肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

肝癌术后预防性肝动脉化疗栓塞对延缓复发的意义

[目的]了解预防性肝动脉化疗栓塞术(TACE)在延缓肝癌手术后复发方面的作用.[方法]对823例行根治性切除并经病理证实为肝细胞癌患者进行随访分析.其中126例患者手术后行预防性TACE,将可能影响原发性肝癌术后复发的观察指标包括性别、年龄、术前AFP、有无癌栓、手术切缘、手术前肿瘤是否破裂、肿瘤大小、肿瘤有无子灶、肿瘤包膜情况、手术后有无行预防性TACE等,用Cox模型分析各因素与复发时间之间的关系.所有数据经SAS6.12和SPSS统计软件处理分析.[结果]年龄小、有癌栓、手术前肿瘤有破裂、肿瘤体积大和肿瘤周围有子灶等因素使肝癌手术后复发时间提前,保证较大手术切缘距离和手术后行预防性TACE可延缓肝癌手术后复发.预防性TACE可明显降低肝癌患者术后2年的复发率.[结论]对有早期复发病理学征象的肝癌患者行预防性TACE治疗可能延缓术后肿瘤复发.     

原发性肝癌患者肝动脉化疗栓塞术后疼痛的影响因素分析

[目的]探讨肝癌患者行经肝动脉化疗栓塞术(TACE)后疼痛的发生情况及影响因素。[方法]对行TACE患者临床基线资料和术后疼痛发生情况进行分析,运用单因素和多因素Lo-gistic回归方法统计分析与TACE术后疼痛发生相关的因素。[结果]研究期间共115例有效病例,其中发生中重度疼痛46例,发生率40%,无疼痛及轻度疼痛69例,发生率60%。多因素Lo-gistic回归提示,与TACE术后发生疼痛具有显著相关性的因素包括:术中使用明胶海绵(P<0.001)、肿瘤位置靠近肝包膜(2cm以内)(P=0.046)。[结论]肝癌患者行TACE术后发生疼痛与术中使用明胶海绵、病灶位置靠近肝脏包膜有着显著关系。     

Health-Related Quality of Life of Patients with Intermediate Hepatocellular Carcinoma after Liver Resection or Transcatheter Arterial Chemoembolization

Background: The aim of our present study was to compare quality of life (QoL) between intermediate-stage(BCLC-B) HCC patients who had undergone either liver resection or transcatheter arterial chemoembolization(TACE). Materials and Methods: A total of 102 intermediate-stage HCC patients participated in our study,including 58 who had undergone liver resection and 44 who had undergone TACE. Baseline demographiccharacteristics, tumor characteristics, and long-term outcomes, such as tumor recurrence, were compared andanalyzed. QoL was assessed using the Short Form (SF)-36 health survey questionnaire with the mental andphysical component scales (SF-36 MCS and PCS). This questionnaire was filled out at HCC diagnosis and 1,3, 6, 12, 24 months after surgery. Results: For the preoperative QoL evaluation, the 8 domains related to QoLwere comparable between the two groups. The PCS and MCS scores were significantly decreased in both theTACE and resection groups at1 month after surgery, and this decrease was greater in the resection group.These scores were significantly lower in the resection group compared with the TACE group (P<0.05). However,these differences disappeared at 3 and 6 months following surgery. One year after surgery, the resection groupshowed much higher PCS scores than the TACE patients (P=0.018), and at 2 years after surgery, the PCS andMCS scores for the resection group were significantly higher than those for the TACE group (P<0.05). Elevenpatients (19.0%) in the resection group and 17 (38.6%) in the TACE group suffered HCC recurrence (P<0.05).Univariate and multivariate analyses indicated that tumor recurrence (HR=1.211, 95%CI: 1.086-1.415, P=0.012)was a significant risk factor for poorpostoperative QoL in the HCC patients.Conclusions: Due to its effectson reducing HCC recurrence and improving long-term QoL, liver resection should be the first choice for thetreatment of patients with intermediate-stage HCC.     

Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone

Aim: The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.     

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。     

肝动脉化疗栓塞术治疗中晚期肝癌120例疗效分析

目的 观察经导管肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的疗效、毒副反应.方法 采用 Seldinger技术,经股动脉穿剌,选择性肝动脉插管灌注化疗药物联合碘油栓塞或加用明胶海绵治疗中晚期原发性肝癌患者120例,共行 280次介入治疗.结果 全组120例患者中,完全缓解60.0%(72/120),部分缓解31.7%(38/120),稳定8.3%(10 /120),12个月以上生存率达63.3%(76/120).结论 TACE治疗中晚期原发性肝癌疗效确切,能够显著延长患者的生存期,提高其生存质量.     

Efficacy of Prophylactic Entecavir for Hepatitis B Virus- Related Hepatocellular Carcinoma Receiving Transcatheter Arterial Chemoembolization

Background and Aims: Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE. Methods: A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints. Results: Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation. Conclusion: Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.     

全身热疗联合导管化疗栓塞对中晚期肝癌的疗效观察

目的 观察全身热疗联合导管化疗栓塞治疗中晚期肝癌的疗效及安全性.方法 128例中晚期肝癌患者分为单纯介入栓塞化疗组（A组）和介入栓塞化疗联合全身热疗组（B组）,其中A组64例给予5-氟尿嘧啶、表柔比星、丝裂霉素介入栓塞化疗2周期,B组64例用同样药物介入栓塞化疗,同时给予深度镇静下全身热疗,使全身温度升至40~42 ℃,维持90 min,2周期;观察A组和B组患者的疗效及毒副反应.结果 A组患者中,CR 0例,PR 29例,SD 19例,PD 16例,有效率为45.3%;B组患者中,CR 0例,PR 41例,SD 18例,PD 5例,有效率为64.1%;2组有效率比较差异有统计学意义（P〈0.05）.Ⅲ、Ⅳ度肝功能损害、肾功能损害、骨髓抑制及胃肠道反应发生率A组为25.3%、13.1%及18.5%;B组为23.9%、11.4%及20.1%,2组比较差异均无统计学意义（P〉0.05）.结论 全身热疗联合导管化疗栓塞治疗中晚期肝癌安全有效.     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

目的: 探讨恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的疗效及安全性。 方法: 选取30例中晚期肝癌患者入组研究,均给予恩度肝动脉灌注联合介入化疗栓塞治疗,同时选取30例中晚期肝癌患者作为对照组,仅行介入化疗栓塞治疗。于1～2个治疗周期后比较RECIST疗效,甲胎蛋白转阴率及生活质量评分,同时比较治疗副作用。 结果: 实验组30例患者中29例可评价疗效。实验组治疗后K氏评分显著升高(80.39±8.37Vs73.93±9.22,P=0.002);恩度治疗组的治疗有效率及甲胎蛋白转阴率显著高于对照组(P=0.021,P=0.046)。治疗副作用轻微。 结论: 采用恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌,患者生活质量及近期疗效提升明显,甲胎蛋白转阴率亦有明显改善,而治疗相关副作用不大,值得临床推广及进一步研究。     

Nausea and Vomiting after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Incidence and Risk Factor Analysis

Background: Nausea and vomiting after transcatheter arterial chemoembolization (TACE) for hepatocellularcarcinoma (HCC) are common in clinical practice, but few studies have reported the incidence and risk factorsof such events. Objective: The purpose of this study was to analyze the incidence and risk factors of nausea andvomiting after TACE for HCC. Methods: This study was a single-center retrospective analysis of a prospectivelymaintained database. Between May 2010 and October 2012, 150 patients with HCC were analyzed for incidenceand preprocedural risk factors. Results: The incidence of postembolization nausea and vomiting was 38.8%and 20.9%, respectively, in patients with HCC. Patients who developed nausea had lower levels (<100 IU/L)of serum alkaline phosphatase (ALP) compared to those without nausea (123.04 ± 69.38 vs. 167.41 ± 138.95,respectively, p=0.044). Female gender correlated to a higher incidence of nausea as well (p=0.024). Patients whodeveloped vomiting, compared to those who did not, also had lower levels (<100 IU/L) of serum ALP (112.52 ±62.63 vs. 160.10 ± 127.80, respectively, p=0.010), and serum alanine transferase (ALT) (35.61 ± 22.87 vs. 44.97± 29.62, respectively, p=0.045). There were no statistical significances in the incidences of nausea and vomitingbetween male patients over 50 years old and female patients who have entered menopause (p=0.051 and p=0.409,respectively). Multivariate analysis by logistic regression analysis demonstrated that female gender and ALP>100IU/L were the most independent predictive factors of postembolization nausea (odds ratio (OR): 3.271, 95%CI: 1.176-9.103, p=0.023 and OR: 0.447, 95% CI: 0.216-0.927, p=0.030, respectively). ALP>100 IU/L was alsothe most independent predictive risk factor of postembolization vomiting (OR: 0.389, 95% CI: 0.159-0.952,p=0.039). Conclusions: Postembolizaiton nausea and vomiting are common in patients with HCC. Recognitionof the risk factors presented above before TACE is important for early detection and proper management ofpostembolization nausea and vomiting. Nevertheless, future studies are required.     

TACE联合射频消融在肝癌肝动静脉分流治疗中的临床应用

[目的]评价肝动脉化疗栓塞术（TACE）联合冷循环射频消融术（RFA）治疗原发性肝癌肝动静脉分流的疗效。[方法]伴有肝动静脉分流的原发性肝癌25例，行TACE联合RFA，术后1个月行CT及DSA检查。[结果]13例快速型肝动静脉分流仍然存在，5例中速型肝动静脉瘘分流量减少，7例慢速型肝动静脉瘘消失。[结论]TACE联合RFA治疗肝癌肝动静脉分流，对慢速型肝动静脉分流有治疗作用，对中速型分流有一定帮助，对快速型分流无治疗意义。     

肝动脉化疗栓塞术联合支持治疗伴HBV感染的中晚期原发性肝癌

[目的]探讨肝动脉化疗栓塞术（TACE）联合支持治疗对伴有乙肝病毒（HBV）感染的中晚期原发性肝癌（PLC）的疗效。[方法]入组伴有HBV感染的中晚期PLC 52例,分为支持治疗组和TACE组,其中支持治疗组给予支持治疗和抗病毒治疗,TACE组在支持治疗和抗病毒治疗的同时给予TACE治疗。治疗结束后分别评价两组的疗效和不良反应。[结果]支持治疗组和TACE组术后1年血清HBV DNA转阴率分别为45.0%和46.9%,差异无统计学意义（P〉0.05）。两组有效率分别为30.0%、59.4%,疾病控制率分别为55.0%、87.5%,差异均有统计学意义（P〈0.05）;1年生存率分别为40.0%、75.0%,2年生存率分别为5.0%、37.5%,差异均有统计学意义（P〈0.05）;中位生存期分别为10个月和19个月;生活质量改善率分别为80.0%和84.4%（P〉0.05）。支持治疗组无明显不良反应出现,TACE组主要不良反应为恶心呕吐和骨髓抑制,但均为Ⅰ～Ⅱ度。[结论]TACE联合支持治疗应用于伴有HBV感染的中晚期PLC患者疗效较好,且不良反应可耐受。     

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。     

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。     

血清血管内皮生长因子在肝癌介入栓塞后的表达

目的探讨血清血管内皮生长因子(VEGF)在肝癌栓塞化疗(TACE)后的表达水平和临床意义。方法分析63例肝细胞肝癌患者的血管造影结果和VEGF血清表达水平,采用ELISA法检测40例TACE前后患者血清VEGF的变化。结果 43例肿瘤富血管患者血清VEGF水平高于20例肿瘤乏血管患者[(136.80±52.13)pg/mlvs(62.30±31.17)pg/ml,P<0.05];患者肝动脉栓塞治疗前后血清VEGF分别为(87.41±43.16)pg/ml和(128.42±43.12)pg/ml,P<0.05.其中有36例患者血清VEGF水平在肝动脉栓塞治疗后升高,第二次血管造影发现27例新生肿瘤血管的患者血清VEGF水平显著升高(179.13±66.27)pg/ml。血清VEGF浓度明显升高的患者介入治疗疗效较差。结论肝癌TACE后肿瘤细胞表达VEGF增强,血清VEGF是影响肝癌栓塞化疗效果的因素之一。     

原发性肝癌肝动脉导管灌注CD_3AK细胞与化疗栓塞联合应用的疗效观察

观察肝动脉导管灌注CD3AK细胞联合TAE治疗晚期HCC的效果。方法：40例晚期HCC分为两组，实验组20例，采用肝动脉导管灌注CD3AK细胞联合TAE治疗；对照组20例，单纯TAE治疗。并检测两组AFP及T细胞亚群的变化。结果：实验组与对照组有效率分别为45％、30％（P＜0．01），治疗后实验组CD4、CD4／CD8比值明显升高（P＜0．01），而对照组则轻度下降。AFP两组均明显下降，以实验组为著（P＜0．005）。结论：肝动脉导管灌注CD3AK细胞联合TAE治疗晚期HCC，是一种最有希望的方法。     

MRI对肝动脉栓塞化疗治疗肝癌近期疗效随访的价值

[目的]评估MRI对经肝动脉栓塞化疗（transcatheter arterial chemoembolization,TACE）治疗肝癌近期疗效随访的价值。[方法]回顾性分析肝癌手术切除后复发22例患者（36个病灶）经TACE治疗后的MRI表现。[结果]MRI可正确判断22例患者（36个病灶）肝癌在TACE治疗后的近期疗效。随访1年,肿瘤完全凝固坏死32个,残留癌灶4个,2例患者在TACE治疗后1～3个月出现复发。[结论]MRI能准确评估TACE治疗肝癌的近期疗效。     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

Objective:To study the efficacy and safety of hepatic arterial infusion of Endostatin(YH-16,Endostar),combined with transcatheter arterial chemoembolization(TACE) on advanced hepatocellular carcinoma.Methods:Thirty patients with advanced hepatocellular carcinoma were enrolled in the study.The patients received hepatic arterial infusion of Endostar combined with TACE.The efficacy was evaluated strictly after 1-2 cycles according to RECIST criteria and the value of AFP;quality of life(QOL) was evaluated according to Karnofsky scores.Adverse effects were evaluated too.Results:29 cases' efficacy was evaluated among the total 30 cases.The KPS were significantly increased after the treatment(80.39 ± 8.37 vs 73.93 ± 9.22,P = 0.002).Compared with control group,the objective response rate(CR and PR) and the rate of AFP negative changed were significantly higher(P = 0.021,P = 0.046).The adverse effects were not obvious.Conclusion:The QOL and preliminary efficiency of patients of advanced hepatocellular carcinoma may be improved by hepatic arterial infusion of Endostar combined with TACE,the rate of AFP negative changed were significantly higher too,and there are little of adverse effects.It is worthy to clinical generalization and further clinical observation.     

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.