Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis
Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis
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DOI：
10.1097/00000658-199712000-00006
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发表时间：
1997-12-01
影响因子：
9
通讯作者：
Azoulay, D
中科院分区：
文献类型：
--
作者：
Majno, PE;Adam, R;Azoulay, D
目的探讨术前经肝动脉碘油化疗栓塞（TACE）在肝癌切除或肝移植患者中的应用价值。结果进行了回顾性分析方面的反应，治疗，类型的程序进行，并发症的发生率，复发的发生率和模式，和生存。通过TACE降低肿瘤分期（49例患者中的21例[42%]）和完全坏死（49例患者中的24例[50%]）与TACE无反应或无TACE相比，（5年时分期下调，29% vs. 10%和11%，p = 0.08和0.10; 5年时坏死，22% vs. 13%和11%，p = 0.1和0.3）。5例（10%）既往不可切除的肿瘤患者可在降级后切除。在肝移植中，肿瘤>3 cm的降级（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不完全缓解或无TACE相比，（5年时分期下调，71% vs. 29%和49%，p = 0.01和0.09; 5年时坏死，87% vs. 41%和80%，p = 0.03和0.14）。多因素分析显示肿瘤直径>5 cm时，肿瘤分期降低的发生率更高。结论62%的病例发生了TACE诱导的肿瘤分期降低或完全坏死，这与肝切除和肝移植后无病生存率的提高有关。在肝切除术中，TACE也有助于提高原发性不可切除肿瘤的可切除性。在肝移植中，肿瘤>3 cm患者的降级与生存率相关，与肿瘤范围较小的患者相似。
Objective To investigate the impact of preoperative transarterial lipiodol chemoembolization (TACE) in the management of patients undergoing liver resection or liver transplantation for hepatocellular carcinoma.Patients and Methods 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.Results 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. 41% and 80% 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.Conclusions 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.