肝細(xì)胞癌患者經(jīng)導(dǎo)管化療栓塞治療結(jié)局相關(guān)獨立危險因素的單中心回顧分析

MUHABUKA Epitace,滕皋軍

(東南大學(xué)附屬中大醫(yī)院 放射科，江蘇 南京 210009)

Hence，we designed and performed this retrospective study to investigate the potential independent factors associated with the recurrence of HCC and patient’s survival after TACE．

1 Material and Methods

1.1 Patients selection

Data from a population of HCC patients，who underwent TACE alone from September 2007 to September 2012 at our institution， were retrospectively analyzed.

The inclusion criteria were: patients with HCC without extrahepatic metastasis who initially underwent TACE in our hospital.The exclusion criteria were:distant metastasis，the first TACE did outside of our Hospital and TACE combined with other types of treatment such as surgical resection，radiofrequency ablation.

Electronic data from medical records were collected and analyzed. These included demographic data， etiology of HCC，tumor number，size and location， serum biochemistries， cirrhosis， ascites， smoking， excessive alcohol drinking，Child Pugh classification，BCLC and Okuda stage， number of TACE， blood pressure value and story of taking hypoglycemic or antihypertensive agents in the medical records.The details of TACE in our hospital are shown in Fig 1．

1.2 Diagnosis of HCC

Fig1ThedetailsofTACEinourhospital

1.3 Last follo up

1.4 TACE procedure

1.5 Statistical analysis

2 Results

2.1 Clinical characteristics in our study

During a median research period of 25 months(range，1-77 months)，a total of 135 patients was available for our study. Among these patients， there were 15 patients(11.1%) with diabetes mellitus associated with hypertension.In addition， there were also 22 patients(16.3%) with hypertension alone.There were 114(84.4%) men and 21(15.6%) women，the mean age for the whole study was(57.6±13.5)years (range， 20-90 years) and the median was 58 years(95%CI:55.00-61.00).Some of the baseline characteristics are shown in details in Tab 1．

Tab1Study’sbaselinecharacteristics

VariablesMCIx±sAge(20-90 years)58.0055.00-61.0057.6±13.5 <60 years(n=75,55.6%) ≥60 years(n=60,44.4%)Sex47.8±8.4 Male(n=114,84.4%) Female(n=21,15.6%)Etiology of HCC69.9±6.8 HBV(n=71,52.6%) HCV(n=38,28.1%) Alcohol(n=14,10.4%) Others(n=12,8.9%)

2.2 Lon term survival after TACE

2.3 Independent risk factors associated with survival

On univariate Cox regression analysis， we investigated the risk factors for survival(Tab 2)，namely:serum total bilirubin level (P=0.017)，serum albumin level(P=0.005)，Child P class(P=0.019)，Okuda stage (P=0.008)，tumor location(P<0.001) and the association of DM and HT (P=0.014).These factors were subsequently tested with multivariate Cox proportional hazard model.Finally，only Child P class(adjustedRR=1.379， 95%CI:1.033-1.841，P=0.029) and the association of DM and HT(adjustedRR=1.621，95%CI:1.199-2.192，P=0.002) were independent risk factors for survival(Tab 3)．

2.4 HCC recurrence after TACE

2.5 Independent risk factors associated with HCC recurrence

Univariate Cox regression analysis was used to investigate the independent risk factors for tumor recurrence (Tab 4):serum total bilirubin level(P=0.015)，TACE number(P<0.001)，HT(P=0.039)，Okuda stage (P=0.009)，tumor location(P<0.001) and the association of DM and HT(P=0.031).However，on the multivariate Cox regression analysis， only the association of DM and HT (adjustedRR=1.775, 95%CI:1.233-2.554，P=0.002) was found to be an independent risk factor for tumor recurrence(Tab 5)．

FactorsβRR95%CIP valueSerum total bilirubin level0.5551.7421.106-2.7440.017Serum albumin level-0.6460.5240.332-0.8270.005Child P class0.5101.6661.088-2.5520.019Okuda0.5351.7071.147-2.5390.008Tumor location0.4181.5191.262-1.829<0.001DM+HT0.7902.2041.171-4.1470.014

FactorsβRR95%CIP valueChild P class0.3211.3791.033-1.8410.029Tumor location RL-2.3030.1000.028-0.353<0.001 LL-1.8600.1560.041-0.5920.006DM associated with HT0.4831.6211.199-2.1920.002

RL: right lobe;LL: left lobe

3 Discussion

The independent risk factors for survival and HCC recurrence after TACE were analyzed retrospectively.The

FactorsβRR95%CIP valueSerum total bilirubin level0.4961.6421.101-2.4490.015Okuda0.4711.6011.127-2.2760.009Tumor location0.3481.4171.173-1.711<0.001TACE number 0.6741.9631.379-2.793<0.001DM+HT0.6591.9331.063-3.5170.031HT0.5471.7281.029-2.9030.039

FactorsβRR95%CIP valueOkuda stage Ⅰ-0.8530.4260.184-0.9870.046Tumor location RL-1.7930.1670.049-0.5710.004 LL-1.3870.2500.071-0.8830.031DM and HT 0.5741.7751.233-2.5540.002TACE number-0.8470.4290.222-0.8260.011

RL: right lobe;LL: left lobe

results showed that Child P class was independent risk factors for poor survival，whereas the association of diabetes mellitus and hypertension was an independent risk factor for both survival and tumor recurrence.

There are some limitations in our study:first，this was a retrospective analysis and not a randomized controlled trial.Although we did not perform a controlled study，independent risk factors for patient survival and HCC recurrence after TACE were adjusted by the univariate and multivariate analysis.Second，the number of patients with DM and HT was relatively small when compared to those without DM and HT.

4 Conclusion

Child class was found to be an independent risk factor patient’s survival， whereas the association of DM and HT was an independent risk factor for both survival and tumor recurrence.However，a prospective study with a randomized controlled trial is needed to confirm these findings with taking account of hypoglycemic and antihypertensive agent intake.

[6] ANTOINE B F，REAL L，PIERRE P，et al.Transcatheter arterial chemoembolization of hepatocellular carcinoma as a bridge to liver transplantation:a Retrospective Clinical Study[J].Int J Hepatol,2011,2011:974514．

[25] GREGORY C C，SAMAN S，RANDEEP K，et al.Diabetes mellitus impacts risk of macrovascular invasion in patients undergoing transplantation for hepatocellular carcinoma[J].BMC Gastroenterol,2013，14(13):9.

[32] KER J A.Hypertension and diabetes:bad companions[J].SA Fam Pract，2004，46(9):14．