Analysis On Influntional Factor Of Hepatic Atery Interventional Therapy Effect For Patients With Primary Hepatic Carcinoma

Objective: Primary hepatiocellular cancinoma(PHC) was one of the most maliganat tumors in our country. Most patients diagnosed at advanced stage, lose the opportunity of surgery, The hepatic arterial interventional therapy has become the perferred method of unresctable patients with PHC. However, it has been showed that transarterial embolization(TAE) was used by some doctors due to disputation on efficacy of chemoherapy for PHC, meantime some doctors believed TACE with lipiodol carrying chemotherapy drugs would be superior to TAE on killing tumor cell, and was widely recommended. Therefore differences between TAE and TACE was focused on this study and further affected factors of patients with PHC interventional treatment were analyzed, to provide a theoretical basis for interventional treatment of PHC.Method:Of all patients with PHC who first underwent TACE or TAE from the Forth Hospitle of Hebei Medical University from January 1st 2004 to December 31 st 2012, 258 patients with whole clinical information were enrolled in retrospective study, including 219 females and 39 males, average age being 57.8±10.5 years, 91 patients performed TAE and 167 patients performed TACE. During course of hepatic arterial infusion, TAE group performed simple embolizatoin with lipiodol or gelation sponge, without chemotherapeutic agents. When TAE was combined with chemotherapeutic agents, mixed with embolization, the procedure was recognised TACE group.Then the patients’ clinical information, such, gender, age, cancer case,et al, were recorded. The survival status were followed up by telephone call.All statistical analyses were performed by SPSS 19.0 computer software. Survival analysis was performed by Kaplan-Meier method and potted survival curves, comparison of survival between TACE and TAE group was made using the Log-Rank test, the univariate and multifactor analysis were done by Cox regression model. P-value, relative risk(RR) and confidence interval(CI) were calculated. P<0.05 was considered statistically significant.Results:1 As for the gender, age, interventional therapy times, tumor location, the maximum diameter of the tumor, arteriovenous fistula, portal vein tumor thrombosis(PVTT), distant metastasis, abdominal cavity metastasis, arteriovenous fistula, ascites, liver cirrhosis, HBs Ag, AFP and BCLC, there were no statistical difference betwwen TACE and TAE group(P>0.05). The ratio of TACE group with Child-Pugh A class was more than TAE(P<0.05).2 Comparison of overall survival rates between the TACE and TAE groupsIn two groups the 1-year survival rates were 53.3% and 45.1%, 2-year were 30.5% and 24.2%, and 3-year were 20.4% and 14.7%, respectively. There was no significant difference in overall survival time between TACE(14.6 mo) and TAE group(12.0 mo)(P=0.313). Further stratified analysis: as for the maximum diameter of the tumor ≥10cm, the survival rates of 1-year, 2-year, 3-year in TACE group(44.4%, 33.3%, 27.8%) were higher than TAE group(17.6%, 5.9%, 0.0%)(P=0.017).3 Efficacy analysis of PHC patients with hepatic arterial infusionThe 17 factors which may effect survival and prognosis were sure with univariate analysis by Cox regression model, the maximum diameter of tumor(<5cm/5cm~10cm/≥10cm, P=0.000), arteriovenous fistula(yes/no, P=0.001), abdominal cavity metastasis(yes/no, P=0.021), PVTT(yes/no, P=0.005), Child-Pugh class(A/B, P=0.032), BCLC(A/B/C, P=0.000), frequency of interventional therapy(<5 times/≥5 times, P=0.000) were significantly prognostic factors.It was showed with multivariate analysis showed that frequency of interventional therapy(RR=0.495; 95%CI : 0.355-0.691; P=0.000), the maximum diameter of the tumor(RR =1.439; 95%CI:1.129-1.835; P=0.003), Child-Pugh class(RR=1.508; 95%CI : 1.068-2.125; P=0.019), BCLC(RR=1.349; 95%CI:1.016-1.792; P=0.038), were associated with prognosis of patients who have primary hepatic cacinoma treated with hepatic arterial infusion.Conclusions:1 As for overall survival on the maximum diameter of the tumor <10cm, there was no significant difference between TACE and TAE,however, the survival rate in TACE was superior to TAE for the tumor diameter ≥10cm.2 Interventional therapy times, the diameter of tumor, Child-Pugh class, BCLC were independently prognosis factors of patients treated with hepatic arterial infusion. The prognosis of patients with frequency of interventional therapy greater than or equal 5 times was superior to the less than 5 times.