| Prefaceliver neoplasm is one of the most common malignant tumors that threaten the health of human. Surgical resection currently is considered to be the only preferred treatment, unfortunately, only a small number of patients are suitable candidates for such resection. Transcatheter arterial chemoembolization ( TACE) has become the first choice of palliative treatment for 80% -90% unresectable liver neoplasms. Since the transcatheter arterial embolization was first introduced by Nakamura et al in 1980s, it has now been widely used with the development of radiographic diagnosis and interventional therapeutic equipment, which brings two problems to the interventional treatment of liver neoplasms: the absence of a acceptance criterion and the variety of efficacy. The purpose of our study was to assess the efficacy of TACE using lipiodol - chemotherapeutic drugs emulsion by following liver neoplasms cases in our interventional ward and analysis some correlative factors and to provide a theoretical basis for treatment of liver neoplasms.MaterialsFrom October 1991 to October 2000, 670 patients with primaryhepatocellular carcinoma ( PHC ) or metastatic hepatic cancer ( MHC) were enrollded in a retrospective trial of TACE, of which PHC 568 cases and MHC 102 cases. All PHC were diagnosed by clinical diagnosis criteria, including 147 cases of pathologic diagnosis, while MHC were diagnosed by the original tumors. There were 573 men and 97 women, with a mean age of 55.6 years (range, 18-78 years). All cases had complete radiographic, following and clinical data.MethodsUsing the Seldinger technique and catheterizing the femoral arter-y, indirect portal vein angiography and hepatic arterial angiography was performed in turn. The embolization emulsion, mixed with MMC 10-20mg, ADM 20 -40mg, 5 - FU 3 - 4ml and ildized oil 8 -15ml, was injected through the catheter. 1 - 3mm gelatin sponge (GS) particles were used in patients with better liver function and rich blood - supplyment tumors. Cases received reexamination of liver function, hepatic CT or DSA to determine whether and how to perform retreatment. Statistical analysis employed SPSS software.ResultsUnivariate analysis showed 14 parameters were significant prognostic factors. However, multivariate analysis showed that tumor type, encapsulant, extrahepatic involvement, HBsAg and treatment times were significant factors. The overall commulative survival rates for 1, 2, 3 and 5 years were 58. 4% , 27. 1% , 13. 6% and 4. 0% respectively.The mid - term efficacy of PHC and MHC was almost the same,but the long - term efficacy of MHC is lower. According to the different regimens, all cases were divided into two groups: TACE (simple embolization by emulsion) and GS -TACE (embolization by emulsion and GS). The efficacy between two groups had no defferences. But the postembolization occurrence of collateral arterial in GS - TACE group was higher than TACE group. According DSA, nodular 217 cases, multinodular 238 cases, massive 170 cases and diffuse 45 cases. Among them, the survival rate of nodular was the highest. Portal vein tumor thrombus 132 cases. By Okuda criterion, Okuda I were 540 cases, Okuda II 109 cases, Okuda III 21 cases. The TACE efficacy of Okuda I is the best. The lipiodol uptake pattern of postembolization consisted of denseness, partretention and sparseness. The denseness survived the longest as a whole. Retreatment can improve the survival rate, furthermore, retreatment times >4 times is the highest. Our study also showed that the 1 year survival rate increased along with the years.DiscussionOur study showed that the mid - term efficacy of PHC and MHC after TACE was almost the same. Analysis the original tumors of MHC, we found that half of the cases were from colonic or rectal carcinoma, pathological type of most of them were highly differenttiative adenocarcinoma, which influenced the liver function lower; DSA often showed hepatic arterial supplying the tumors and encapsulant; CT of postembolization showed lipiodol uptake as...
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