Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: Does transarterial chemoembolization improve survival in these patients?
Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: Does transarterial chemoembolization improve survival in these patients?
复制标题
DOI：
10.1111/j.1440-1746.2010.06341.x
复制
发表时间：
2011-01-01
影响因子：
4.1
通讯作者：
Suh, Dong Jin
中科院分区：
文献类型：
--
作者：
Yoo, Dong-Jun;Kim, Kang Mo;Suh, Dong Jin
背景与目的：经动脉化疗栓塞（TACE）治疗肝外转移的肝细胞癌（HCC）的疗效尚未得到评价。我们研究了TACE联合/不联合全身化疗（s-chemo）对这些患者的疗效。方法：我们采用Child-Pugh分类和肝内HCC T分期，回顾性分析了在初次就诊时根据分层后的治疗方式诊断为肝外转移的连续HCC患者的生存分析。结果：2005年至2007年间，251例新诊断为肝外转移的HCC患者在我院就诊。其中Child-Pugh A-B组226例，Child-Pugh c组25例。Child-Pugh A-B组171例患者进行了重复TACE或经动脉化疗输注（TACI），有/无s-化疗。226例患者中8例单独接受s-化疗，47例单独接受保守治疗。Child-Pugh A期和t3期HCC患者中，TACE/TACI联合s-chemo、TACE/TACI单用和CM治疗的中位生存时间分别为10、5和2.9个月（TACE/TACI联合s-chemo vs CM， P = 0.0354； TACE/TACI单用vs CM， P = 0.0553）； Child-Pugh B期和t3期患者中位生存时间分别为7.1、2.6和1.6个月（TACE/TACI联合s-chemo vs CM， P = 0.0097； TACE/TACI单用vs CM， P < 0.0001）。在多变量分析中，单独使用TACE/TACI或索拉非尼治疗具有独立的预后意义。结论：在肝功能保守、肝内肝癌T3期转移性HCC患者中，重复TACE治疗可显著提高生存期。本研究的生存数据可作为未来临床试验中TACE单药治疗的历史对照，以评估这些患者含TACE的联合治疗。
Background and Aims:The therapeutic efficacy of transarterial chemoembolization (TACE) has not been evaluated in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. We investigated the efficacy of TACE with/without systemic chemotherapy (s-chemo) in these patients.Methods:We performed a survival analysis of consecutive HCC patients with extrahepatic metastasis, diagnosed at initial presentation according to treatment modality after stratification, using the Child-Pugh classification and intrahepatic HCC T stage, retrospectively.Results:Between 2005 and 2007, 251 patients were newly diagnosed with HCC involving extrahepatic metastasis at our institution. Among those, 226 were classified as Child-Pugh A-B and the other 25, Child-Pugh C. Within the Child-Pugh A-B group, repeated TACE or transarterial chemoinfusion (TACI) was performed with/without s-chemo in 171 patients. Eight of 226 received s-chemo alone, and 47, conservative management (CM) alone. The median survival time of patients treated with TACE/TACI with s-chemo, TACE/TACI alone, and CM was 10, 5, and 2.9 months in patients classified as Child-Pugh A and T3-stage HCC (TACE/TACI with s-chemo vs CM, P = 0.0354; TACE/TACI alone vs CM, P = 0.0553) and 7.1, 2.6, and 1.6 months in Child-Pugh B and T3-stage patients, respectively (TACE/TACI with s-chemo vs CM, P = 0.0097; TACE/TACI alone vs CM, P < 0.0001). Individual treatment with TACE/TACI or sorafenib showed independent prognostic significance in the multivariate analysis.Conclusion:Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients.