The Effect of Preoperative Transarterial Chemoembolization of Resectable Hepatocellular Carcinoma on Clinical and Economic Outcomes
The Effect of Preoperative Transarterial Chemoembolization of Resectable Hepatocellular Carcinoma on Clinical and Economic Outcomes
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DOI：
10.1002/jso.21248
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发表时间：
2009-05-01
影响因子：
2.5
通讯作者：
Chiu, Herng-Chia
中科院分区：
文献类型：
--
作者：
Lee, King-Teh;Lu, Yi-Wei;Chiu, Herng-Chia
背景：肝细胞癌（Hepatocellular carcinoma，HCC）是世界上最常见的恶性肿瘤之一。术前肝动脉化疗栓塞术（TACE）对可切除肝癌的疗效仍有争议，相关治疗费用也不清楚。方法：我们回顾性比较了术前行TACE的患者肝切除术后的临床结局和资源利用情况结果：TACE-LR组总死亡率为27.54%，TACE-LR组为39.47%，两组比较差异有统计学意义（P < 0.05）。LR组总复发率为29.36%，TACE-LR组总复发率为35.90%（P > 0.05）。多因素考克斯回归分析显示，术前TACE是HCC总体长期生存率的显著危险因素（P = 0.002，HR = 1.995 95%CI 1.297-3.069）。TACE-LR组有较长的男性住院时间和较高的住院费用，无论是在指数住院，并在6个月的following.Conclusion：术前TACE不仅与较高的医疗利用率，但它也与较高的死亡率超过5年的时间。术前TACE对可切除的HCC患者没有益处。应制定金标准或临床指南，为HCC患者提供更好的临床决策和决策支持。
Background: Hepatocellular carcinoma (HCC) is one of the most malignant cancers in the world. The effect preoperative transarterial chemoembolization (TACE) for resectable HCC is still controversial and cost-associated treatments are unknown.Methods: We retrospectively compared clinical outcomes and resource utilization after liver resection between patients who underwent preoperative TACE (TACE-LR group, n = 114) and those who did not (LR group, n = 236).Results: The overall mortality rate was 27.54% for the LR group versus 39.47% for the TACE-LR group (P < 0.05). The overall recurrent rates were 29.36% for the LR group versus 35.90% for the TACE-LR group (P > 0.05). Multivariate Cox regression analysis showed that preoperative TACE was a significant risk factor (P = 0.002, HR = 1.995 95% CI 1.297-3.069) for overall long-term survival for HCC. The TACE-LR group had longer men lengths of stay and higher hospital charges, both at index hospitalization and at 6 months for follow-up.Conclusion: Preoperative TACE is not only associated with higher medical utilizations, but it is also correlated with higher mortality rates over a 5-year period. The preoperative TACE does not benefit patients with resectable HCC. The golden standard or clinical guidelines should be developed to provide better clinical decisions and decision support for HCC patients.