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Rofo 2004; 176(3): 375-385
DOI: 10.1055/s-2004-812776
Interventionelle Radiologie

© Georg Thieme Verlag Stuttgart · New York

Chemoembolisation des hepatozellulären Karzinoms: Welche Faktoren bestimmen Therapieansprechen und Überleben?

Chemoembolization of Hepatocellular Carcinomas: Which Factors Determine Therapeutic Response and Survival?P. E. Huppert1 , W. Lauchart2 , S. H. Duda1 , C. Torkler1 , S. P. Kloska2 , M. Weinlich2 , N. Benda3 , P. Pereira1 , C. D. Claussen1
  • 1Abteilung für Radiologische Diagnostik, Universität Tübingen
  • 2Chirurgische Klinik, Universität Tübingen
  • 3Institut für Medizinische Biometrie, Universität Tübingen
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Publication History

Publication Date:
16 March 2004 (online)

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Zusammenfassung

Ziel der Studie war die Ermittlung unabhängiger Prognosefaktoren bei Patienten mit hepatozellulärem Karzinom (HCC) und transarterieller Chemoembolisation (TACE). Methodik: Bei 91 Patienten mit irresektablem HCC wurden 269 repetitive TACE mit an Tumorgröße und Leberfunktion angepassten Dosen Epirubicin (40 - 60 mg) und Lipiodol (8 - 12 ml) durchgeführt. Für die Merkmale Tumorgröße, makroskopischer Typ, Lokalisation, Pfortaderinfiltration, Kapselinfiltration, Vaskularisationsgrad, Speichergrad nach erster TACE, Child-Pugh-Stadium und Okuda-Stadium wurde in uni- und multivariaten Varianzanalysen der Einfluss auf die Überlebenszeit geprüft. Ergebnisse: Ein unabhängiger signifikanter Einfluss auf die Überlebenszeit nach TACE ergab sich für die Merkmale Tumortyp (nodulär versus ­infiltrativ; p = 0,008), Tumorgröße (p = 0,01), Child-Pugh-Sta­dium (A versus B; p = 0,02) und Vaskularisationsgrad des HCC (p = 0,04). Bei 57 Patienten mit nodulärem HCC betrug die mediane Überlebenszeit 17,0 Monate und war signifikant größer als bei 32 Patienten mit infiltrativem HCC (7,9 Monate; p < 0,003; 2 Tumoren waren nicht klassifizierbar). Die 1-, 2- und 3-Jahres-Überlebensraten betrugen bei 57 Patienten im Okuda-Stadium I 73, 31 und 8 % und waren signifikant größer als bei 34 Patienten in den Okuda-Stadien II und III (23, 6 und 4 % p < 0,0001). Schlussfolgerung: Tumortyp, Tumorgröße und Zirrhosestadium bestimmen maßgeblich die Prognose der Patienten nach TACE von HCC. Um eine Lebenszeitverlängerung zu erreichen, ist eine geeignete Auswahl der Patienten erforderlich.

Abstract

Purpose: To determine independent prognostic factors influencing the survival of patients with hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). Materials and Methods: Ninety-one patients with unresectable HCC were treated with 269 repetitive TACE. The dosages of epirubicin (40 - 60 mg) and ethiodized oil (8 - 20 ml) were adjusted to tumor size and liver function. The impact of tumor size, macroscopic tumor type, tumor location, portal vein infiltration, capsular infiltration, tumor vascularization, uptake of ethiodized oil within the tumors, Child-Pugh-Class and Okuda-Stage on patient survival were evaluated by means of univariate and multivariate regression analysis. Results: The following independent prognostic factors were found: tumor type (nodular vs. infiltrating, p = 0 008), tumor size (p = 0.01), Child-Pugh-Class (A vs. B; p = 0.02) and grade of tumor vascularization (p = 0.04). In 57 patients with HCC of the nodular type, the median survival time was significant longer than in 32 patients with HCC of the infiltrating type (17.0 months vs. 7.9 months; p < 0.003; 2 tumors could not be classified). The 1-, 2- and 3-year-survival rates were significantly higher in 57 patients with Okuda-Stage I disease, compared to 34 patients with Okuda-Stage II and III disease (73 %, 31 % and 8 % vs. 23 %, 6 % and 4 % p < 0.0001). Conclusions: Tumor type, tumor size and grade of liver cirrhosis have an independent impact on prognosis of patients with HCC treated by TACE. An appropriate selection of patients is necessary to improve patients survival.

Key words

Hepatocellular carcinoma - chemoembolization, transarterial - prognostic factors, independent - regression analysis - multivariate

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Priv.-Doz. Dr. med. Peter Huppert

Institut für Strahlendiagnostik und Nuklearmedizin, Klinikum Darmstadt

Grafenstraße 9

64283 Darmstadt

Email: PeterHuppert@t-online.de

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