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.     

综合治疗晚期原发性肝癌72例疗效观察

目的 探讨腹腔化疗或联合其他方法综合治疗晚期原发性肝癌的治疗效果.方法 72例不能手术切除的、合并门静脉癌栓、腹腔内转移或淋巴结转移的晚期肝癌,采取腹腔化疗或者联合TACE等其他方法治疗.5-氟尿嘧啶(5-FU)0.5～0.75 g,腹腔内注入1/日,连用10～15天,总量5.0～12.5 g,最后一天腹腔内注入丝裂霉素(MMC)10 mg或卡铂100 mg.7例胆管细胞癌联合使用健择800～1000 mg.结果 全组平均生存时间13.97±6.27月.累积1年、2年生存率分别为59.7%和30.6%.肝功能Child A级平均生存时间15.91±5.49月,B级8.55±5.09月,有显著性差别.结论 腹腔化疗或联合其他综合治疗方法是肝癌并腹腔内转移的有效治疗方法,可延长部分晚期肝癌患者的生存时间,改善生活质量.     

肋骨切除术在HIFU联合TACE治疗中晚期肝癌中的临床价值

目的:探讨肋骨切除术在高强度聚焦超声(Hihg intensity focused ultrasound,HIFU)联合经导管动脉栓塞化疗(Tran-seatheter arterial chemoembolization,TACE)治疗中晚期肝癌中的临床价值.方法:68例右叶中晚期肝癌分为肋骨切除组(36例,43病灶)和非肋骨切除组(32例,40病灶),随访两组患者HIFU联合TACE后的疗效,并进行比较.结果:总平均随访(11.9±11.4)月,两组中位生存期及1、2年生存率分别依次为13月、52.3%、21.8%与12月、46.8%、17.6%,两组比较无统计学意义(P=0.8155);其病灶完整消融率和消融体积>80%比例分别依次为46.5%、79.1%与37.5%、67.5%,两组比较无统计学意义(P>0.05).结论:肋骨切除术不能有效提高HIFU联合TACE治疗中晚期肝癌的疗效.     

122例肝癌合并门脉癌栓的综合治疗与单纯TACE治疗效果比较

目的:研究肝癌合并门脉癌栓综合治疗的效果。方法:122例肝癌分为2组:A组(72例)行肝动脉化疗栓塞(TACE);B组(50例)行TACE结合外放射治疗。结果:A组1、2年生存率分别为22.3％、4.5％,平均生存期7.5个月;B组1、2、3年生存率分别为39.2%、21.2%、13.5%,平均生存期17.5个月,P<0.05。结论:对合并门脉癌栓的肝癌综合治疗能明显提高治疗效果。     

经导管肝动脉化疗栓塞联合立体定向放射治疗对不可切除原发性肝癌的疗效分析

目的:分析经导管肝动脉化疗栓塞(TACE)联合立体定向放射治疗(SRT)治疗不可切除原发性肝癌的疗效及不良反应。方法:选取56例不可切除肝癌患者,根据治疗方法的不同将其分为TACE联合SRT组(联合组,32例)和单纯TACE组(单纯组,24例),联合组采用TACE联合SRT方法,单纯组采用单纯TACE治疗方法。依据实体瘤疗效评价标准(RECIST)1.1版进行近期疗效评价,观察记录治疗相关不良反应。结果:联合组近期有效率为84.3%,1年局部控制率为71.9%,单纯组近期有效率为79.2%,1年局部控制率为45.8%,近期有效率两组间差异无统计学意义(x~2=0.254,P>0.05),1年局部控制率联合组显著优于单纯组,差异有统计学意义(x~2=3.899,P<0.05)。两组间不良反应差异无统计学意义。结论:SRT联合TACE治疗不可切除肝癌局部控制率高,耐受性好,可以作为一种可靠而有效的治疗方法。     

索拉非尼联合免疫检查点抑制剂治疗TACE抵抗的中晚期肝癌的疗效及安全性

目的 探讨索拉非尼联合免疫检查点抑制剂（immune checkpoint inhibitors,ICIs）治疗经肝动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）抵抗的中晚期肝癌的疗效及安全性。方法 回顾性分析2017年1月至2021年3月期间在温州医科大学附属第五医院确诊为TACE抵抗的中晚期肝癌患者的资料,共54例,年龄28～82（56.1±11.8）岁,其中BCLC B期24例,C期30例;Child-Pugh A级34例,B级20例。根据治疗方法不同,分为对照组和联合组,对照组接受单一索拉非尼治疗（n=33）,联合组接受索拉非尼联合ICIs治疗（n=21）;比较两组患者的一般情况、肿瘤反应性、肿瘤无进展生存时间（progression-free survival,PFS）及不良反应的发生情况。结果 联合组（2例CR、11例PR、4例SD和4例PD）的肿瘤反应性明显优于对照组（2例CR、8例PR、10例SD、13例PD）（P=0.041）。联合组的中位PFS明显长于对照组（13.5个月 vs 6.8个月,P=0.010）;多因素分析显示Child-Pugh B级（HR 2.202,95%CI 1.059～4.581,P=0.035）、BCLC C期（HR 4.077,95%CI 1.902～8.742,P<0.001）、AFP≥400 ng/mL（HR 5.728,95%CI 2.227～14.729,P＜0.001）是TACE抵抗肝癌PFS的独立危险因素,索拉非尼联合ICIs（HR 0.180,95%CI 0.082～0.392,P<0.001）是肝癌患者的保护因素。联合组并发皮炎、腹泻的发生率明显多于对照组（P<0.05）。结论 索拉非尼联合ICIs治疗提高TACE抵抗中晚期肝癌的肿瘤反应性,延长患者PFS,是一种有效、安全的治疗方案。     

不能手术切除原发性肝癌的综合治疗(附254例报告)

目的:探讨不能手术切除的原发性肝癌有效治疗方法.方法:回顾性总结254例原发性肝癌临床资料、治疗手段及随访资料.结果:231例患者得到随访,随访率91%;62例患者Ⅰ期行肝癌冷冻手术,术后配合综合治疗:192例患者实施以TACE为主的综合治疗,其中,21例获得Ⅱ期手术探查,13例行肝切除术,8例行肝癌冷冻手术.肝癌冷冻患者1、3、5年生存率分别为63.2%、37.1%和25.8%;13例Ⅱ期的肝切除手术患者1、3、5年生存率分别为100%、76.9%、53.8%;以TACE为主综合治疗患者1、3、5年生存率分别为73.4%、27.1%、9.3%:全组患者1、3和5年生存率分别是70.9%、29.5%和13.4%.结论:个体化合理有序的综合治疗可以有效提高不能手术切除的原发性肝癌疗效.     

盐酸昂丹思琼的两种不同剂型的临床应用研究

目的观察盐酸昂丹司琼口腔崩解片与注射液两种剂型的临床应用情况。方法选取拟行TACE治疗的肝癌患者38例,按随机原则分为A组和B组,各19例。A组在TACE围手术期使用盐酸昂丹司琼口腔崩解片,B组在TACE围手术期使用盐酸昂丹司琼注射液。观察两组术后恶心、呕吐的发生率及输液量的差异。结果 A组的恶心、呕吐的发生率及输液量均显著低于B组。结论盐酸昂丹司琼的两种剂型均可有效地预防和治疗肝癌TACE后的恶心、呕吐,口腔崩解片较注射液更有效、更安全、更便捷。     

Chemoembolization and radioembolization

Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.