The Outcomes and Affecting Factors Analysis of Hepatocellular Carcinoma Patients Underwent Transcatheter Arterial Chemoembolization

肝癌患者施行肝動脈化學栓塞後療效與影響因子分析

劉大忠(Da-Chung Liou) ； 邱亨嘉(Herng-Chia Chiu) ； 莊欣慧(Sin-Hui Chuang) ； 陸教義(Chiao-Yi Lu)

《中華放射線醫學雜誌》 35卷2期 (2010/06) Pp. 71-79

摘要

肝癌為台灣男性癌症死因的第一位，女性的第二位，對於無法施行肝癌切除術的肝癌病患而言，肝動脈化學栓塞療法(transcatheter arterial chemoembolization, TACE)是現今被視為最具積極性之治療方式。
作者採病歷審查回溯性分析，以2000年1月到2005年12月間，在本院作過TACE的病人為對象，以病歷審查方式取得治療變項，利用Kaplan-Meier和Cox regression分析2000年到2005年間執行TACE病人的一、二、三年存活率和其重要的影響因子。
總共有80名病患接受了414次的TACE治療，平均每人5.2次，平均年齡為60.2±14.2歲，疾病特質中，40人有B肝，32人有C肝，在Child's分類中，A、B、C各類分別為19、8和4人，其他沒有肝硬化的病人有49人。80名病患中，有合併症者40人，有併發症者4人。在存活率分析中(n=80)，其一、二、三年的存活率為76.3%、45%、31.3%，平均存活時間24個月。影響存活率顯著的影響因子為年齡、腫瘤大小、腫瘤數目、Child's C、AJCC腫瘤分期、病理分級，作完TACE一個月後AFP下降一半，及門靜脈栓塞。年齡越小、腫瘤越大、腫瘤數目越多、Child's C、AJCC腫瘤分期越高、病理分級越高、有門靜脈栓塞、作完TACE一個月後AFP沒有下降一半以上的病患，其預後愈差。

並列摘要

Liver cancer is the first leading cause of cancer death among the male Taiwanese and the second among the female Taiwanese. Nowadays, transcatheter arterial chemoembolization (TACE) is a widely accepted treatment option for liver cancer patients who can't receive surgical resection.
This study adopted retrospective medical record review analysis method, which took the patients who received TACE in this district teaching hospital between January 2001 and December 2005 as research subjects. KaplanMeier life table analysis was applied to calculate the one-year, two-year, three-year survival rates of patients who received TACE between 2000 and 2005, and the multivariate Cox regression was used to analyze the important affecting factors.
There were 80 patients who received 414 TACE treatments. On average, each patient received 5.2 TACE, and the mean age was 60.2±14.2 years old. Among these patients, 40 patients had hepatitis B, and 32 patients had hepatitis C. According to Child's c1assification, 19 patients were in Child's A, 8 in Child's B and 4 in Child's C and 49 patients were non-cirrhosis. Among these 80 patients, 40 had comorbidity, and 4 had complication. In the survival analysis (n=80), the one-year, two-year, three-year survival rates were 76.3%, 45% and 31.3%, respectively, and the mean survival time was 24 months. The factors which significantly affected the survival rate included age, size of tumor, number of tumors, Child's C, AJCC cancer staging, pathology c1assification, AFP reduction to one half in one month after receiving TACE (AFP-D50), and portal vein thrombosis (PVT). It was found that younger age, larger tumor size, more tumor numbers, Child's C, high grade of AJCC stage, high grade of pathologic c1assification, AFP-D50 and PVT all had poorer prognosis.