical examinations. laboratory tests, and US, CT, and MR studies performed at regular time intervals. The follow-up period ranged 4 to 65 months (mean: 27.8 months; median: 26 months). No major treatment-related complication occurred. The therapeutic response, as assessed with imaging studies performed after the end of treatment, was complete tumor necrosis in 71 of 86 patients (82%) and partial tumor necrosis in the remaining 15. Overall survival rates by the Kaplan-Meier method were 92% at 1 year, 83% at 2 years, 69% at 3 years, 58% at 4 years, and 47% at 5 years. The survival of Child A patients (75% at 3 years and 59% at 5 years) was significantly longer (p < .01) than that of Child B patients (61% at 3 years and 35% at 5 years). During the follow-up, a recurrence of the treated tumors was observed in 5 patients, and new HCCs appeared in 46 patients. The 1-, 2-, 3-, 4-, and 5-year recurrence rates by the Kaplan-Meier method were 14%, 35%, 56%, 69%, and 82%, respectively. The long-term results of combined treatment with TACE and PEI confirm the effectiveness of this therapeutic approach in patients with large uninodular HCC.
我们研究了经导管动脉化疗栓塞术（TACE）联合经皮乙醇注射（PEI）治疗肝细胞癌（HCC）的长期疗效。1991年1月至1996年6月期间，我们机构对86例经活检证实为HCC的患者进行了治疗。所有患者均有一个直径大于3 cm的单一原发性肿瘤，肿瘤为孤立性或伴有不超过2个小结节。48例患者为Child A级，38例患者为Child B级。病灶直径为3至8 cm（平均：5.3 cm）。治疗方案包括通过节段性方法进行单次TACE，注射20 - 70 mg阿霉素或表柔比星与5 - 20 ml碘油的乳剂，随后注入明胶海绵颗粒。四周后，进行CT和MR随访研究，随后开始PEI。PEI包括在超声引导下进行4 - 16次治疗（平均：6.8次）。酒精注射总量为16至215 ml（平均：69 ml）。所有患者在治疗后均接受临床检查、实验室检查以及定期进行的超声、CT和MR检查随访。随访期为4至65个月（平均：27.8个月；中位数：26个月）。未发生重大治疗相关并发症。根据治疗结束后进行的影像学研究评估，治疗反应为86例患者中有71例（82%）肿瘤完全坏死，其余15例为部分肿瘤坏死。采用Kaplan - Meier法计算的总体生存率1年时为92%，2年时为83%，3年时为69%，4年时为58%，5年时为47%。Child A级患者的生存率（3年时为75%，5年时为59%）显著长于Child B级患者（3年时为61%，5年时为35%）（p < .01）。随访期间，5例患者出现治疗后肿瘤复发，46例患者出现新发HCC。采用Kaplan - Meier法计算的1年、2年、3年、4年和5年复发率分别为14%、35%、56%、69%和82%。TACE与PEI联合治疗的长期结果证实了该治疗方法对大的单结节HCC患者的有效性。
