内容紹介
Significance of Transcatheter Arterial Chemoembolization for BCLC Stage B Hepatocellular Carcinoma with Mal-Nutrition
Summary
Background and Aim: The recommended indication of transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC)is Barcelona Clinic Liver Cancer(BCLC)stage B HCC. But there are some cases in which we do not perform TACE because of liver damage with malnutrition in stage B. So we examined whether branched-chain amino acid(BCAA)improve nutritional status and perform TACE to contribute the prolongation of HCC survival. Methods: This study included 88 patients treated for liver cirrhosis with HCC. All patients initially received BCAA granules. In patients with unchanged or decreased Alb levels, BCAA granules were discontinued and BCAA enriched nutrient was started. TACE for HCC were performed in those with an improved Child-Pugh score. Results: TACE were performed following the aggressive intervention with BCAA nutritional education in 66 of 88(75%)patients. Finally, overall survival time was significantly extended in TACE group(p<0.0001). Conclusion: Timely aggressive nutritional intervention in BCLC stage B HCC, early partial replacement with BCAA enriched nutrient before TACE may consequently contribute to improvement of the treatment outcome of HCC.
要旨
背景・目的: Barcelona Clinic Liver Cancer(BCLC)stage Bの肝細胞癌(HCC)に推奨される治療法は経カテーテル的肝動脈化学塞栓術(TACE)であるが,stage Bには栄養障害のためTACEが施行できない症例も含まれる。そこで,分岐鎖アミノ酸(BCAA)製剤で栄養障害を改善させTACEを施行することで,HCC生存期間の延長に寄与できるか検討した。方法: 対象は肝硬変合併HCC 88例で,まず全例にBCAA顆粒製剤を投与した。投与後にAlb値が変化なし,もしくは低下例はBCAA顆粒製剤から肝不全用経腸栄養剤に変更した。本治療でChild-Pugh scoreが改善した症例はHCCに対するTACEを施行した。成績: BCAA製剤による積極的な栄養療法の介入により,88例中66例(75%)にTACEを施行し得た。TACEを施行した症例は有意に生存期間が延長した(p<0.0001)。結論: BCLC stage BのHCCに対しては早期に肝不全用経腸栄養剤へ変更し,TACEを行うことでHCC治療成績の向上に寄与する可能性がある。
目次
Summary
Background and Aim: The recommended indication of transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC)is Barcelona Clinic Liver Cancer(BCLC)stage B HCC. But there are some cases in which we do not perform TACE because of liver damage with malnutrition in stage B. So we examined whether branched-chain amino acid(BCAA)improve nutritional status and perform TACE to contribute the prolongation of HCC survival. Methods: This study included 88 patients treated for liver cirrhosis with HCC. All patients initially received BCAA granules. In patients with unchanged or decreased Alb levels, BCAA granules were discontinued and BCAA enriched nutrient was started. TACE for HCC were performed in those with an improved Child-Pugh score. Results: TACE were performed following the aggressive intervention with BCAA nutritional education in 66 of 88(75%)patients. Finally, overall survival time was significantly extended in TACE group(p<0.0001). Conclusion: Timely aggressive nutritional intervention in BCLC stage B HCC, early partial replacement with BCAA enriched nutrient before TACE may consequently contribute to improvement of the treatment outcome of HCC.
要旨
背景・目的: Barcelona Clinic Liver Cancer(BCLC)stage Bの肝細胞癌(HCC)に推奨される治療法は経カテーテル的肝動脈化学塞栓術(TACE)であるが,stage Bには栄養障害のためTACEが施行できない症例も含まれる。そこで,分岐鎖アミノ酸(BCAA)製剤で栄養障害を改善させTACEを施行することで,HCC生存期間の延長に寄与できるか検討した。方法: 対象は肝硬変合併HCC 88例で,まず全例にBCAA顆粒製剤を投与した。投与後にAlb値が変化なし,もしくは低下例はBCAA顆粒製剤から肝不全用経腸栄養剤に変更した。本治療でChild-Pugh scoreが改善した症例はHCCに対するTACEを施行した。成績: BCAA製剤による積極的な栄養療法の介入により,88例中66例(75%)にTACEを施行し得た。TACEを施行した症例は有意に生存期間が延長した(p<0.0001)。結論: BCLC stage BのHCCに対しては早期に肝不全用経腸栄養剤へ変更し,TACEを行うことでHCC治療成績の向上に寄与する可能性がある。