Effect of Transarterial Chemoembolisation in Unresectable Hepatocellular Carcinoma with Portal Vein Tumour Thrombosis: Single-centre Study
KL Siu, PY Chu, HW Lau, CX Chan, SK Ip
Hong Kong J Radiol 2015;18:277-81
DOI: 10.12809/hkjr1515316
Objectives: To determine the effect of transarterial chemoembolisation (TACE) on liver function and procedure-related mortality in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT).
Methods: This was a retrospective study of patients with HCC and PVTT who underwent TACE from January 2012 to December 2013 at a single tertiary medical centre in Hong Kong. Patient demographics, aetiology of cirrhosis, alpha fetoprotein (AFP) level, tumour size, number of tumours, liver function (total bilirubin, albumin, international normalised ratio [INR]), and Child-Pugh score were evaluated before and 4 weeks after TACE. The 30-day mortality was also recorded.
Results: TACE was performed in 26 patients with unresectable HCC and PVTT (mean age, 61 years). The mean total bilirubin level before and after TACE was 18.2 µmol/l and 26.8 µmol/l (p = 0.140), respectively, and mean albumin level fell from 36.8 g/l to 33.9 g/l (p = 0.009). The respective mean INR before and after TACE was 1.1 and 1.2 (p = 0.120), the AFP level was 35,364.0 ng/ml and 37,424.5 ng/ml (p = 0.563), and the mean Child-Pugh score was 6.0 and 6.6. The mean and median survival of patients was 5.1 months (range, 1.5-8.8 months) and there was no 30-day mortality.
Conclusion: TACE has a deteriorating effect on liver function in patients with unresectable HCC and PVTT. Nonetheless since there were no procedure-related deaths and TACE has potential survival benefits, it should be a treatment option along with superselective catheterisation of tumour feeding vessels for patients with HCC and PVTT.
中文摘要
經肝動脈栓塞化療對不能切除肝癌患者合併門靜脈癌栓的影響：單中心研究
蕭廣樂、朱炳容、劉漢威、陳積聖、葉筱筠
目的：探討經肝動脈栓塞化療（TACE）對於合併門靜脈癌栓（PVTT）的肝癌患者在肝功能和手術相關死亡率的影響。
方法：本回顧研究在香港一所三級醫療服務的醫院內完成，對象是在2012年1月至2013年12月期間有PVTT的肝癌患者。在進行TACE前和4週後記錄病人肝硬化的病因、α-胎蛋白（AFP）水平、腫瘤大小、腫瘤數目、肝功能指數（總膽紅素、白蛋白、國際標準化比率〔INR〕）和Child-Pugh評分。記錄患者30天死亡率。
結果：共26例有PVTT並不能切除的肝癌患者進行TACE，平均年齡61歲。進行TACE前後的平均總膽紅素水平分別為18.2 µmol/l和26.8 µmol/l (p = 0.140)，白蛋白平均水平從36.8 g/l下降至33.9 g/l （p=0.009），而相應的INR平均值為1.1和1.2（p=0.120）、AFP水平為35,364.0 ng/ml和37,424.5 ng/ml（p=0.563）、Child-Pugh平均分數為6.0和6.6。患者的平均和中位生存期為5.1個月（介乎1.5-8.8個月）。無30天內死亡率患者。
結論：TACE能令有PVTT肝癌患者肝功能下降。由於沒有手術相關的死亡病例，而TACE有利於患者的生存期，對於有PVTT的肝癌患者來說，TACE合併富血供腫瘤施以超選擇插管治療可作為一種選擇。