Fan J, Tang Z Y, Yu Y Q, Wu Z Q, Ma Z C, Zhou X D, Zhou J, Qiu S J, Lu J Z
Liver Cancer Institute, Zhong Shan Hospital, Shanghai Medical University, Shanghai, P.R. China.
Dig Surg. 1998;15(6):674-8. doi: 10.1159/000018676.
This retrospective study was undertaken to analyze the outcome of hepatic resection in hepatocellular carcinomas (HCCs) that shrunk after transcatheter hepatic arterial chemoembolization (TACE) in 65 patients with unresectable HCCs between June 1987 and September 1996.
Among these 65 patients, the median diameter of the tumor was 9.9 cm (5.6-20.0) prior to the first TACE, after 1-6 times of TACE (median 3) the median tumor diameter reduced to 3.7 cm (1.9-12.5) prior to resection. The duration between the last TACE treatment and sequential resection varied from 1 to 9 months (median 2.5). Serum alpha-fetoprotein (AFP) levels were abnormal in 39 out of the 65 patients. In AFP producing HCCs, the AFP level returned to normal (</=20 microgram/l) in 14 out of 39 patients (35.9%). Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in 61 patients, right hemihepatectomy in 1, left trisegmentectomy in 2, and left hemihepatectomy in 1.
Tumor necrosis ranged from 40 to 100% and pathologically and complete tumor necrosis occurred in 11 patients (16.9%). Of 14 patients with AFP levels decreased to normal, 10 still had microscopic living tumor foci. The 1-, 3- and 5-year survival rates of the 65 patients were 80.0, 65.0 and 56.0% respectively.
TACE treatment can provide a chance of tumor resection for those patients with initially judged unresectable HCCs, and liver resection should be performed when the tumor has shrunk to be resectable, even when the AFP level has returned to normal.
本回顾性研究旨在分析1987年6月至1996年9月期间65例不可切除肝细胞癌（HCC）患者经肝动脉化疗栓塞术（TACE）后肿瘤缩小而行肝切除的结果。
这65例患者中，首次TACE前肿瘤中位直径为9.9 cm（5.6 - 20.0），经1 - 6次TACE（中位次数为3次）后，切除术前肿瘤中位直径缩小至3.7 cm（1.9 - 12.5）。最后一次TACE治疗与后续肝切除之间的间隔时间为1至9个月（中位时间为2.5个月）。65例患者中39例血清甲胎蛋白（AFP）水平异常。在产生AFP的HCC患者中，39例中有14例（35.9%）AFP水平恢复正常（≤20微克/升）。61例行肝段切除术、多肝段切除术或部分肝切除术，1例行右半肝切除术，2例行左三叶切除术，1例行左半肝切除术。
肿瘤坏死范围为40%至100%，11例（16.9%）病理检查显示肿瘤完全坏死。14例AFP水平降至正常的患者中，10例仍有微小存活肿瘤病灶。65例患者的1年、3年和5年生存率分别为80.0%、65.0%和56.0%。
TACE治疗可为那些最初判定为不可切除的HCC患者提供肿瘤切除机会，即使AFP水平已恢复正常，当肿瘤缩小至可切除时也应行肝切除术。
