TAE治疗原发肝细胞癌(对不同组织细胞学类型疗效的初步研究)

Therapeutic efficacy of transcatheter arterial embolization of primary hepatocellular carcinoma: descrepancy in different histopathological types of HCC

目的：通过对一组１５７例经组织细胞学检查证实的原发性肝细胞癌患者生存资料及影像学资料的分析，初步研究经导管动脉栓塞（ＴＡＥ）对不同组织细胞学类型肝细胞癌的治疗效果。材料与方法：８种不同组织细胞学类型的资料较完整的原发性肝细胞癌患者，共计１５７例，分别接受单纯ＴＡＥ、单纯手术或ＴＡＥ＋手术切除治疗。对上述病例分别按照不同组织细胞学类型及不同治疗方法进行生存资料和影像学资料分析。结果：本组原发性肝细胞癌的１年、２年、３年和５年的累计生存率分别为７４．５２％、４８．４０％、３２．４８％和１１．４６％。各组织细胞学类型中，纤维板层型与透明细胞型肝细胞癌的５年生存率分别为２５％和２９％，。三种治疗方法中，单纯ＴＡＥ组、单纯手术组与ＴＡＥ＋手术组的平均生存时间分别为２５．０６（标准误＝１．８７）、３０．３８（标准误＝２．０５）和７２．７２（标准误＝６．９０）个月。结论：ＴＡＥ对不同组织细胞学类型的原发性肝细胞癌在治疗效果上存在差异；本组中，以透明细胞型肝细胞癌对ＴＡＥ较为敏感，而以小细胞型和低（未）分化型肝细胞癌较不敏感。

Purpose: To evaluate the therapeutic efficacy of transcatheter arterial embolization (TAE) for different histopathological types of primary hepatocellular carcinoma (HCC). Materials and methods: A retrospective study of 226 patients with histopathologically diagnosed primary HCC was performed. The patients were treated with simple TAE, surgical resection alone, or TAE combined with operation. Follow up information was achieved in 157 of 226 patients. Comparative analyses of survival data and image findings were performed correlated to histopathological classification and different therapeutic methods respectively. Results: Eight histo pathological types of primary HCC were classified in this group, including HCC of trabecular pattern, pseudoglandular pattern, fibrolamellar HCC and sclerosing HCC, as well as HCC of clear cell, small cell, poorly differentiated or undifferentiated, types and hormonally active HCC. The accumulated survival rates for this 157 patients was 74.52% for 1 year, 48.40% for 2 years, 32.48% and 11.46% for 3 and 5 years, respectively. Fibrolamellar HCC and clear cell HCC had relative high survival rates than that of other types (25.00% and 29.00% of 5 years), and the median survival time of the latter was 71 months. The mean survival time was 25.06 months ( s 1.87) for simple TAE group, 30.38 ( s 2.05) months for surgical resection, and 72.72 months ( s 6.9) for TAE combined with operation. Conclusion: Discrepancy exists in therapeutic effect of different types of HCC. In this study, clear cell HCC was more sensitive to TAE than other types, in contrast, small cell HCC and poorly differentiated or undifferentiated HCC were of lower sensitivity to TAE.