膀胱移行细胞癌中PCNA的表达与术后复发的相关性分析

目的 通过对膀胱移行细胞痛术后复发组与未复发组的增殖细胞核抗原(PCNA)表达的检测,探讨其与肿瘤术后复发的关系.方法 通过对膀胱手术后病理证实的65例膀胱移行细胞癌进行电话复访、信件回访及门诊复诊回访,以复查过膀胱B超为标准为复发组43例,末复发组22例,对其病理组织采用(S-P法)进行PCNA的测定,观察PCNA在不同组别中的表达.结果 复发组PCNA阳性表达率72.09%(31/43),未复发组40.91%(9/22),两组比较差异有统计学意义(P<0.05).结论 PCNA的表达可作为预测膀胱移行细胞癌术后复发的指标.     

经导管肝动脉化疗栓塞预防肝细胞癌术后复发的临床分析

目的探讨经导管肝动脉化疗栓塞(TACE)预防肝细胞癌根治性切除术后复发的效果。方法回顾性分析2002年6月至2012年6月间收治的44例肝细胞癌患者术后临床病例资料,按术后有无行TACE分为TACE组和单纯手术组,其中单纯手术组20例,术后TACE组24例,随访2年,并对1、2年的复发率进行分析。结果 44例患者均随访2年,TACE组1年和2年的复发率分别为16.7%(4/24)和50.0%(12/24),单纯手术组则分别为40.0%(8/20)和80.0%(16/20),组间差异有统计学意义(P<0.05)。结论肝细胞癌根治性切除术后TACE可以延长肝细胞癌患者术后复发时间。     

TACE对肝癌组织中MMP-2和MMP-9表达及其预后的影响

目的 探讨TACE对肝癌MMP-2、MMP-9的表达及预后的影响.方法 选取肝癌患者80例,随机分为两组,分别为术前TACE组、直接手术组.采用酶联免疫吸附法检测两组患者术前静脉血中MMP-2、MMP-9的水平;采用免疫组织化学法检测两组患者术中所取肝癌及癌旁组织中MMP-2、MMP-9的表达;比较两组患者术后1、2、3年的生存情况,并分析其影响因素.结果 直接手术组患者血液中MMP-2、MMP-9水平明显高于术前TACE组患者,差异有统计学意义(P<0.05);两组肝癌组织中MMP-2、MMP-9表达阳性率均较癌旁组织高,且直接手术组肝癌组织中MMP-2、MMP-9的阳性率明显高于术前TACE组,差异有统计学意义(P<0.05);术前TACE组1、2、3年生存率及中位生存期明显优于直接手术组,两组比较差异有统计学意义(P<0.05);Child-Pugh分级、MMP-2、MMP-9表达、门静脉癌栓、行TACE术均是影响患者生存期的因素(P<0.05);与患者性别、年龄、AFP、肿瘤大小、肿瘤数目无关(P>0.05).结论 TACE术能够降低肝癌患者血液及组织中MMP-2、MMP-9的表达,延长患者术后生存期,且患者生存期的长短受Child-Pugh分级、MMP-2、MMP-9的表达、出现门静脉癌栓以及行TACE术的影响,MMP-2、MMP-9可能成为评价肝癌治疗效果及预后的新的指标.     

VEGF和MVD在术前接受过肝动脉栓塞化疗的肝癌组织中的表达及临床意义（摘要）

目的探讨血管内皮细胞生长因子（VEGF）和平均微血管密度（MVD）在接受术前经导管肝动脉栓塞化疗（TACE）肝癌细胞中的表达和在二期切除肝癌复发预后中的意义。方法选取91例术前TACE和50例未行TACE肝癌手术切除标本,     

可切除大肝癌TACE后手术切除标本的病理研究

目的 探讨可切除大肝癌TACE后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前TACE组(36例)与一期手术组(47例)，术前TACE组31例二期切除(二期手术组)，5例失去手术切除机会，78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE组除较一期手术组肿瘤坏死广泛、包膜更完整外，两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异；TACE组TACE后肿瘤体积缩小并不显著，子灶、门脉癌栓完全坏死者少，肝硬化加重。结论 可切除大肝癌术前TACE不能使肿瘤完全坏死，部分患者耽误手术时机，应严格选择应用。     

可切除大肝癌TACE后手术切除标本的病理研究(英文)

目的探讨可切除大肝癌 TACE 后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前 TACE 组(36例)与一期手术组(47例),术前 TACE组31例二期切除(二期手术组),5例失去手术切除机会,78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE 组除较一期手术组肿瘤坏死广泛、包膜更完整外,两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异;TACE 组TACE 后肿瘤体积缩小并不显著,子灶、门脉癌栓完全坏死者少,肝硬化加重。结论可切除大肝癌术前 TACE 不能使肿瘤完全坏死,部分患者耽误手术时机,应严格选择应用。     

TACE后残余肝癌细胞β-catenin和p28GANK的表达及意义的研究

目的 探讨经导管动脉化疗栓塞术(Transcatheter arterial chemoembolization,TACE)后残余肝癌细胞β-连环蛋白(β-catenin)和p28GANK的表达及意义。方法 收集TACE后手术切除的肝细胞癌组织标本45例(TACE组)和未经任何治疗直接手术切除的肝细胞癌组织标本30例(单纯手术组)。采用免疫组化SP法检测残余肝细胞癌中β-catenin、p28GANK的表达水平。结果 TACE组组织标本β-catenin和p28GANK的表达阳性率分别为77.78%和75.56%,单纯手术组肝癌组织标本β-catenin和p28GANK的表达阳性率分别为46.67%和53.33%,两组差异具有统计学意义(P＜0.05)。TACE组残余肝细胞癌中β-catenin和p28GANK的阳性表达存在相关性(Φ=0.318,P=0.033)。TACE组β-catenin和p28GANK的高表达与患者门静脉癌栓形成和肿瘤远处转移有关(P＜0.05)。结论 原发性肝癌TACE后残余肝细胞癌β-catenin和p28GANK的表达明显升高,β-catenin和p28GANK的高表达与患者存在门静脉癌栓和肿瘤的远处转移有关。β-catenin和p28GANK的高表达可能是TACE后肿瘤侵袭、转移的原因之一。     

术前辅助性肝动脉化疗栓塞对可切除巨块型肝癌术后生存的影响

目的:探讨术前辅助性肝动脉化疗栓塞(TACE)治疗对可切除巨块型肝癌患者长期生存的影响.方法:回顾性分析接受手术切除的176例巨块型肝癌病例资料,按照术前是否曾行辅助性TACE治疗分为TACE组(n-51)和non-TACE组(n=125),根据是否伴有门静脉分支癌栓和子灶等癌残留高危因素分层,比较各组的总体生存率.结果:TACE组与non-TACE组1、3和5年总体生存率分别为65.60%、43.00%、30.70%和52.90%、30.60%、25.10%,两组差异无统计学意义,P=0.214;但对于伴有子灶或门静脉分支癌栓等癌残留高危因素的巨块型肝癌,TACE组与non-TACE组1和3年总体生存率分别为 58.00%、21.70%与 35.90%、9.10%.差异有统计学意义.P=0.027.结论:可切除巨块型肝癌的术前辅助性TACE治疗可选择性应用,对于伴有门静脉分支癌栓和子灶等癌残留高危因素的巨块型肝癌,术前辅助性TACE治疗有助于延长患者生存时间.     

沙利度胺联合TACE术治疗中晚期肝癌的临床观察

目的:探讨沙利度胺联合肝动脉化疗栓塞术(TACE)对无法手术切除的中晚期肝癌的疗效以及血管内皮生长因子(VEGF)在TACE术前及术后的变化。方法:收集2004-12-01-2007-12-31入住徐州市肿瘤医院无法手术切除的100例中晚期肝癌患者,随机分为治疗组(沙利度胺+TACE术,50例)和对照组(单纯TACE术,50例)。治疗组患者每晚口服200 mg沙利度胺,服用至少3个月,所有患者至少行TACE术2次,并检测TACE术前1周及术后2周血清VEGF水平。结果:治疗组和对照组有效率分别为56.0%和42.0%,两组间差异无统计学意义,P>0.05;治疗组和对照组疾病控制率(DCR)分别为80.0%和56.0%,两组比较差异有统计学意义,P<0.05;治疗组和对照组1年生存率分别为64.0%和62.0%,2年生存率分别为28.0%和24.0%,差异均无统计学意义,P>0.05;血清VEGF水平治疗组治疗后下降显著,P<0.05;对照组治疗后较治疗前血清VEGF水平偏高,对比差异无统计学意义,P>0.05。结论:沙利度胺联合TACE术能改善中晚期肝癌患者的疾病控制率,并降低血清VEGF水平,有可能延长患者生存及有效率。     

肝细胞癌中ErbB3表达水平与肝癌切除术后辅助性TACE疗效的关系

目的研究肝细胞癌中人类表皮生长因子受体3(ErbB3)表达水平与肝癌切除术后辅助性经肝动脉化疗栓塞(TACE)疗效的关系。方法回顾性分析徐州医科大学附属医院2014年6月至2015年12月收治的102例肝癌患者的临床资料。根据术后是否行辅助性TACE分为TACE组(术后行辅助性TACE,49例)和对照组(术后未行辅助性TACE,53例)。采用SP免疫组织化学染色法检测肝癌组织中ErbB3表达水平,并据其将本组患者分为ErbB3高表达者77例和ErbB3低表达者25例。比较TACE组与对照组的一般临床资料和术后1、2、3年的生存率,采用Cox回归分析影响患者术后生存率的因素。结果 TACE组与对照组术后1、2、3年的生存率分别为69.07%、51.82%、45.06%和64.15%、40.65%、36.58%,差异无统计学意义(P0.05);对于ErbB3高表达者,TACE组术后1、2、3年的生存率分别为72.54%、52.24%、49.17%,高于对照组的55.00%、25.93%、23.05%,差异有统计学意义(P0.05);对于ErbB3低表达者,TACE组术后1、2、3年的生存率分别为58.33%、50.0%、33.33%,低于对照组的92.31%、84.62%、76.92%,差异有统计学意义(P0.05)。Cox回归分析结果显示:在ErbB3高表达的肝癌患者中,肝硬化、肿瘤直径大是影响患者术后长期生存的危险因素,术后辅助性TACE是患者术后长期生存的保护因素(P0.05)。在ErbB3低表达的肝癌患者中,HbsAg阳性、肿瘤直径大、肿瘤数量多是影响肝癌患者术后长期生存的危险因素(P0.05)。结论肝癌切除术后给予辅助性TACE可延长肿瘤组织中高表达ErbB3患者的生存期,而对于肿瘤组织中低表达ErbB3的患者,术后辅助性TACE不能明显改善患者预后。     

Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma.

AIMS: To study the effect of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival after hepatic resection for hepatocellular carcinoma (HCC), we conducted a comparative analysis in 235 HCC patients who underwent hepatic resection with a curative intent. METHODS: We compared clinicopathologic background, mortality, and survival rates after hepatic resection between those who underwent preoperative TACE (n=109) and those who did not (n=126). RESULTS: One hundred and two patients in the TACE group (93.6%) received TACE only once. The mean interval between TACE and hepatic resection was 33.1days. Patients in the TACE group were younger than those in the non-TACE group, and liver cirrhosis and non-anatomical hepatic resection were more prevalent in this group. The 5-year overall survival rate after hepatic resection was significantly lower in the TACE group (28.6%) than in the non-TACE group (50.6%), especially in patients without cirrhosis or with stage I or II tumor. There was no difference between the two groups in mortality or disease-free survival after hepatic resection. Multivariate analysis showed preoperative TACE, preoperative aspartate aminotransferase elevation, and microscopic portal invasion to be independent risk factors for a poor outcome after hepatic resection. CONCLUSIONS: Preoperative TACE should be avoided for patients with resectable HCC, especially for those without cirrhosis or with an early stage tumor.     

VEGF与MMP-9在肝癌组织中的表达及其临床意义

背景与目的：血管内皮生长因子vascular endothelial growth factor,VEGF）及基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）与恶性肿瘤的侵袭、血管生成及预后有一定关系。VEGF与MMP-9表达对预测肝细胞癌（以下简称“肝癌”）患者预后的报道结果不一。本研究旨在探讨VEGF与MMP-9在肝癌组织中的表达及其预测肝癌患者预后的意义。方法：按是否复发将80例肝癌患者分为复发组与未复发组,采用免疫组化方法检测两组手术切除标本中VEGF及MMP-9的表达情况,分析两者的表达与临床病理指标的关系。建立Cox比例风险模型进行肝癌术后复发风险的多因素分析。结果：MMP-9及VEGF表达于肿瘤细胞浆中,复发组的阳性率分别为50．0％（24／48）及87．5％（42／48）,未复发组分别为15．6％（5／32）及59、4％（19／32）,差异均有显著性（P〈0．05）。VEGF与MMP-9的表达呈正相关（rs=0．36,P〈0．01）,并均与复发呈正相关（P〈0．01）。VEGF阴性患者的1、2、3年累积无瘤生存率分别是85．7％、71．4％及66．3％,VEGF阳性患者分别为58．0％、38．9％及33．9％,差异有显著性（P〈0．01）;MMP-9阴性组分别为72．4％、63．8％及55．5％,MMP-9阳性组分别为50．0％、14．1％及14．1％,差异有显著性（P〈0．01）。多因素分析发现,肝癌组织中VEGF和MMP-9的表达、术前播散结节及镜下微转移灶是肝癌术后复发的独立危险因素。结论：肿瘤组织中VEGF及MMP-9的表达与肝癌患者的术后复发密切相关,为预测肝癌患者术后复发的指标之一。     

Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

Background.

The effectiveness of adjuvant transarterial chemoembolization (TACE) for intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study was performed to identify ICC patients who would benefit from adjuvant TACE.

Patients and Methods.

The study included 553 patients who underwent hepatectomy for ICC between January 2008 and February 2011 at the Eastern Hepatobiliary Surgery Hospital and who were treated with or without TACE (122 with TACE and 431 without TACE). Survival risk stratification was performed using the established prognostic nomogram (ICC nomogram). The predictive performance was evaluated by concordance index and calibration. The tumor recurrence and overall survival (OS) rates were analyzed by the Kaplan-Meier method before and after propensity score matching (PSM).

Results.

The predictive performance of the ICC nomogram was demonstrated by the well-fitted calibration curves and an optimal c-index of 0.71 for OS prediction. In the whole cohort, the 5-year recurrence and OS rates between the TACE and non-TACE groups were significantly different (5-year recurrence: 72.9% vs. 78.1%; OS: 38.4% vs. 29.7%). After 1:1 PSM, the TACE and non-TACE groups (122 patients each) had similar 5-year recurrence and OS rates (5-year recurrence: 72.9% vs. 74.2%; OS: 38.4% vs. 36.0%). By survival risk stratification based on ICC nomogram, only the patients in the lowest tertile (nomogram scores ≥77) benefited from adjuvant TACE (TACE vs. non-TACE groups: 90.4% vs. 95.9% for 5-year recurrence; 21.3% vs. 6.2% for 5-year OS).

Conclusion.

Adjuvant TACE following liver resection might be suitable for ICC patients with high ICC nomogram scores (≥77).

Implications for Practice:

The accurate predictive performance of the established prognostic nomogram for intrahepatic cholangiocarcinoma (ICC) following liver resection was reconfirmed in an independent cohort with 553 patients. Based on the survival risk stratification using the nomogram, adjuvant transarterial chemoembolization following liver resection might be suitable only for ICC patients with high scores from the nomogram.     

TACE combined with liver resection versus liver resection alone in the treatment of resectable HCC: a meta-analysis

Objective:The ef icacy of preoperative transarterial chemoembolization (TACE) for hepatectomy on hepatocel-luar carcinoma (HCC) is stil controversial. This study aims to evaluate the ef icacy of preoperative TACE on resectable HCC. Methods:Pubmed, SCI, Medline, EMBASE, Cochrane Datebase, CNKI were searched. The articles that focused on pre-operative TACE for resectable HCC, published from 1990 to 2012, were col ected by computerized search of literatures and manual search of bibliographies. The relevant clinical trials’ data were reviewed by meta-analysis using the random ef ects model or fixed ef ect model by heterogeneity. The outcomes were expressed as odds ratio (OR) with 95%confidence intervals (CIs). Results:A total of 1347 patients were included in these 7 studies, the cases were divided into the preoperative TACE group and the non-preoperative TACE group, and there was no dif erence between the two groups in the 3-year disease-free survival rate, with an odds ratio of 1.14 (95%CI=0.90-1.45, P=0.27);the 5-year disease-free survival rate in the preopera-tive TACE group was better than that in the non-TACE group with an odds ratio of 1.35 (95%CI=1.07-1.74, P=0.02);the 5-year overal survival rate in the preoperative TACE group was higher than that in the non-TACE group with an odds ratio of 0.59 (95%CI=0.46-0.77, P<0.0001). Conclusion:The present data suggests that preoperative TACE has no dif erent in improving the 3-year disease-free survival rate with non-TACE group for resectable HCC, while it can improve the 5-year disease-free survival rate and the 5-year overal survival rate. More randomized control ed trials using large sample size are needed to provide suf icient evidence to confirm current conclusion.     

射频消融治疗原发性肝癌的生命质量对比评价

背景与目的以往对原发性肝癌(hepatocellularcarcinoma,HCC)各种治疗疗效的评价主要从治愈率、生存率和生存时间方面进行,近年来生命质量(qualityoflife,QOL)研究倍受关注,能较全面地反映肝癌患者体能恢复状况和切身感受而被广泛应用于癌症、慢性病的疗效评价。目前对于经皮射频消融(radiofrequencyablation,RFA)、经动脉插管栓塞化疗(transcatheterhepaticarterialchemo-embolization,TACE)治疗意义的评价大多关注局部肿瘤灭活率及患者生存率,而对治疗后患者生命质量的研究尚不多见。本研究从患者整体角度对比评估原发性肝癌经皮射频消融治疗后患者的生命质量。方法采用国内肝癌特异性生命质量量表(QOL-LCV2.0),对80例HCC经RFA治疗后QOL进行评定;并与同期40例经动脉插管栓塞化疗(TACE组)以及TACE RFA(联合组)40例分别进行比较。3组患者在年龄、性别、临床分期等方面分布均衡,无明显差异。结果RFA组的QOL总分中位数(168.6)高于TACE组(146.8),差异有显著性(P=0.025);RFA组和联合组在症状/副作用领域的得分中位数45.5、46.0,分别优于单纯TACE组38.1(P<0.01);RFA组躯体功能领域得分呈略高于TACE组的趋势。患者的年龄、收入、治疗后Child-Pugh分级、治疗后新生/复发率、并发症等方面与患者生命质量相关。TACE组和联合组于治疗后Child-Pugh分级提高的比例分别高于RFA组;TACE组新生/复发的比例明显高于RFA组。RFA组的1年、2年和3年生存率(92.8%、89.3%和76.5%)与联合治疗组(94.1%、87.4%、60.0%)比较无统计学差异,但高于TACE组(74.3%、48.2%、48.2%)。结论RFA治疗肝癌,多数患者可获得较好的疗效,严重的副作用少。TACE与RFA联合治疗与单纯TACE相比,可减少患者肝功能损伤,有利于提高原发性肝癌患者的生命质量。     

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

目的 建立肝细胞癌（简称肝癌）根治性切除术后预防性动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）治疗的卫生经济学评价模型。方法 140例肝癌患者根治性切除术后分为TACE组和非TACE组（即门诊随访组）,收集两组治疗方案直接医疗成本和治疗效果（复发率及无瘤生存时间）,进行成本效果分析、增量成本效果分析和敏感度分析。结果 （1）40例非TACE组患者门诊总平均费用为7 121.44元/人;100例TACE组患者复发前总费用为2 8250.45元/人。（2）非TACE组和TACE组的1、2、3、4、5年复发率比较差异无统计学意义（P＞0.05）;两组无瘤生存时间比较差异无统计学意义（P=0.322）。（3）非TACE组的成本效果比为389.15元/月,TACE组为1 278.30元/月,增量成本效果比为5 560.27元/月。（4）敏感度分析中非TACE组的成本度效果比为350.84元/月,TACE组为1 215.81元/月,增量成本效果比为5 381.35元/月。结论 从卫生经济学角度,预防肝癌术后复发,预防性TACE并不是最优方案,至少不是每个患者都应该或都适合做,在相同的效果下（复发率、无瘤生存时间）门诊随访治疗可能更经济。     

可切除大肝癌TACE后手术切除标本的病理研究

To investigate pathological changes in surgically excised specimens from resectable large hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE ) and their significance. From January 2002 to January 2003, 83 patients with resectable large HCC were randomized into two groups: group A, 36 patients who underwent preoperative TACE, and group B, 47 patients who underwent one-stage operation without TACE. Hepatectomy was performed in 31 patients of group A (two-stage operation group) and 47 patients of group B (one-stage operation group). The remaining 5 patients in group A were not operable. The diagnosis of HCC was pathologically confirmed in all 78 patients after hepatectomy. Pathological changes of the excised specimens between the two groups were compared, including main tumors, capsular containment, daughter nodules, tumor thrombi and liver cirrhosis. There were no significant differences in the incidence of daughter nodules, portal vein tumor thrombi (PVTT) and extrahepatic metastasis between the two groups, but the area of main tumor necrosis was more extensive and the rate of encapsulation was higher in two-stage operation group than those in one-stage operation group. No significant shrinkage in the average tumor size was seen in two-stage operation group, where daughter nodules and PVTT necrosis were less, and liver cirrhosis was more serious. Preoperative TACE for resectable large HCC should be used on the basis of strict selection because it does not provide complete tumor necrosis and may result in delayed surgery in some cases.     

The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma

BACKGROUND: Although surgical resection has produced better results than other therapies for local control of hepatocellular carcinoma (HCC), the long term results have not been satisfactory because of a low disease-free survival rate. The effects of preoperative transcatheter arterial chemoembolization (TACE) on improving disease-free survival of HCC after hepatectomy has remained controversial. METHODS: The current study was retrospective survey of 1725 patients who had hepatectomy for HCC between January 1990 and December 1995 and had follow-up data for 1457 cases. The follow-up rate was 84.5%. The significant prognostic factors were analyzed using a Cox proportional hazards survival model, and the disease-free survival was calculated by Kaplan-Meier estimation. Among 1457 cases, 120 patients underwent preoperative TACE and were divided into a one time TACE group, over two times TACE group, an effective group, and ineffective group. RESULTS: Multivariate analyses revealed significant prognostic factors as follows: preoperative TACE number, preoperative TACE effect, preoperative lesion number, intraoperative tumor thrombus, tumor size, tumor gross type, daughter nodules, vascular invasion, and postoperative alpha-fetoprotein value. Kaplan-Meier estimation showed that the 5-year disease-free survival rates of the over two times group, the one time group, and no TACE group were 51.0%, 35.5%, and 21.4%, respectively, and that the mean disease-free survival times of the three groups were 66.4, 22.5 and 12.5 months, respectively. The effective group had a 5-year disease-free survival rate of 56.8%, with a mean time of 90.1 months. CONCLUSIONS: Effective preoperative TACE may be one of the best methods, which can be clinically performed at present, for resectable HCCs including small HCCs for improving disease-free survival after hepatectomy. According to tumor size, range, location, hepatic function, and TACE effect, TACE can be performed 2-4 times preoperatively within 6 months.