| Objective:To investigate the efficacy and safety of drug-eluting beads in transarterial chemoembolization(DEB-TACE)as a treatment of large hepatocellular carcinoma(HCC,≥5.0 cm).Methods:A total of 61 patients with large hepatocellular carcinoma treated with DEB-TACE were retrospectively included.The safety of DEB-TACE in the treatment of large hepatocellular carcinoma was evaluated by recording the patients’ baseline data,tumor characteristics(including tumor size,quantity,location,and the completeness of tumor boundary).According to CTCAE 4.0,Postoperative curative effect for the patient records,including complete response(CR),partial response(PR),stable disease(SD)and progressive disease(PD),objective response(CR + PR),disease control(CR + PR,SD),time to progression(TTP)and overall survival(OS).The single factor and multiple factors of complete remission(CR)rate,TTP and OS were analyzed.Results:Among the 61 patients,22(48.38%)CR,16(19%)PR,9(12.90%)SD,12(16.2%)PD,67.74% ORR and 87.09% DCR,achieved complete remission of intrahepatic lesions(P <0.001)within 6 months after surgery.The logistics analyse confined that the simple tumor(P < 0.05)and noninfiltrating margins(P< 0.001)is the DEB-TACE patients postoperative half year to obtain the influence factors of CR.With conventional median follow-up time of 19.0 months(95% CI,14.1 to 23.9),30 cases died during the follow-up period,median OS(mOS)was 22.0 months(95% CI,13.9 to 30.1 months),the median TTP intrahepatic tumor(mTTP)was 9.0 months(95% CI,7.4 to 10.6 months),the single factor and multiple factors analysis,tumor size,tumor margins are the effects of prognosis of TTP and OS.Compared to the patinets with >7cm tumor,The patients with large hepatocellular carcinoma(5.0~7.0 cm),mTTP(12.0 months vs.10.4 months P=0.037;12.0 months vs.7.0 months,P =0.022),mOS(23.0 months vs.13 months P=0.014;23.0 months vs.19.0 months,P =0.042)was extended and statistically significant.The patients with noninfiltrating margins tumors were also significantly longer than that of patients with border infiltration,mTTP(12.0 months vs 6.0 months,P <0.001)mOS(24.0 months vs 14.0 months,P =0.001).In terms of safety,61 cases of patients with postoperative after 55 cases with different degree of embolism syndrome,in which 22 patients with fever(33.33%)and 41 patients with abdominal pain(62.12%),13 cases(21.3%)patients experienced vomiting,among them 2 cases of postoperative intrahepatic biliary tumor formation,to drainage and anti-infection treatment can alleviate,and are removed after June drainage drainage tube chi-square hint,DEB-conventional TACE postoperative week alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)Albumin(ALB)was higher than that before the operation(P <0.05).5 patients(16.13%)changed from preoperative grade A to grade B in the liver function grading of child-pugh within one week after the operation,but returned to baseline in the review one month after the operation Conclusion:1、 DEB-TACE is an effective treatment for large hepatocellular carcinoma.Complete tumor capsule and tumor located in a single lobe are independentinfluencing factors for achieving complete respond(CR)6 months aftertreatment.2、 Tumor size and whether the tumor envelope is intact are independentinfluencing factors for TTP and OS.TTP and OS in patients with themaximum tumor diameter of 5.0-7.0 cm and complete tumor boundary aresignificantly longer than those with the maximum tumor diameter of >7cmand tumor envelope infiltration。3、 DEB-TACE is safe in the treatment of large hepatocellular carcinoma.Postoperative liver function declines temporarily,but postoperativeembolism syndrome,such as fever and pain,needs to be paid enoughattention and timely symptomatic treatment.Postoperative biloma formationshould be closely observed,and timely catheter drainage should beperformed if necessary。... |
