Prognostic Factors Of Primary Liver Cancer Patients In Meta-later Treated By Interventional Therapy

Primary Liver Cancer(PLC) is one kind of common malignant tumors worldwide,which is a great threat to human health.The prevalence of PLC, significantly varied in different regions where.China is on the top of the list.It is estimated that the PLC occurs nearly 300,000 to 1,000,000 per year in the world,while. China contributes to the 45 percent of the total number,which are approximately 110,000 every year.Therefore,the death caused by PLC occupies the first place in the mortality of all kind of malignant tumors.For PLC has a relative long nature history and is asymptomatic in it's nearly stage,most patients are in the advanced stage when diagnosed as PLC,with the natural survival time only about 1～4 months.Therefore,it is important to improve the prognosis of PLC especially in its advanced phase.For a long time,hepatic resection has been considered as the most important factor which influences the prognosis of PLC.Radical resection seems as the first choice for treating PLC and might be also the only one which can cure PLC.With the development in diagnosis and surgery techniques as well as the research in the basic and clinic of hepatocellular carcinoma,the long-term survival rate was prolonged and the operative mortality was decreased.However,the overall effect is still not satisfactory as the rate of operation is only 15%～30%and even after resection,the recurrence rate of PLC after operation reached as high as 36%～66%.Improving the survival rate of PLC is depended on new technique.Fortunately the development of interventional radiology has provided a new method to cure the PLC.Interventional therapy has also turned out to be an effective method for PLC and been widely used. Transcather arterial chemoembolization(TACE) is the most widely used method in hospital which can remarkably prolong the survival rate of the patient who is not suitable for operation.However,TACE only acts as a palliative method for PLC when compared with radical resection,and the pathological result indicates that there are still liver malignant cells under the capsule of PLC after TACE.So how to use TACE to improve survival rate of the patient is a new challenge nowadays.To apply multimode treatment might be the most effective method for inoperable patients.Some reports suggest that the effects of second-stage operation after TACE,percutaneous ethanol injection(PEI),radiofrequency ablation after TACE are better than pure TACE in those patients.ObjectiveTo evaluate the effect of TACE in PLC patients of advanced stage and the factors influencing the prognosis of those patients,the potential factors were investigated including sex,age,tumor area,tumor size and number,HBsAg,AFP,portal cancerous thrombus,liver function(Child's system),the way of treatment,times of TACE,pathological type of tumors,tumor's metastasis.Method and Statistics109 patients(85 male,24 female),were diagnosed as PLC in the first affiliated hospital of Zhejiang University School of Medicine from September,2005 to November,2006.Follow up was carried out by telephone communication.After collecting the essential data.SPSS 16.0 was used for analysis,where the life table, Log-rank test,Breslow test,Wilcoxon(Gehan) test,Chi-squared test and Cox regression were utilized.P＜0.05 was considered as statistically significant.ResultsOur data showed that the total 6,12,24 months survival rate was 77%,45%,22%and in TACE group that was 81.4%,42.4%,13.6%,in interventional therapy group was 100%,82.5%,47.5%,in keep therapy group was 50%,0%,0%.Comparing the survival rate of these three groups,the TACE group is better than the conservative therapy group and the interventional therapy group is the best.Simple factor analysis displayed that there was no significant difference between various sex,age,gender, tumor area,tumor size and number,HBsAg.However,there was significant difference between various AFP,tumor size,the way of treatment,liver function(Child's system), tumor emboli in portal vein,times of TACE,pathological type of tumors,tumor's metastasis.Moreover,Multi-factor analysis displayed that the way of treatment,liver function(Child's system),tumor emboli in portal vein,times of TACE,pathological type of tumors,tumor's metastasis are risk prognostic factors(x~2=98.377,p=0.000, p＜0.05).Conclusion1.The combinational TACE procedure is safe and effective.TACE procedure can remarkably prolong the survival rate of the patient who is not suitable for operation.2.In this study,6 factors directly influencing the prognosis of PLC are liver function(Child's system),portal cancerous thrombus,times of TACE,pathological type of tumors,tumor's metastasis and the way of treatment(x~2=98.377,p=0.000,p＜0.05). 3.The effects of second-stage operation after TACE,percutaneous ethanol injection (PEI),radiofrequency ablation or remedy after TACE are better than pure TACE in those patients.