| Backgrounds and Objective Primary liver carcinoma (PLC) is one of the common malignant tumors that has a high malignancy and poor prognosis. The mean survival time is 3 to 6 months if it wasn't treated by some suitable means. Transcameter arterial chemoembolization (TACE) has become the first choice of the treatment for 80% unresectable liver cancer. The survival rate of those patients had improved significantly and some got II stage resectable. It is very valuable that study the factors affecting the prognosis of TACE to the patients of PLC. Scientists of civil and foreign had performed lots of jobs to evaluate TACE in the treatment of PLC, and to study the factors affecting the prognosis. In CT assess the therapeutic efficacy of TACE, the majority of studies used unidimensional liner measurements and bidimensional technique to measure the morphologic of tumors which could not perfect assess the efficacy of volumetric and morphologic for tumors. However, volumetric CT could more objectively value the prognosis of liver volume(LV) or tumor volume(TV), tumor-to-liver volume ratios(TTLVR)or the retention of lipiodol(LP). Currently the study was reported rarely in other countries and it wasn't searched for evaluation the prognosis with volumetric CT in China. The purpose of our study was system to analysis the major efficacy factors of TACE to the patients of PLC by following and to emphasize on the value of volumetric CT measurement and to provide a theoretical basis for treatment of PLC.Materials and Methods Between January 1999 and January 2004, 166 patients with PLC were enrolled in a retrospective trial of TACE, of which advanced PLC 267 cases from the interventional hospital room of the first affiliated hospital of Anhui medical university. The hepatic CT of all patients were performed before TACE and in 2 weeks to 2 months after TACE, for to define the tumor type, size, tumor thrombus location, TV, TTLVR, the tumor regression rate and LP retention after TACE. All patients had clinical data, general data and following by telephone or outpatient. Statistical analysis was performed by SPSS 10.0 statistical software. The prognostic influence of the following parameters was evaluated with univariable analysis. Then multivariate Cox regression analysis model was used to analyze the factors affecting the prognosis to avoid any confounding interaction between them. The cumulative survival time was calculated according to the Kaplan-Meier method. The prognosis influence of the following parameters was analyzed by using of the log-rank tests.Results The overall cumulative survival rates for 6,12,24 and 36 months were 78.54%, 47.23%, 23.68% and 14.09% respectively. The median survival time was 12 months. Univariate analysis showed 15 parameters were significant prognostic factors. The main factors affecting the prognosis were sex, tumor type, number of lesions, Child-Pugh's grade of liver function, Okuda's stage, times of TACE, decrease in AFP concentration after treatment, portal cancerous thrombus, times of treatment, extrahepatic spread, tumor size, TV, TTLVR, tumor margin, the tumor regression rate, degree of lipiodol retention within the tumor, PEI and integrative treatment. However, multivariate analysis showed that TTLVR, portal cancerous thrombus, times of treatment and decrease in AFP concentration after treatment were significant factors.Conclusion 1. Morphologic CT parameters can have objective evaluation to the prognosis factors of PLC with TACE.2. Volumetric CT technique was a reasonable method to better quantitatively predict the prognosis of patients who undergo TACE. TTLVR was a significant prognosis factor that influences the survival of PLC with TACE. There was a statistically significant prolongation of survival time when TTLVR was less 50% and between 50% and 75%. It was not suitable for TACE when TTLVR was more 75%.3. Portal cancerous thrombus was risk factors affecting prognosis, but the survival rate of portal left cancerous thrombus showed no difference.4. Retreatment can... |
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