| Objective:To study and analyse factors affecting the prognosis in patients with primary hepatic carcinoma treated with combinated transcatheter hepatic artery chemoembolizatin (TACE). The factors include sex, age, ALT,AFP, HbsAg, liver function (Child's system), the way of treatment, tumor size and number , serum albumin, portal cancerous thrombus, tumor pattern, and HbeAg. To evaluate the effectiveness of combinated TACE.Materials and Methods:Materials:141 consecutive patients with primary hepatic carcinoma were treated from 1996.1 ~ 1999.6. There were 125 men and 16 women (mean age, 52 years; age range, 21~76 years ). Of the patients 17 cases was diagnosed Ultrasounographically, 124 by CT, and 34 pathologically. Tumor pattern included massive type(88 eases), nodular type(29 cases), diffuse type( 23 cases), One case without file. Left liver was involved in 31 cases, right liver in 122, both left and right liver in 12; Of massive type, tumor size was smaller than 5cm in 11 cases, 5cm~10cm in 39,and larger than 10cm in 38. Ill cases had positive serum HbsAg and 30 cases negative, 66 case had AFP<20ng/L and 48 cases had AFP 20~400ng/L. 9 cases AFP>400ng/L. No information in 18 cases.60 cases had ALT<40U/L, 79 ALT>40U/L,no information in 2, 7 cases had serum albumin <30g/L,16 cases 30~35g/L ,and 118 cases >35g/L. 118 cases liver function was within Child A ,16 Child B , 7 Child C.75 cases had no portal cancerous thrombus, and 54positive portal cancerous thrombus, 12 cases had no related information. 17 cases were treated with TACE and then surgical resection, 17 received TACE and PEI, 100 only received TACE, 7 received TAI. The clinical manifestations were mainly abdominal distention and pain in 115 cases, discomfort in 23, asymptom in 3, complicating digestive hemorrhage in 13 cases.Combinated TACE treatment:TACE: With Seldinger technique, 4 or 5F catheter was inserted in common hepatic and superior mesenteric arteries. Angiography was performed and blood supply condition was observed. Then supply artery of tumor was catheterized superselectively, TACE was performed with sandwich technique. The drugs included Fluorouracil, hydroxycamptothecine, adriamycin, cisplatium, mytomycin,etc. Lipiodol and Gelfoam were used as embolus. Once/1 ~ 1.5m. Three times consecutively. According local lipiodol deposit, repeat TACE were performed if necessary. The patients were followed up.TACE and then surgical treatment: 3 weeks after TACE, the patients'condition was improved and the tumors became necrotic and shrinked. Surgical resection can be performed. 40days later, hepatic arteriography was performed in order to find if abnormal blood supply reexisted. If necessary, TACE would be performed. The patients were followed up.TACE and Percutaneous Ethanol Injection(PEI): 2 weeks after TACE, the patients received PEI(lipiodol: ethanol 1:3).The Lipiodol and ethanol emulsion injected was about 10~40ml, 2 times a week. The TACE and PEI were implemented consecutively 3 times for 3 months. The patients were followed up.Transcatheter hepatic artery infusion(TAI): The common hepatic and superior mesenteric arteries were selectively catheterized with Seldinger techniques, blood supply condition was observed. If the tumors show diffuse type or obvious HA-HV shunt, TAI was performed. The agents included: Fluorouracil, hydroxycamptothecine, adriamycin,cisplatium, mytomycin, etc. Lipiodol and Gelfoam were used as embolus. Once every 1~1.5 months, consecutively 3 times. The patients were followed up.Statistics:All 141 patients'data was managed with Microsoft Excel and SAS 6.12 . Survival rate was calculated by survival model and tested by Log-rank Wilcoxon -2Log (LR) .The Cox's regression analysis model was used to analyse the factors affecting the prognosis (sle=0.2, sls=0.05) .P<0.05 means significant.Results:Total survival figure was set. Total mid- survival time is 19 months, mean 23.5855months. The survival rate of 1,2,3,5 y were 63.91%, 44.47%, 25.76%, and 7.38% respectively(95% confidence limit). Multivariable analyses revealed signifi...
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