Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients
Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients
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DOI：
10.1053/j.gastro.2006.05.021
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发表时间：
2006-08-01
期刊：
影响因子：
29.4
通讯作者：
Yamaoka, Yoshio
中科院分区：
文献类型：
--
作者：
Takayasu, Kenichi;Arii, Shigeki;Yamaoka, Yoshio
背景和目标：目的探讨经肝动脉碘油化疗栓塞术（TACE）治疗不能切除的原发性肝癌（HCC）患者的生存率，并分析影响生存率的因素。研究方法：在过去的8年中，在8510例接受TACE的不可切除HCC患者中进行了一项全国性前瞻性队列研究，这些患者使用阿曲库碘油和抗癌药物乳剂，随后使用明胶海绵颗粒作为初始治疗。排除标准为肝外转移和/或在当前TACE之前的任何既往治疗。主要终点是生存率。采用Kaplan-Meier法计算生存率。采用考克斯比例风险模型对影响生存的因素进行多因素分析。平均随访时间为1.77年。结果：对于TACE的总生存率，中位和1年、3年、5年和7年生存率分别为34个月、82%、47%、26%和16%。日本肝癌研究组提出的肝损伤程度和肿瘤淋巴结转移（TNM）系统均显示了良好的生存分层（P =.0001）。多变量分析显示肝损伤程度（P =.0001）、甲胎蛋白值（P =.0001）、最大肿瘤大小（P = 0.0001）、病变数量（P = 0.000：1）和门静脉侵犯（P = 0.000：1）。后3个因素可以用TNM分期代替。初始治疗后TACE相关死亡率为0.5%。结论：TACE是一种安全的治疗方法，对于不能切除的HCC患者，5年生存率为26%。肝损害程度、TNM分期和甲胎蛋白值是影响患者生存的独立危险因素。
Background&Aims: To elucidate the survival of the patients with unresectable hepatocellular carcinoma (HCC) who underwent transcatheter arterial lipiodol chemoembolization (TACE) and to analyze the factors affecting the survivals. Methods: During the last 8 years, a nationwide prospective cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment. Exclusion criteria were extrahepatic metastases and/or any previous treatment prior to the present TACE. The primary end point was survival. The survival rates were calculated by the Kaplan-Meier method. The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model. The mean follow-up period was 1.77 years. Results: For overall survival rates by TACE, median and 1-, 3-, 5-, and 7-year survivals were 34 months, 82%, 47%, 26%, and 16%, respectively. Both the degree of liver damage and the tumor-node-metastasis (TNM) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals (P =.0001). The multivariate analyses showed significant difference in degree of liver damage (P =.0001), alpha-fetoprotein value (P =.0001.), maximum tumor size (P =.0001), number of lesions (P =.000:1), and portal vein invasion (P =.000:1). The last 3 factors could be replaced by TNM stage. The TACE-related mortality rate after the initial therapy was .5%. Conclusions: TACE showed safe therapeutic modality with a 5-year survival of 26% for unresectable HCC patients. The degrees of liver damage, TNM stage, and alpha-fetoprotein values were independent risk factors for patient survival.