| Objective:Transarterial chemoembolization (TACE) has been thepreferred therapeutic procedure for patients with advanced primary hepaticcarcinoma (PHC). Few data have been available on the efficacy of TACE inPHC patients compared with conservative treatment in terms of survival untilnow. We aimed to compare the survival benefit of transarterialchemoembolization with conservative treatment for patients with primaryhepatic carcinoma, to reveal the factors influencing the prognosis of primaryhepatic carcinoma and primary hepatic carcinoma treated with TACE. Thedata of our study could be used as a historical control for TACE monotherapyand prognosis in future clinical trials.Methods:1Patients Five hundred and twenty-six patients with PHCwere included at Hebei Medical University from January1st2002toDecember31st2010. There were443males and83females in total number,the age from18to94. Three hundred and forty-seven patients receivedtreatment for TACE, and179patients were included in conservative groupreceived best supportive care as controls. Within the347patients of TACEgroup,290were men,57were women and the mean age of all patients was（58.2±10.6）years. There were153men and26women in conservative group,and the mean age wa（s58.4±10.6）years. Patients were made clinical diagnosisfor PHC according to the domestic standard of clinical diagnosis and stages(Guangzhou,2001). Subgroup analysis was made in100patients withBCLC-C and Child-Pugh-B. Of a total of100patients,39were treated withTACE, and61were treated with conservative treatment. In TACE group,31were men,8were women, and the mean age was（57.8±8.6）years. There were 52men and9women in conservative group, and the mean age was（58.3±10.6）years.2Follow up Then the clinical information of all the patients wererecorded, and the survival status were followed up through telephone contact.3Statistical analysis All statistical analyses were carried out usingSPSS17.0computer software. A two-tailed P<0.05was consideredstatistically significant.Result:1The characteristics of the526patients and the comparison ofsurvival analyses in two groupsTwo hundred and eleven showed HBsAg positive at the initial diagnosisin TACE group, and123patients showed positive in conservative group. InTACE group,311patients showed liver cirrhosis, and162patients showed itin conservative group. Among all patients of TACE group,222patientsdisplayed single tumor, whereas113patients displayed multiple tumor at theinitial diagnosis. In conservative group,83patients displayed single tumor,whereas70patients displayed multiple hepatic tumor. In TACE group,84patients had portal vein tumor thrombosis (PVTT), whereas260patients didnot have. And in conservative group, they were91, and85patientsrespectively. Of a total number of TACE group,31patients displayedabdominal cavity metastasis, whereas312patients did not. In conservativegroup,30patients displayed abdominal cavity metastasis, whereas139patients did not. In TACE group,33patients displayed distant metastasis,whereas314patients did not. And in conservative group, they were20, and159patients respectively. In TACE group,170patients had serum AFPconcentrations equal or more than400μg/L, and160patients had serum AFPconcentrations less than400μg/L. In conservative group, they were91and73patients respectively. In TACE group,265,77, and5patients were scored asChild–Pugh A, B, and C by Child–Pugh classification. In conservative group,they were46,77, and56patients respectively. In TACE group,43,158,141and5patients were staged as A, B, C, and D by the Barcelona Clinic LiverCancer Classification,(BCLC). And in conservative group, they were9,24, 90, and56patients respectively. There was no significant difference in termsof age, gender, chronic liver disease, distant metastasis and AFP level in twogroups（all P＞0.05）. But there were some significant differences in terms oftumor number, PVTT, abdominal cavity metastasis, Child-Pugh stage, BCLC,hematological indexes in two groups（all P＜0.05）.In TACE group, the mean number of TACE frequency was（2.4±1.8）times. In total number,155patients have received TACE only once. And other192patients received TACE2-12times.The overall median survival period was significantly better in the TACEgroup than in the conservative group (8.0months vs.2.0months, P＜0.05).The1-year overall survival rates in the TACE group compared withconservative group were39.4%and9.5%respectively, the2-year overallsurvival rates were20.0%and2.8%respectively, the3-year overall survivalrates were9.2%and1.7%respectively, and the5-year overall survival rateswere7.4%and1.7%respectively（P=0.000）.2Subgroup analysis of patients with BCLC-C and Child-Pugh-BTwenty-six showed HBsAg positive at the initial diagnosis in TACEgroup, and40patients showed positive in conservative group. In TACE group,38patients showed liver cirrhosis, and56patients showed in conservativegroup. Among all patients of TACE group,24patients displayed single tumor,whereas12patients displayed multiple tumor at the initial diagnosis. Inconservative group,31patients displayed single tumor, whereas21patientsdisplayed multiple hepatic tumor. In TACE group,20patients had PVTT,whereas19patients did not have. And in conservative group, they were40,and21patients respectively. Of a total number of TACE group,8patientsdisplayed abdominal cavity metastasis, whereas31patients did not. Inconservative group,7patients displayed abdominal cavity metastasis, whereas54patients did not. In TACE group,6patients displayed distant metastasis,whereas33patients did not. And in conservative group, they were8, and53patients respectively. In TACE group,20patients had serum AFPconcentrations equal or more than400μg/L, and16patients had serum AFP concentrations less than400μg/L. In conservative group, they were26and25respectively. There was no significant difference between the two groups inage, gender, chronic liver disease, tumor number, PVTT, abdominal cavitymetastasis, distant metastasis, AFP level, and hematological indexes.On subgroup analysis of patients with BCLC-C and Child-Pugh-B, theoverall median survival period in TACE group compared with in conservativegroup was6.0months versus2.0months (P＜0.05). The1-year overallsurvival rates in the TACE group compared with conservative group were33.3%and8.2%respectively, the2-year overall survival rates were11.1%and0%respectively, the3-year overall survival rates were5.6%and0%respectively, and the5-year overall survival rates were5.6%and0%respectively（P=0.000）.3Factors affecting the survival of PHC patients and the prognosis ofPHC treated with TACEAnalysis of factors affecting survival and prognosis were made usingmultivariate analysis by COX proportional hazard model.Only treatmentmode (HR,1.106;95%CI,1.073-1.140; P=0.000), PVTT (HR,1.398;95%CI,1.124-1.739; P=0.003), AFP level (HR,1.201;95%CI,1.042-1.385; P=0.012),BCLC (HR,1.236;95%CI,1.071-1.427; P=0.004), and abdominal cavitymetastasis (HR,1.200;95%CI,1.013-1.422; P=0.035) remained asindependent predictors of survival. And portal vein tumor thrombosis (HR,1.533;95%CI,1.200-1.959; P=0.001), AFP level (HR,1.243;95%CI,1.035-1.492; P=0.020), and frequency of TACE (HR,0.797;95%CI,0.745-0.852; P=0.000) were contributors to the prognosis of patients who haveprimary hepatic carcinoma treated with TACE．Conclusions:1TACE is an effective treatment mode compared withconservative treatment for PHC and may provide a significantly bettersurvival benefit. The survival period was significantly better in the TACEgroup than in the conservative group, especially in patients with BCLC-C andChild-Pugh-B.2Trearment mode, AFP level, portal vein tumor thrombosis, BCLC and abdominal cavity metastasis are contributors to the prognosis of patients withprimary hepatic carcinoma.3AFP level, portal vein tumor thrombosis, and frequency of TACE arecontributors to the prognosis of patients who have primary hepatic carcinomatreated with TACE．... |
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