经导管肝动脉化疗栓塞联合经皮无水乙醇注射治疗肝癌的长期疗效观察

背景与目的肝癌的介入治疗中,经导管肝动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)与经皮无水乙醇注射(percutaneousethanolinjection,PEI)是开展最广泛、效果最显著的两项治疗措施。TACE联合PEI可明显提高肝癌的近效疗效,但远期随访结果报道较少。本研究拟探讨TACE联合PEI治疗肝癌的长期效果及价值。方法675例肿瘤直径为2～15cm(平均9.6cm)、不能切除的原发性肝细胞癌(hepatocellularcarcinoma,HCC)接受介入治疗,其中179例行TACE联合PEI治疗(联合组),496例行单纯TACE治疗(TACE组)。两组中各有10例介入治疗后行Ⅱ期手术切除,标本送病理研究。其他病例随访5～7年以上(平均6.6年),分别统计1、3、5、7年累计生存率。联合组与TACE组两组无论是手术切除病例,还是随访病例,介入治疗前的一般资料均具有可比性。结果病理研究显示,虽然治疗前后肿块缩小程度两组无显著性差异,但联合组肿瘤平均坏死程度[(100.0±0.0)%]及完全坏死率(100%)均显著高于TACE组[分别为(91.5±7.1)%和20%,P<0.05或0.01]。随访结果显示,联合组1、3、5、7年生存率分别为80.5%、58.6%、29.6%和16.5%,TACE组分别为68.5%、27.8%、7.2%和5.2%,统计学处理均有显著性差异(P<0.01)。结论TACE联合PEI是提高HCC远期生存率较好的治疗

Long-term result of combination of transcatheter arterial chemoembolization and percutaneous ethanol injection for treatment of hepatocellular carcinoma

BACKGROUND & OBJECTIVE: Both transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) are the most important and popular procedures of interventional treatment for hepatocellular carcinoma (HCC). Although the improvement of the short-term efficacy of the combination of TACE and PEI has been proved, the long-term efficacy is seldom reported so far. The purpose of this study was to evaluate the long-term efficacy of the combination of TACE and PEI for treatment of HCC. METHODS: Six hundred and seventy-five patients with HCC from 2 cm to 15 cm in the greatest diameter (average 9.6 cm) were enrolled in this study. Among them, 179 were treated by a combination of TACE using the emulsion of lipiodol and anti-cancer drugs and PEI (TACE/PEI group) and 496 patients by TACE alone (TACE group). Ten patients in each group underwent resection after the final interventional treatment and the resected specimens were detected by histopathology method. The unresected patients had been followed up for 5-7 years and the 1-, 3-, 5 -, and 7-year survival rates were evaluated. The clinical data of the patients in two groups before intervention were comparable. RESULTS: Pathological data of two groups showed that remarkable differences were found in the mean necrosis rates (100.0+/-0.0% vs 91.5+/-7.1%, P< 0.05) and the complete necrosis rates of tumors (100% vs 20%, P = 0.0007), while there were no statistical significances in the extent of shrinkage of tumors after treatment between two groups. The results of follow-up showed that the 1-, 3-, 5-, and 7-year survival rates were 80.5%, 58.6%, 29.6%, 16.5% in TACE-PEI group, and 68.5%, 27.8%, 7.2%, 5.2% in TACE group, respectively. Significant differences were found between two groups (P< 0.01). CONCLUSION: The combination of TACE and PEI is a valuable remedy for HCC to prolong long-term survival rate.