OBJECTIVE To investigate technical factors affecting local tumor control of small hepatocellular carcinoma (HCC) treated by superselective conventional transarterial chemoembolization (cTACE) using lipiodol and to compare prognoses between groups with and without these factors. MATERIALS AND METHODS Sixty-three consecutive patients with 73 HCC nodules (diameter, 1-3 cm) treated by cTACE were retrospectively analyzed. A positive or a negative 3D-safety margin was defined as a ≥ 1-mm area of lipiodol accumulation or as a diameter of lipiodol accumulation < 1 mm in liver parenchyma surrounding the tumor using plain CT images obtained within a week after TACE. Uni- and multivariate analyses were performed to identify technical factors determining local tumor control rate. Subgroup analysis of survival rates in treatment-naïve patients was performed according to the detected factors. RESULTS In univariate analyses, three-dimensional (3D)-safety margin and portal vein visualization were associated with local tumor control rates. In multivariate analysis, only positive 3D-safety margin remained a significant contributor (p = 0.001). Two-year cumulative local disease-free survival rates with positive and negative 3D-safety margin were 82.8% and 19.3%, respectively (p = 0.001). In subgroup survival analysis of the 36 newly diagnosed patients, the 1-, 2-, 3-, 4-, and 5-year cumulative OS rates for patients with and without positive margins were 100% versus 100%, 96.4% versus 75.0%, 81.8% versus 62.5%, 74.4% versus 41.7%, and 47.0% versus 0%, respectively (median survival time; 57.6 months vs. 37.1, p = 0.047). CONCLUSION Obtaining a 3D-safety margin can suppress local tumor recurrence and prolong survival in superselective cTACE for small HCC.

中文翻译：

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通过在小型肝细胞癌的超选择性经动脉化学栓塞中获得3D安全裕度来改善局部肿瘤控制和生存率。

目的探讨影响使用碘油超常规常规经动脉化学栓塞术（cTACE）治疗小肝癌（HCC）局部肿瘤控制的技术因素，并比较有或无这些因素的组之间的预后。材料与方法回顾性分析了连续63例经cTACE治疗的73例HCC结节（直径1-3 cm）患者。使用TACE后一周内获得的普通CT图像，将3D安全裕度的正值或负值定义为在肿瘤周围的肝实质中，碘油堆积的面积≥1 mm或碘油堆积的直径<1 mm。进行单变量和多变量分析以鉴定决定局部肿瘤控制率的技术因素。根据检测到的因素对未接受治疗的患者的存活率进行亚组分析。结果在单因素分析中，三维（3D）安全裕度和门静脉可视化与局部肿瘤控制率相关。在多变量分析中，只有积极的3D安全裕度仍然是重要的贡献者（p = 0.001）。阳性和阴性3D安全边际的两年累计局部无病生存率分别为82.8％和19.3％（p = 0.001）。在对36名新诊断患者的亚组生存分析中，有和无阳性切缘的患者的1年，2年，3年，4年和5年累积OS率分别为100％对100％，96.4％对75.0％分别为81.8％和62.5％，74.4％和41.7％，47.0％和0％（中位生存时间； 57.6个月和37.1，p = 0.047）。