基于NDR评分评估多发性肝癌根治术后经导管动脉化疗栓塞治疗效果研究

目的 探讨NDR评分与多发性肝癌肝切除术后经导管动脉化疗栓塞术（TACE）疗效的关系。方法 回顾性分析2009年3月至2015年3月在海军军医大学东方肝胆外科医院行肝切除术的505例多发性肝癌病人的临床资料。根据术后是否行辅助性TACE将病人分为TACE组（n=272）和非TACE组（n=233），采用倾向得分匹配（PSM）对病人行1∶1配对。应用Kaplan-Meier法分析术后无复发存活率（RFS）和总体存活率（OS）的差异，并分析NDR评分与TACE疗效的关系。结果 PSM后，TACE组1、3、5年RFS和OS均高于非TACE组（66.8%、41.2%和27.6%；49.6%、37.2%和27.7%，P=0.031；86.1%、63.7%和42.6%；69.1%、49.0%和37.2%，P=0.002）。NDR评分≤2分时，TACE 组1、3、5年RFS和OS与非 TACE 组差异无统计学意义（68.6%、44.1%、29.0% vs. 58.0%、43.3%、35.2%，P=0.445；88.3%、65.0%、44.4% vs. 76.4%、55.0%、45.7%，P=0.109）；NDR评分>2分时，TACE 组1、3、5年RFS和OS均高于非TACE组（60.5%、34.2%、28.5% vs. 20.3%、16.2%、8.1%，P=0.001；78.9%、51.6%、42.8% vs. 43.8%、29.9%、15.9%，P=0.007）。PSM后NDR评分>2分时，多因素分析显示，甲胎蛋白（AFP）和辅助性TACE是无复发生存的独立影响因素（HR=1.90、0.43；P<0.05）；AFP、肿瘤最大最小径比值和辅助性TACE是总体生存的独立影响因素（HR=2.23、2.96、0.53；P<0.05）。结论 NDR评分>2分时，肝癌肝切除术后行辅助性TACE可有效减少术后复发，改善远期生存。对NDR评分>2分的多发性肝癌病人，推荐辅助性TACE作为术后抗复发治疗手段。     

Reproducibility of LI-RADS treatment response algorithm for hepatocellular carcinoma after locoregional therapy

PurposeTo determine inter-reader agreement in categorizing hepatocellular carcinoma (HCC) treated with locoregional therapy using the Liver Imaging Reporting and Data System (LI-RADS) treatment response (LR-TR) algorithm.Materials and methodsA total of 93 patients with a total of 112 HCC nodules that were treated using thermal ablation or transarterial chemoembolization were prospectively included. There were 79 men and 14 women with a mean age of 55 ± 2.6 (SD) years (range: 48–63 years). All patients underwent magnetic resonance imaging (MRI) examination of the liver and MR images were analyzed by two independent observers. Treated HCC nodules were categorized into four groups according to LR-TR scoring system including: (i) LR-TR non-evaluable (treated, response not evaluable); (ii) LR-TR nonviable (treated, probably or definitively not viable); (iii) LR-TR equivocal (treated, equivocally viable) and (iv) LR-TR viable (treated, probably or definitively viable). The inter-observer agreement in LR-TR categorization was assessed using the kappa statistics.ResultsThere was excellent inter-observer agreement between the two reviewers for overall treated HCC according to LR-TR algorithm (kappa = 0.938; 95% CI: 0.89–1.00; P = 0.001) with 97.31% agreement. The LR-TR categories by both reviewers were non-viable (77/112; 69.6% and 76/112; 67.9%), viable (30/112; 26.8% and 32/112; 27.7%) and equivocal (5/112; 4.4% and 4/112; 3.6%). There was excellent inter-observer agreement for LR-TR nonviable (kappa = 0.938; 95% CI: 0.87–1.0; P = 0.001) with 97.3% agreement, LR-TR viable (kappa = 0.955; 95% CI: 0.89–1.00; P = 0.001) with 98.2% agreement and good inter-observer agreement for LR-TR equivocal (kappa = 0.700; 95% CI: 0.28–1.0; P = 0.001) with 97.3% agreement.ConclusionLR-TR algorithm conveys high degrees of inter-observer agreement for the evaluation of treatment response of HCC after thermal ablation and transarterial chemoembolization.     

Relationship between plasma cell-free DNA (cfDNA) and prognosis of TACE for primary hepatocellular carcinoma

BackgroundOur study aims to investigate changes in cell-free DNA (cfDNA) concentration and integrity in primary hepatocellular carcinoma (PHC) patients before and after transcatheter arterial chemoembolization (TACE) treatment and their influence on the evaluation of prognosis of the disease.MethodsA total of 84 PHC patients admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from December 2016 to December 2017 were included as the study group, while 55 healthy people served as the control group. Plasma cfDNA concentration and integrity were determined using qRT-PCR. The correlation between cfDNA concentration/integrity and clinical characteristics of PHC patients were analyzed. A ROC curve was used to investigate the sensitivity and specificity of cfDNA as detection indices. Univariate and multivariate analyses were used to analyze factors affecting recurrence in PHC patients and compare recurrence-free survival (RFS) of PHC patients with high cfDNA expression and low cfDNA expression.ResultsPlasma cfDNA concentration and integrity were significantly higher in PHC patients before TACE treatment than in healthy people and significantly lower after treatment than before (P<0.05). The cfDNA concentration was significantly correlated with tumor size, lymph node metastasis, TNM stage, and BCLC stage, while cfDNA integrity was significantly correlated with tumor size, TNM stage, and BCLC stage (P<0.05). ROC results showed that the area under the curve (AUC) value of cfDNA concentration was the largest, with an optimal cut-off of 10.51 ng/mL. Multivariate regression analysis for COX showed that the TNM stage, cfDNA concentration, and AFP were independent risk factors that affected PHC patients’ survival.ConclusionsPlasma cfDNA concentration in PHC patients is more sensitive and specific than any other tumor marker. It is an independent risk factor for PHC patients treated with TACE. Therefore, it is hypothesized cfDNA is a potential biomarker for prognostic evaluation of PHC patients treated with TACE.     

Five-year clinical outcomes using the bioresorbable vascular scaffold: Insights from the FRANCE ABSORB registry

Central illustration: cumulative major adverse cardiac events (MACE) and bioresorbable vascular scaffold (BVS) thrombosis rates after 1, 2, 3, 4 and 5 years.

     

Transarterial Chemoembolization vs Radioembolization for Neuroendocrine Liver Metastases: A Multi-Institutional Analysis

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TACE 术前天冬氨酸氨基转移酶与淋巴细胞比值对原发性肝癌并门脉癌栓患者预后预测的价值

目的 探讨肝动脉化疗栓塞（transcatheter arterial chemoembolization，TACE）术前天冬氨酸氨基转移酶与淋巴细胞比值（aspartate aminotransferase to lymphocyte ratio index，ALRI）在原发性肝癌并门脉癌栓（primary liver cancer-portal vein tumor thrombosis，PLC-PVTT）患者预后预测中的价值。方法 选取2013年11月21日至2018年8月22日于广西医科大学附属肿瘤医院接受TACE治疗的175例PLC-PVTT患者为研究对象。采用时间依赖性ROC曲线确定ALRI的最佳临界值。采用Cox 回归模型分析总生存期（overall survival，OS）的独立预测因素，Kaplan-Meier法计算生存率。结果 ROC曲线显示，ALRI的最佳临界值为49.37，对应曲线下面积为0.71。Kaplan-Meier分析显示，ALRI>49.37的患者OS较ALRI≤49.37的患者短（P=0.003）。Cox 回归分析结果显示，ALRI>49.37、行1次以上TACE治疗、Child-Pugh分级B级、凝血酶原时间≥13 s是患者TACE术后OS的独立危险因素（均P＜0.05）。结论 TACE术前ALRI>49.37是PLC-PVTT患者OS的独立危险因素。     

利多卡因-表阿霉素-超液化碘油混合乳剂在肝癌TACE相关疼痛管理中的应用

目的探讨利多卡因-表阿霉素-超液化碘油乳剂在缓解TACE术中及术后患者疼痛的有效性及安全性。方法采用前瞻性随机对照的研究方法,共纳入55例患者。运用最小化法动态随机将患者分为A组(n=28)与B组(n=27)。A组在栓塞前通过导管一次性注入利多卡因100 mg,再注入表阿霉素-超液化碘油乳剂,B组在栓塞术中注入利多卡因-表阿霉素-超液化碘油乳剂。两组利多卡因用量均为100 mg。观察并记录患者术中及术后72 h内的疼痛评分(使用视觉疼痛评分量表),比较两组患者的一般情况,术后不良反应及其他止痛药物使用量。计量资料用均数±标准差或中位数(四分位间距)表示,计数资料用百分比表示;两组患者之间计量资料比较使用独立样本t检验或Mann-Whitney U检验,计数资料比较用χ2检验或者Fisher精确检验;以P<0.05为差异有统计学意义。结果两组患者的一般情况、碘油使用总量、TACE手术时长、表阿霉素用量及术后不良反应均无统计学差异(P>0.05)。B组在术中及术后4 h、8 h、24 h的疼痛评分均明显小于A组(P<0.01),而在术前,术后48 h、72 h两组间的疼痛评分差异无统计学意义(P>0.05)。B组患者TACE术后曲马多使用量小于A组患者(P<0.05),两组患者术后哌替啶使用量差异无统计学意义(P>0.05)。结论利多卡因-表阿霉素-超液化碘油乳剂具有延长利多卡因止痛时长的作用,可以在TACE术中和术后有效减轻患者疼痛程度,达到长时间的止痛效果,从而提高患者住院期间生活质量。