早期AFP应答对经肝动脉化疗栓塞术后中期肝细胞癌患者预后的预测价值

目的对AFP应答进行最佳定义并探讨AFP应答与经肝动脉化疗栓塞术(TACE)治疗BCLC-B期肝细胞癌疗效的关系。方法回顾性纳入2010年1月-2014年12月在西京消化病医院消化介入科行TACE治疗连续的中期肝细胞癌患者116例,利用受试者工作特征曲线确定AFP变化率的最佳临界值,将术后AFP降低程度大于临界值的定义为AFP应答(AFP-R)组,其余为AFP不应答(AFP-NR)组。采用Kaplan-Meier法进行生存分析,生存时间的比较采log-rank检验,利用Cox回归进行多因素预后分析。结果中位肿瘤大小为7.5 cm,112例(96.6%)患者的肝功能为Child-Pugh A级。术后1个月AFP较基线降低16%为最佳临界值。AFP-R组的生存明显高于AFP-NR组,中位生存时间分别为26.6(20.9~32.3)个月和7.0(5.2~8.8)个月[风险比(HR)=3.56,95%可信区间(95%CI):2.12~5.95,P0.001],在亚组分析中同样能证实AFP-R组的预后明显优于AFPNR组(P值均0.05),多因素分析发现年龄(HR=0.97,95%CI:0.95~0.99,P=0.003)、肿瘤大小(HR=1.14,95%CI:1.06~1.22,P0.001)、ECOG体能评分(HR=2.15,95%CI:1.24~3.73,P=0.006,)、AFP应答(HR=1.56,95%CI:2.12~5.95,P0.001)是影响患者生存的独立危险因素。结论早期AFP应答可预测经TACE治疗的中期肝细胞癌患者的预后。     

肝动脉介入化疗栓塞术后甲胎蛋白的应答对进展期肝癌预后的影响

目的评价甲胎蛋白(AFP)应答对进展期肝细胞癌(HCC)患者行肝动脉介入化疗栓塞术(TACE)长期预后的影响。方法回顾性分析我院符合巴塞罗那分期B期的165例进展期HCC患者,根据TACE术后AFP是否下降50%分为两组:AFP应答组(n=80)和AFP未应答组(n=85)。采用Kaplan-Meier计算总体生存时间,Log-rank检验评估不同组别患者的生存差异,Cox比例风险模型分析影响总体生存的独立危险因素。结果一般临床资料两组比较差异无统计学意义。AFP应答组的1,3,5年总体生存率为68.9%,46.6%和40.8%,AFP未应答组为45.9%,20%和17.5%,经Log-rank检验,差异有统计学意义(P=0.001)。Cox多因素比例风险模型分析发现,AFP400ng/ml(HR:2.12,P=0.001)、肿瘤直径5cm(HR:3.33,P0.001)、肿瘤数目3(HR:2.06,P=0.001)、以及Child-Pugh B级(HR:1.93,P=0.004)是影响TACE预后独立的危险因素,AFP应答(HR:0.45,P0.001)是TACE术后生存的保护因素。结论连续AFP测量是TACE术后监测治疗反应的有效方法,AFP应答可提高进展期HCC行TACE后的长期生存。     

不同抗病毒治疗方案对慢性丙型肝炎持续应答患者肝细胞癌发生的影响

目的 研究直接抗病毒药物(DAAs)与利巴韦林(PR)方案治疗慢性丙型肝炎患者获得持续病毒学应答后肝细胞癌发生率的差异,并分析其危险因素。方法 回顾性分析河北医科大学第三医院2006年1月以来符合纳入标准的慢性丙型肝炎住院患者的临床病例资料,根据患者治疗方案将其分为DAAs组和PR组。使用倾向性匹配分析均衡两组间基线资料。采用Kaplan-Meier法估计发生率,并用Log-rank法比较两组间差异,单因素和多因素Cox比例风险模型分析肝细胞癌发生的危险因素。结果 在369名符合纳入条件的患者中,229(62.1%)例应用PR方案治疗,140(37.9%)例应用DAAs治疗,经倾向性匹配后每组各106例。两组肝细胞癌的4年发生率分别为：7.9%和10.2%,无统计学意义(P=0.070)。多因素分析显示：丙肝初治时的年龄(HR=1.093, 95%CI:1.007, 1.186)、合并糖尿病(HR=9.988, 95%CI:2.093, 47.662)、肝硬化(HR=9.422, 95%CI:1.079, 82.250)、基线AFP水平≥10 ng/mL(HR=5.683, 95%CI...     

肌肉减少症对接受TACE治疗原发性肝癌患者生存期的影响

目的肌肉减少症(Src)对经导管动脉化疗栓塞术(TACE)预后的影响尚不十分明确,拟评估术前Src与TACE治疗后生存期的影响。方法回顾性分析2014年1月至2018年1月在成都市第六人民医院初次诊断和接受首次TACE治疗的155例原发性肝癌(HCC)患者的资料,依据纳入排除标准筛选其中98例纳入分析。依据术前CT影像计算第三腰椎骨骼肌质量指数,判断Src的存在,分为Src组(60例)和无Src组(38例)。采用Kaplan-Meier生存分析,Log-rank比较Src组和无Src组患者肿瘤无进展生存时间(TTP)和总生存时间(OS)。在Cox比例风险回归模型下进行单因素和多因素分析TACE预后不良的相关危险因子。结果随访观察期间95.92%(94例)患者出现肿瘤进展,88.78%(87例)患者死亡。Src组患者的TTP和OS显著低于无Src组(P<0.0001)。影响TACE预后的独立危险因素包括Src(HR:2.265,95%CI:1.350~3.800;P=0.002)、肿瘤BCLC分级≥C级(HR:1.627,95%CI:1.044~2.534;P=0.031)、ECOG-PS评分≥2分(HR:1.811,95%CI:1.050~3.125;P=0.033)和血AFP>400μg/L(HR:1.867,95%CI:1.198~2.911;P=0.006)。结论61.22%的HCC患者首次接受TACE治疗前已合并Src。Src是TACE治疗总体生存欠佳的独立危险因素,可以作为HCC患者接受TACE治疗预后的预测因子。     

术前血清γ-谷氨酰转肽酶水平对老年肝细胞癌患者行肝动脉化疗栓塞术后预后的影响分析

目的 探究术前血清γ-谷氨酰转肽酶(GGT)水平对老年肝细胞癌(HCC)患者行肝动脉化疗栓塞术(TACE)术后预后的影响因素。方法 回顾性分析2016年1月—2019年12月在成都市公共卫生临床医疗中心接受治疗的272例老年HCC患者的临床资料，将其中进行TACE的89例患者作为观察组，未进行TACE的183例患者作为对照组。根据既往的研究，选择可能与生存有关的临床病理因素，进行单因素和多因素Cox分析，以识别总体生存的独立预测因素。结果 单变量分析结果显示，总胆红素>20.4 mmol/L(HR=1.52,P=0.015)、 GGT>54 U/L(HR=2.02,P<0.001)、区域淋巴结转移(HR=1.58,P=0.014)和ES级Ⅲ～Ⅳ(HR=1.50,P=0.007)是与HCC老年患者术后生存时间相关的可能因素。在血清GGT水平≤54 U/L的患者中，ES分级Ⅲ～Ⅳ(HR≤1.94,P≤0.030)是生存的唯一重要危险因素。观察组和对照组患者术后生存时间差异无统计学意义(中位生存时间分别为38个月和26个月，P=0.818)。TACE不是与生存相关的独立变量...     

Child-Pugh评分和ALBI分级预测经肝动脉化疗栓塞治疗不可切除肝细胞癌预后的价值比较

目的在经肝动脉化疗栓塞术(TACE)治疗的肝功能良好的肝细胞癌患者中,评估并比较Child-Pugh评分和ALBI分级对患者总生存情况的预测能力。方法回顾性收集2010年1月-2014年12月在空军军医大学西京消化病医院接受TACE治疗的不可切除185例HCC患者,收集患者的流行病学资料(年龄、性别、病因等),实验室检查资料(血常规、肝肾功能、凝血功能等),以及影像学检查资料(肿瘤大小、数目等),计算总生存时间,根据其基线状态以及实验室检查结果计算Child-Pugh评分和ALBI分级。使用Child-Pugh评分和ALBI评分进行危险分层,采用Kaplan-Meier绘制生存曲线,log-rank检验对总生存时间进行分析比较。Cox回归模型进行危险因素分析。通过依时ROC曲线分析和C指数比较2种评分预测生存情况的能力。结果根据ChildPugh评分,5分患者的中位生存时间及95%可信区间(95%CI)为25.3(20.1~30.5)个月;6分患者的中位生存时间为8.6(7.5~16.9)个月,2者生存时间比较差异有统计学意义(P=0.002);根据ALBI评分,1级的患者中位生存时间为29.1(25.9~32.3)个月,2级患者的中位生存时间为15.1(12.7~17.6)个月,2者生存时间比较差异有统计学意义(P<0.001)。单因素分析结果显示,ECOG评分、肿瘤大小、肿瘤数目、AFP、AST、Alb、TBil、Child-Pugh评分以及ALBI分级均与生存相关(P值均<0.05);多因素分析调整风险比(HR)之后,白蛋白[HR(95%CI):0.93(0.90~0.97),P<0.001)]、胆红素[HR(95%CI):1.04(1.02~1.06),P<0.001)]、Child-Pugh评分[HR(95%CI):1.75(1.18~2.59),P=0.005)]以及ALBI评分[HR(95%CI):1.82(1.29~2.59),P=0.001]均是患者总生存时间的独立预测因素。根据依时ROC曲线,随着观察时间的延长,Child-Pugh评分对生存的预测能力呈下降趋势,而ALBI评分的预测能力比较稳定。在预测1年以内的生存方面,2种评分方式预测能力相近,而随着时间的延长,ALBI评分的预测价值更高。Child-Pugh评分的C指数略低于ALBI的C指数为[0.57(95%CI:0.53~0.60)vs 0.63(95%CI:0.57~0.68)]。结论对于接受单纯TACE治疗的肝细胞癌患者,ALBI评分与Child-Pugh评分均是生存时间的独立预测因素,但是ALBI的远期预测能力相对更好。     

肝细胞癌术后复发患者行TACE治疗疗效及影响因素分析

目的探究肝细胞癌(HCC)术后复发患者行经肝动脉介入化疗栓塞术(TACE)治疗疗效及术后复发的影响因素。方法回顾性分析120例HCC术后复发患者的临床资料,依据术后是否接受TACE治疗分为TACE组(n=68)和非TACE组(n=52),统计两组随访生存率,分析患者TACE预后影响因素。结果 TACE组1、2年总体生存率分别为88.2%、80.9%,与非TACE组的86.5%、76.9%比较,差异无统计学意义(P0.05),TACE组术后3年总体生存率67.65%较非TACE组的48.08%高(P0.05)。血管侵犯(OR=1.102,P=0.013,95%CI:1.016～1.382)、最大癌结节直径5 cm(OR=1.433,P=0.005,95%CI:1.012～2.238)是HCC术后复发患者TACE预后的影响因素(P0.05)。结论 HCC术后复发患者行TACE能有效改善预后,或可推荐血管侵犯、最大癌结节直径5 cm的术后复发患者行TACE治疗。     

葡萄糖-6-磷酸脱氢酶表达与肝细胞癌预后的关系

目的探究葡萄糖-6-磷酸脱氢酶(G6PD)基因在肝细胞癌(HCC)组织中的表达与患者预后的关系。方法收集2016年6月—2018年1月在武汉大学中南医院首诊的44例HCC患者癌组织及对应癌旁组织样本,RT-qRCR检测G6PD mRNA表达,比较癌组织和癌旁组织G6PD表达水平差异。按照G6PD基因表达水平的中位数将HCC患者分为G6PD高表达组(n=22)和G6PD低表达组(n=22),结合数据库数据进行分析,用Kaplan-Meier法绘制生存曲线,分析两组HCC患者总生存期和无进展生存期的差异。正态分布的计量资料2组间比较采用t检验,偏态分布的计量资料2组间比较采用Mann-Whitney U检验,计数资料2组间比较采用Fisher确切概率法;相关性分析采用Spearman法。结果肝癌组织中G6PD mRNA表达水平是癌旁组织的2.09倍,差异具有统计学意义(Z=-3.221,P=0.001)。G6PD高表达是影响HCC患者肝切除术后总生存期(HR=1.84,95%CI:1.30～2.61,P=0.000 52)和无进展生存期(HR=1.75,95%CI:1.27～2.42,P=0.000 54)的危险因素。在G6PD低表达组中淋巴细胞/单核细胞比值(LMR)明显高于G6PD高表达组(t=2.681,P=0.011),G6PD与LMR呈负相关(r=-0.439,P=0005)。结论肝癌患者癌组织中G6PD表达升高可能会引起LMR降低,G6PD表达可能与肿瘤微环境炎症有关,G6PD的高表达对HCC的预后评估具有一定的临床价值。     

老年非小细胞性肺癌胸腔镜解剖性肺切除术远期预后及危险因素分析

目的 比较单孔胸腔镜下肺段切除术和肺叶切除术治疗老年早期非小细胞性肺癌(NSCLC)的预后情况，并探讨影响预后的相关危险因素。方法 回顾性分析我院2015年1月至2019年6月间行单孔胸腔镜下解剖性肺切除手术治疗的老年NSCLC患者150例临床资料，按照手术方式不同分为肺段切除组(n=62)和肺叶切除组(n=88),比较两种手术方式下患者的3年生存率和无进展生存期的差异。使用Cox比例风险回归模型分析影响无进展生存期的独立危险因素。结果 肺段切除组和肺叶切除组的3年生存率分别为93.5%和95.5%,差异无统计学意义(P=0.608)。肺段切除组和肺叶切除组的无进展生存时间分别为(28.4±7.6)个月和(35.4±7.0)个月，组间比较差异有统计学意义(P=0.045)。Cox回归分析显示年龄(HR=9.999,95%CI:2.047～48.845,P=0.004)、肿瘤大小(HR=4.371,95%CI:1.322～14.454,P=0.016)、手术方式(HR=0.021,95%CI:0.003～0.132,P<0.001)、切除淋巴结数量(HR=4.059, 95%CI:...     

MiR-449b表达对老年原发性肝细胞癌患者预后的影响

目的探讨miR-449b对老年原发性肝细胞癌(HCC)患者预后的影响。方法选取2013年1月-2015年1月于徐州医科大学附属医院肿瘤科接受肝癌根治性切除术治疗的老年HCC患者176例。应用实时荧光聚合酶链反应检测miR-449b在患者癌组织中的表达水平,随访患者的生存状况至2020年1月,评估miR-449b对HCC预后的预测值,分析影响老年HCC患者预后的因素。结果176例患者年龄66~82岁,平均(70.3±2.7)岁,其中男性141例、女性35例。截至2020年1月,随访的168例患者中,死亡97例。MiR-449b预测老年HCC患者死亡的临界值为0.36。当miR-449b为0.36时,miR-449b预测老年HCC患者死亡的敏感度为72.23%,特异度为70.38%,曲线下面积为0.712(P=0.001)。Kaplan-Meier和Log-rank检验显示,蔡尔德-皮尤改良(CTP)评分B级(HR=1.17,P<0.001)、肿瘤直径>5 cm(HR=1.13,P<0.001)、淋巴结转移(HR=1.09,P<0.001)和miR-449b低表达(HR=2.54,P<0.001)会增加老年HCC患者的死亡风险。Cox比例风险回归模型显示,CTP评分B级(HR=1.14,P<0.001)、肿瘤直径>5cm(HR=1.11,P<0.001)、淋巴结转移(HR=1.07,P<0.001)和miR-449b低表达(HR=2.48,P<0.001)是老年HCC患者死亡风险增加的独立危险因素。结论MiR-449b表达与老年HCC患者预后相关,miR-449b表达下调可能增加老年HCC患者的死亡风险。     

Efficacy of platinum analogue for advanced hepatocellular carcinoma unresponsive to transcatheter arterial chemoembolization with epirubicin

Aim:  Hepatocellular carcinoma (HCC) often shows resistance to transcatheter arterial chemoembolization (TACE). Such patients often have a poor prognosis and are unresponsive to other forms of therapy. The aim of this retrospective study was to determine the response to TACE using platinum analogues in patients deemed resistant to TACE using epirubicin.
Methods:  We studied 152 consecutive patients with advanced HCC resistant to TACE using epirubicin. All cases were treated with platinum analogue using transcatheter arterial chemotherapy with or without embolization.
Results:  Computed tomography at 3 months after therapy showed complete response (CR) in 6 patients (4.0%), partial response (PR) in 28 (18%), stable disease (SD) in 35 (23%), and progressive disease (PD) in 83 (55%). The cumulative survival rates for PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization (81.8% at first year, 53.9% at second year, and 33.1% at third year) were significantly higher than those of SD/PD patients (36.6%, 17.5% and 7.4%, respectively) ( P  < 0.001). The 50% survival period was extended almost 1.4 year in PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization.
Conclusion:  Our retrospective study is the first to report the efficacy of platinum analogues for advanced HCC unresponsive to TACE using epirubicin.     

External beam radiation therapy for inoperable hepatocellular carcinoma with portal vein thrombosis

Portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC) has a poor impact on prognosis. Many of these tumors may cause intrahepatic and extrahepatic metastases. From January 1991 to December 1996, 41 unresectable HCC patients with PVT underwent transcatheter arterial chemoembolization (TACE) and external beam radiation therapy (EBRT) to the portion of PVT. The irradiated field, with a mean equivalent field size of 6.6 x 7.1 cm2, was localized and simulated by abdominal sonography, angiography and computed tomography. Radiation dose ranged from 36 to 66 Gy (mean dose: 51.4 Gy), in a daily fraction of 1.8 to 2 Gy. The response of EBRT was evaluated by abdominal sonography within 3 months of completion of EBRT. The response rates of the PVT after treatment were 39% for complete response (CR), 41% for partial response (PR), and 19% for no response (NR), respectively. The median overall survival time from start of radiotherapy was 10 months for all patients, 17 months for CR patients, 8 months for PR patients and 4 months for NR patients. By multivariate analysis, response of PVT resulted in a significant improvement in survival. (P = 0.001) There was no occurrence of severe complication of radiation-induced liver disease. The results obtained with combined treatment modality of EBRT and TACE in the treatment of HCC patients with PVT are encouraging.     

肝细胞癌患者TACE治疗前后血清miR-145水平变化及其临床意义

目的 探讨肝细胞癌(HCC)患者在经导管动脉化疗栓塞术(TACE)治疗前后血清microRNA-145(miR-145)水平变化及其临床意义。方法 2013年1月～2015年12月我院收治的72例HCC患者和同期60例健康体检者,采用qRT-PCR法检测血清miR-145水平,采用ROC曲线分析血清miR-145和甲胎蛋白(AFP)预测不良预后的价值。结果 在治疗1个月末,16例(22.2 %)为PR,13例(18.1%)为SD,43例(59.7 %)为PD;HCC组血清miR-145水平为(0.59±0.25),显著低于对照组【(1.02±0.28),P＜0.05】,术后1个月,HCC患者血清miR-145水平为(0.81±0.26),显著高于术前(P＜0.05);不同性别、年龄、肿瘤直径、肿瘤分化、癌栓和Child-Pugh分级患者血清miR-145水平无显著性差异(P＞0.05),而不同TNM分级和术前AFP水平患者之间差异显著(P＜0.05); PD组血清miR-145水平为(0.86±0.21),显著高于PR组或SD组【分别为(0.62±0.19)和(0.75±0.19),P＜0.05】;随访3年,28例(38.9%)患者死亡,其中高miR-14 水平患者3 a生存率为75.6 %,显著高于低水平患者的41.9 %(x²=8.765,P＜0.05);血清miR-145、AFP和miR-145联合AFP预测HCC不良预后的曲线下面积分别为0.871、0.851和0.942,两者联合预测的敏感度为91.7 %,准确度为90.2%。结论 TACE术后检测血清miR-145水平可能预示HCC患者预后较好。     

Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma

AIM: To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone. METHODS: In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient’s demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liverdisease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed. RESULTS: Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatment-related toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes. CONCLUSION: Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are needed to further validate this observation.     

立体定向放射联合肝动脉灌注化疗栓塞治疗原发性肝癌临床分析

目的探讨立体定向放射治疗联合经肝动脉化疗栓塞(TACE)治疗原发性肝癌的疗效。方法单纯TACE治疗58例,TACE联合伽玛刀治疗62例肝癌患者,比较治疗后的近期和远期疗效。结果在治疗后3个月,在单纯TACE治疗的58例患者中,总有效率(CR+PR)为60.3%(35/58),在TACE联合伽玛刀治疗组的62例患者中,总有效率(CR+PR)为79.0%(49/62,P0.01);TACE组治疗后1年、2年和3年生存率分别为67.2%(39/58)、34.5%(20/58)和18.9%(11/58),TACE联合伽玛刀组分别为72.6%(45/62)、41.9%(26/62)和22.6%(14/62)。结论立体定向放射治疗联合TACE治疗原发性肝癌是治疗肝癌安全有效的方法,可以提高患者的生存率。     

Pretreatment predictor of response,time to progression,and survival to intraarterial 5-fluorouracil/interferon combination therapy in patients with advanced hepatocellular carcinoma

Background Several studies have reported survival benefits of combination therapy with intraarterial 5-fluorouracil (5-FU) and subcutaneous interferon (IFN) α for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). We investigated the pretreatment predictive factors of early response, time to progression (TTP), and survival in response to intraarterial 5-FU/IFN combination therapy. Methods Patients with nonresectable HCC and variable PVTT grades (without PVTT to PVTT in the trunk) received intraarterial 5-FU/IFN combination therapy (n = 55). Results After two courses of the combination therapy, 1 (2%), 15 (27%), 16 (29%), 12 (22%), and 11 (20%) of 55 patients showed complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), or had dropped out (DO), respectively, when their early response to treatment was assessed. Univariate analysis identified only hepatitis C virus (HCV) antibody positivity as having significantly influenced the early response (P = 0.028) and TTP (P = 0.021). Multivariate analysis identified performance status (P = 0.003) and HCV antibody positivity (P = 0.007) as significant and independent determinants of survival. PVTT grade did not influence early response, TTP, or survival. The survival rate was significantly higher in patients who achieved CR or PR than in those that assessed as SD or PD, or DO (P < 0.0001, each). Conclusions HCV antibody positivity may be a significant pretreatment predictor of early response, TTP, and survival of patients with advanced HCC treated with 5-FU/IFN. CR or PR as the early response to the combination therapy might indicate a more favorable prognosis in patients with advanced HCC. PVTT grade did not seem to influence the efficacy of combination therapy.     

Transarterial chemoembolization for inoperable,early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B: results of a comparative study in 96 Chinese patients

OBJECTIVE: The efficacy of transarterial chemoembolization (TACE) in prolongation of survival is controversial. We conducted a comparative study to determine whether TACE treatment had any survival benefit for patients with unresectable hepatocellular carcinoma (HCC) and with relatively preserved liver function. METHODS: In all, 96 patients with unresectable HCC of Okuda stage I or II and Child-Pugh grade A or B were recruited. A total of 80 patients (group 1) who received TACE were compared to 16 patients (group 2) who were treated conservatively. RESULTS: The median survival time of group 1 patients was significantly longer than that of group 2 patients (31.2 vs 14.1 months respectively, p = 0.0126). The cumulative survival rates at 6 months, 1 yr, 2 yr, 3 yr, and 4 yr of group 1 compared to group 2 were as follows: 93.8% versus 62.5% (p = 0.002); 86.3% versus 62.5% (p = 0.023); 78.8% versus 50% (p = 0.017); 57.5% versus 50% (p = ns); and 51.3% versus 43.8% (p = ns), respectively. Tumor response was observed in 28% of patients receiving TACE. Patients with higher pretreatment albumin levels, lower pretreatment alpha-fetoprotein levels, and Okuda stage I disease were associated with a favorable response to TACE. CONCLUSION: TACE treatment improved survival in patients with unresectable HCC in the early stages and with relatively preserved liver function.     

肝细胞癌患者肝动脉化疗栓塞术后外周血长链非编码RNA TINCR水平与Th1/Th2平衡及预后的相关性分析

目的探讨分析外周血长链非编码RNA(lncRNA)TINCR表达水平与肝细胞癌(HCC)患者行肝动脉化疗栓塞术(TACE)术后辅助性T淋巴细胞1(Th1)/Th2平衡及预后的相关性。方法回顾性选取2015年3月—2017年3月在湖北省武汉市金银潭医院行TACE治疗的HCC患者85例,并随机抽取在本院体检的健康志愿者30例作为对照组。检测HCC患者TACE完成后7 d及对照组外周血lncRNA TINCR表达情况、Th1/Th2细胞因子表达情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,等级资料组间比较采用Kruskal-Wallis H检验。lncRNA TINCR相对表达量与Th1/Th2细胞因子的相关性采用Spearman相关性分析。lncRNA TINCR相对表达量对生存情况的影响采用Kaplan-Meier生存曲线分析,生存曲线比较采用log-rank检验。结果HCC组患者外周血lncRN TINCR相对表达量(1.784±0.429)高于对照组(0.926±0.263),差异有统计学意义(t=10.277,P<0.05)。lncRNA TINCR相对表达与HCC患者血管侵犯、肿瘤大小、肿瘤分期及血清AFP水平有关(t值分别为3.958、4.499、3.361、4.949,P值分别为<0.001、<0.001、0.001、<0.001)。HCC组患者血清IFNγ、IL-2水平明显低于对照组[(13.48±5.20)pg/ml vs(27.49±7.21)pg/ml、(21.89±6.45)pg/ml vs(32.05±7.89)pg/ml,t值分别为11.408、6.986,P值均<0.05],而IL-4、IL-10水平明显高于对照组[(13.73±3.35)pg/ml vs(9.36±2.73)pg/ml、(12.75±2.74)pg/ml vs(8.93±2.16)pg/ml,t值分别为6.426、6.909,P值均<0.05]。HCC患者外周血lncRNA TINCR相对表达量与血清IFNγ、IL-2水平呈负相关(r值分别为-3.164、-3.270,P值均<0.001),与患者血清IL-4、IL-10呈正相关(r值分别为2.963、3.044,P值分别为0.007、<0.001)。以lncRNA TINCR相对表达量≥1.700作为高表达,85例HCC患者中lncRNA TINCR高表达患者47例,低表达患者38例。log-rank检验结果显示,lncRNA TINCR低表达患者生存情况明显优于高表达患者(χ2=4.182,P<0.05)。结论HCC患者行TACE后外周血lncRNA TINCR表达明显高于健康人群,lncRNA TINCR表达与患者病理特征及Th1/Th2免疫平衡有密切联系,可作为患者生存预后的潜在预测指标之一。     

Chemoembolization outcomes for hepatocellular carcinoma in cirrhotic patients with compromised liver function

Background

Transarterial chemoembolization (TACE) is recommended as a treatment for unresectable hepatocellular carcinoma (HCC) in patients with normal underlying liver function. The efficacy of TACE in cirrhotic patients with compromised liver function is unknown.

Methods

All ‘first’ TACE interventions for HCC performed at a single institution from 2008 to 2012 were retrospectively reviewed (n = 190). Liver function was quantified via the Child''s score. Tumour necrosis after TACE was quantified via the mRECIST criteria.

Results

The ‘first’ TACE procedures of 100 Child''s A and 90 Child''s B/C cirrhotic patients were evaluated. As expected, the lab-model for end-stage liver disease (MELD) score was significantly higher in the Child''s B/C group. Although the number of tumours were similar between the groups, both the size of the largest tumour and the total tumour diameter were greater in the Child''s A group. There were no significant differences in post-TACE tumour necrosis between groups. The median survival after TACE was significantly longer in the Child''s A compared with Child''s B/C patients (21.9 versus 13.7 months, P = 0.03).

Conclusions

TACE appears to be equally efficacious in cirrhotic patients regardless of their Child''s classification based upon equivalent mRECIST measures of tumour necrosis. However, inferior survival after TACE was observed in the Child''s B/C group.