Objective To observe the 3 year survival rate and clinical effect of late-stage hepatocellular carcinoma ( HCC ) patients treated with epirubicin. Methods 173 HCC patients who were not suitable for curable treatments were pro-spectively enrolled. Child Pugh ( Child ) class was A/B ( 102/71 ). The embolization procedure was performed as selectively cumulative survival rates were calculated. Kaplan-Meier 3 year survival curves were plotted for various subgroups, and differences between curves were analyzed using log rank test. Possible variables predictive of survival were analyzed by univariate a-nalysis using chi square test with Yates'correction. Results Overall survival rate at 1, 2, 3 years were 93. 6% , 83. 8% , 62.0% , with higher rates achieved in Child class A compared with Child class B patients ( 95.0% , 84. 2% , 61. 7% vs. 91. 5% , 70.0% , 43.7% ). Mean overall survival period was 43. 8 months ( ranged from 1.2 to 64. 8 months ). Cumulative survival was better for Child class A compared with Child class B patients ( P <0.05 ). For patients with dominant lesions ≤5 cm, 1, 2, 3 years survival rates were 100% , 95. 2% , 71. 4% for Child class A and 94. 1% , 88. 2% , 58. 8% for Child class B patients. Regarding TACE treatment, multivariate analysis identified the number of lesions ( P <0.05 ), lesion vascularity ( P < 0.01 ), initially achieved complete response ( P <0.01 ), and objective response ( P <0. 05 ) as significant and independent determinants of 3 year survival. Conclusion Epirubicin reveals high rates of 3 year survival for patients with late-stage HCC. Numbers of lesion, lesion vascularity, and local response were significant independent determinants of 3 year survival.%目的 观察表柔比星栓塞化疗对肝癌患者3年生存率的影响及其临床效果.方法 对173例无法切除的肝癌患者(A级102例,B级71例)进行超选择性动脉栓塞,使用表柔比星50 mg后予超液化碘油栓塞进行治疗,观察不同肿瘤特征和肝功能患者3年生存率,并对影响患者生存的因素进行分析.结果 患者1、2、3年的总体生存率分别为93.6%、83.8%、62.0%.肝功能Child分级A级患者生存率明显高于B级患者,1、2、3年的生存率分别为95.0%、84.2%、61.7%和91.5%、70.0%、43.7%.患者的总体生存时间为43.8个月(1.2～64.8)个月.其中Child A级患者的生存时间明显长于B级患者(P<0.05).对于单个肿瘤直径﹤5 cm的患者来说,Child A级患者1、2、3年的生存率分别为100%、95.2%、71.4%,B级分别为94.1%、88.2%、58.8%.通过多因素分析发现,患者肿瘤的数量、血供以及对介入治疗的反应性、适当的辅助治疗是影响其生存的主要因素(P<0.05,P<0.01).结论 使用表柔比星介入治疗对于无法根治的肝癌患者可有效提高其生存率,其中肿瘤数量、血供、辅助治疗以及局部反应性是影响介入治疗3年生存率的主要因素.
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