Nabeshima M, Ochi J, Hikita H, Nishikawa H, Ohara T, Torii A, Fujita S, Takeda J, Miura K
Division of Gastroenterology, Kyoto Katsura Hospital.
Gan To Kagaku Ryoho. 1998 Feb;25 Suppl 1:99-104.
Therapeutic effects of SMANCS and LpTAE were evaluated for hepatocellular carcinoma (HCC). Since June 1995, SMANCS has been used in 59 patients for their first treatment. LpTAE had been performed for HCC before introduction of SMANCS in our hospital, and 71 patients treated after 1992 were chosen for comparison with the therapeutic effect of SMANCS. Among the patients treated with SMANCS, complete and partial responses (CR and PR) were obtained in 24 cases (41%) and 17 cases (33%), respectively. SMANCS accompanied by TAE was more effective than SMANCS alone. The effects did not depend on the level of the hepatic arterial branch at which SMANCS was administered. In patients treated with LpTAE, CR and PR were obtained in 12 cases (17%) and 18 cases (25%), respectively. SMANCS was significantly more effective than LpTAE. Because of our short experience with SMANCS, we could only show a two year survival rate. The one- and two-year survival rates for SMANCS were 71% and 57%, respectively. They were not significantly different from those for LpTAE, at 80% and 60%. Despite good results of treatment for HCC, a better prognosis could not be expected by SMANCS in this study. These results may be explained as follows. The evaluating the cause of death within two years after first treatment, hepatic failure was more common in patients treated with SMANCS. After treatment by SMANCS, 11 patients (55%) died from hepatic failure. On the other hand, 4 patients (15%) died from hepatic failure after LpTAE. Although there is no significant difference of Child Pugh score, this may indicate that SMANCS has been used for patients with lesser hepatic reserve and this leads to early deaths in patients treated with SMANCS. However, because of the short experience in this study, further observation is necessary for precise evaluation of clinical efficacy of SMANCS.
评估了丝裂霉素（SMANCS）和肝动脉化疗栓塞术（LpTAE）对肝细胞癌（HCC）的治疗效果。自1995年6月以来，59例患者首次使用SMANCS进行治疗。在我院引入SMANCS之前，LpTAE已用于HCC的治疗，选取1992年后接受治疗的71例患者与SMANCS的治疗效果进行比较。在接受SMANCS治疗的患者中，分别有24例（41%）和17例（33%）获得完全缓解（CR）和部分缓解（PR）。SMANCS联合TAE比单独使用SMANCS更有效。疗效不取决于给予SMANCS的肝动脉分支水平。在接受LpTAE治疗的患者中，分别有12例（17%）和18例（25%）获得CR和PR。SMANCS的疗效明显优于LpTAE。由于我们使用SMANCS的经验有限，仅能显示两年生存率。SMANCS的一年和两年生存率分别为71%和57%。它们与LpTAE的80%和60%没有显著差异。尽管HCC的治疗效果良好，但在本研究中，SMANCS并未带来更好的预后。这些结果可能如下解释。在首次治疗后两年内评估死亡原因，接受SMANCS治疗的患者中肝衰竭更为常见。SMANCS治疗后，11例患者（55%）死于肝衰竭。另一方面，LpTAE治疗后有4例患者（15%）死于肝衰竭。虽然Child Pugh评分没有显著差异，但这可能表明SMANCS用于肝储备较差的患者，导致接受SMANCS治疗的患者早期死亡。然而，由于本研究经验有限，需要进一步观察以精确评估SMANCS的临床疗效。
