肝动脉化疗栓塞术对肝癌患者肝功能影响评价

肝动脉化疗栓塞术 (ＴＡＥ)广泛用于不能手术的肝癌患者 ,其疗效取决于对肝癌组织的杀灭和对正常肝组织的保护两方面。本文对 71例ＴＡＥ术前后肝功能的变化及影响因素进行分析 ,探讨ＴＡＥ对肝脏损害的程度及其临床意义。材料与方法一、临床资料选择肝癌患者 71例 ,男 47例 ,女 2 4例。年龄为 2 3～ 74岁 ,肝癌病例经临床和 /或病理检查确诊 ,肝硬化病例均符合1995年北京会议制定的肝硬化诊断标准。二、治疗方法经股动脉穿刺 ,超选择导管进入肝固有动脉或肝叶、肝段动脉内 ,灌注阿霉素 40～ 5 0ｍｇ ,丝裂霉素 12～ 16ｍｇ ,有时加 5 -氟尿…     

八宝丹胶囊对肝癌患者肝动脉化疗栓塞术后并发症的疗效观察

目的:观察八宝丹胶囊治疗肝癌患者肝动脉化疗栓塞术(TACE)术后不良反应并发症的临床应用效果。方法:将162例均经B超、CT、MRI、肝动脉造影和(或)AFP检查确诊为不能手术的中、晚期肝癌患者随机分为两组,每组81例;治疗组入院后即服用八宝丹胶囊,对照组为入院后即服用水飞蓟宾胶囊。观察治疗前后患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、γ-谷氨酰转肽酶(γ-GT)及术后不良反应的发生率。结果:对照组患者TACE术后ALT、AST、γ-GT、TBil等指标均上升,与TACE术前比较差异有统计学意义。而治疗组患者TACE术后以上各项指标未见明显上升,与TACE术前比较差异无统计学意义。对照组与治疗组TACE术后肝功能比较差异有统计学意义。对两组患者TACE术后不良反应症状的疗效观察:两组患者术后发热、腹痛比较差异有统计学意义,治疗组明显低于对照组;恶心、呕吐两组比较差异无统计学意义。结论:八宝丹胶囊对肝癌患者TACE术后并发症,如肝功能损伤、术后发热、术后腹病等不良反应有一定的治疗效果。     

120例原发性肝癌肝动脉化疗栓塞术疗效观察

我院自1990年12月～2 0 0 3年5月对12 0例原发性肝癌患者行肝动脉化疗栓塞术(TACE)介入治疗,现报道如下。资料与方法一、临床资料选择12 0例经B超、CT或肝细胞活检确诊的原发性肝癌患者,男94例,女2 6例,年龄17～78岁,平均49.3岁。肝功能按Child Pugh分级,A级78例,B级2 4例,C级18例。HBsAg阳性97例,甲胎蛋白(AFP) >2 0 0 0 μg/L 14例,>40 0 μg/L 66例,持续低水平阳性2 1例,阴性19例。肿瘤为块状型65例,结节型3 7例,弥漫型18例,肿瘤为2 .5cm×3 .0cm～12 .5cm×16.8cm。合并门脉癌栓13例,均无远处器官转移。按1997年全国肝癌会议拟…     

120例原发性肝癌的肝动脉化疗栓塞术疗效观察

目的 观察中晚期原发性肝癌经导管肝动脉化疗栓塞术(TACE)治疗的疗效。方法自1990-2003年共有120例中晚期肝癌患者，接受TACE介入治疗，评估和随访治疗前后的疗效。结果经过治疗，79．2％(95／120)的患者临床症状缓解；88．3％(55／120)肿块缩小；78．2％(79／101)AFP明显下降；生存期延长，1、2、3年生存率分别为80．8％(87／120)、48．3％(58／120)和1130％(36／120)。结论TACE治疗是中晚期肝癌的有效手段，使不能手术切除的肝癌成为适应手术治疗，延长了患者的生命，提高了生活质量。     

肝动脉化疗栓塞术治疗原发性肝癌后的临床疗效调查

目的评价肝动脉化疗栓塞术(TACE)治疗原发性肝癌后的临床疗效。方法选取安徽省立医院2000年～2005年经肝动脉化疗栓塞术治疗的原发性肝癌患者168例,采用自身前后对照的方法,通过观察手术前后各项生化指标和血常规的变化,评价TACE的治疗效果。结果经统计学配对t检验分析,可观察到手术后诸项生化指标及血常规得到显著改善,总胆红素明显下降,总蛋白、白蛋白、球蛋白、白球比明显改善,总胆固醇(Ach)及极低密度脂蛋白(VLDL)均明显上升(P<0.05)。结论原发性肝癌患者经TACE治疗后,各项生化指标和血常规得到明显改善,肝细胞功能恢复,治疗效果明显。     

经肝动脉化疗栓塞治疗原发性肝癌56例

2005年2月-2006年2月,我院采用经导管肝动脉化疗栓塞术（TACE）治疗原发性肝癌56例,取得满意疗效。现报告如下。     

肝动脉插管化疗栓塞对肝癌患者常规肝功能的影响

肝动脉插管化疗或／和栓塞（以下简称插管治疗）目前已成为原发性及继发性肝癌中晚期治疗的一种常用方法［１～３］。我院自１９９２年２月至１９９７年１２月对７７例肝癌病人进行插管治疗，现将该疗法对肝功能的影响分析如下。材料与方法一、病例：共７７例，其中原发性...     

原发性肝癌切除术前后的肝动脉化疗栓塞

我国原发性肝癌的治疗已取得显著的进展，肝癌切除术是根治性治疗的最有效手段，也是肝癌患者获得长期生存的最主要途径。然而切除率低和复发率高仍是制约肝癌手术治疗的关键。近年来，以外科治疗为中心与各种非手术治疗方法优化组合的综合治疗日益发展，成为进一步提高肝癌疗效的新途径。肝动脉化疗栓塞（ＴＡＣＥ）在肝癌的综合治疗中具有举足轻重的作用。 人体肝脏接受肝动脉和门静脉双重血供，原发性肝癌的血供９０％以上来自肝动脉。肝动脉阻断后，肝癌血流减少９０％～９２％，肿瘤发生严重缺血坏死而缩小，但正常肝组织血流量仅减少…     

肝动脉化疗栓塞术治疗大肝癌105例报告

对105例大肝癌以肝动脉化疗栓塞术（Hepatic arteial chemoembolization,HAE)治疗，化疗栓塞剂用阿霉素、5Fu加碘油。以寿命表法统计半年、1年、2年、3年生存率为52．4％，27．5％，14．7％，12．2％。其中以导管栓塞组65例和手术中栓塞组40例比较，生存率无统计学差异。肝动脉化疗栓塞术是值得推荐作为首选的姑息性治疗肝癌的方法。     

射频消融与肝动脉栓塞化疗对肝癌疗效的临床分析

目的评价射频消融(RFA)与肝动脉栓塞化疗(TACE)对肝癌的疗效和副反应。方法对65例肝癌患者,随机分成RFA治疗组30例及TACE治疗组35例,术后观察病人的主要临床症状、AFP及肝功能变化、B超和CT检查结果。结果 RFA治疗组,肿块直径5cm者的完全消融(complete ablation,CA)率为86.96%(20/23),5cm者为20.59%(7/34),其中10cm的均为不完全消融或部分消融;射频后大多数患者症状明显改善;副反应包括术中疼痛、恶心和术后出现发烧、转氨酶升高等。TACE治疗组:肿块的碘油沉积大部分低于50%,且复发率较高,常见副反应有发热、骨髓抑制、消化道反应。结论 RFA、TACE在治疗肝癌上是安全、有效的方法,但应慎重进行。     

Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: Propensity score analysis

AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.     

Comparison of hepatic resection and transarterial chemoembolization for solitary hepatocellular carcinoma

AIM: To compare the outcomes of hepatic resection and transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging system.METHODS: A consecutive sample of 540 patients with solitary HCC who underwent liver resection (n = 312) or TACE (n = 128) were included in the present study. Baseline characteristics, tumor characteristics, and post-operative complications were compared between the two groups. The Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were identified using the Cox proportional hazards model (univariate and multivariate analyses).RESULTS: The TACE and liver resection groups had similar baseline demographic and clinicopathological characteristics. The TACE group showed a significantly lower rate of major complications than the liver resection group (3.9% vs 17.4%, P < 0.001). Univariate and multivariate analyses indicated that TACE did not contribute to poor overall survival compared with liver resection; however, a solitary tumor diameter of greater than 6 cm should be considered a risk factor for poor overall survival (HR = 1.328, 95%CI: 1.002-1.783, P = 0.048). The liver resection and TACE groups had comparable overall survival rates at 1 year, 3 years, and 5 years (86.2%, 62.8%, and 44.0% vs 88.3%, 59.8%, and 40.6%, respectively, P = 0.419). In cases with tumor diameters equal to or less than 6 cm, the liver resection group showed a survival benefit compared with the TACE group at 1 year, 3 years, and 5 years (P = 0.030). The 1-, 3-, and 5-year overall survival rates of HCC cases with tumor diameters of more than 6 cm were similar among the liver resection and TACE groups (P = 0.467).CONCLUSION: A tumor diameter of 6 cm should be the cutoff for deciding between liver resection and TACE.     

经肝动脉化疗栓塞后联合索拉非尼治疗肝癌患者临床观察

目的探讨索拉非尼联合经肝动脉化疗栓塞术（TACE）治疗肝癌患者的效果。方法选取142例肝癌患者,其中57例接受TACE治疗,47例接受索拉非尼治疗,38例接受索拉非尼联合TACE治疗。在治疗后12 w,评估治疗效果、总生存期（OS）和疾病进展时间（TTP）。结果联合治疗组有效率为26.32%,显著高于TACE组的17.54%或索拉非尼组的19.15%（P<0.05）;联合治疗组疾病控制率为71.05%,显著高于TACE组的57.89%或索拉非尼组的53.19%（P<0.01）;联合治疗组患者OS为8.6 m,显著高于索拉非尼组的6.2 m或TACE组的7.3 m（P<0.05）;联合治疗组TTP为6.7 m,显著高于索拉非尼组的5.1m或TACE组的 5.6 m（P<0.01）。结论索拉非尼联合TACE治疗肝癌患者具有较好的临床效果。     

A prediction model for liver abscess developing after transarterial chemoembolization in patients with hepatocellular carcinoma

BackgroundLiver abscess is a rare but potentially fatal complication of transarterial chemoembolization. Other than for biliary abnormalities, risk factors for liver abscess formation after transarterial chemoembolization have rarely been discussed.AimsTo identify other risk factors of liver abscess after transarterial chemoembolization in patients with hepatocellular carcinoma.MethodsData for 5299 patients with hepatocellular carcinoma who underwent transarterial chemoembolization from July 1999 to December 2009 were retrospectively reviewed. 72 patients who experienced liver abscess after transarterial chemoembolization were enrolled as a case group, which was compared with a randomly selected control group (n = 1009) of patients who did not develop liver abscess after transarterial chemoembolization.ResultsPneumobilia, type 2 biliary abnormality, type 1 biliary abnormality, diabetes mellitus, tumour number (≥3), tumour size (≥3 cm), and tumour necrosis on the pre-transarterial chemoembolization computed tomography, and gelfoam embolization and vessel injury during transarterial chemoembolization were all significant predisposing factors for liver abscess after transarterial chemoembolization. A prediction model for postembolization liver abscess was developed from these risk factors.ConclusionThe group of patients with risk scores greater than 71 showed a significantly increased risk of liver abscess after transarterial chemoembolization. These high-risk patients should be monitored carefully after transarterial chemoembolization.     

Chemotherapy for transarterial chemoembolization in patients with unresectable hepatocellular carcinoma

AIM: To compare the efficacy of different chemotherapeutic agents during conventional transarterial chemoembolization (cTACE) in the treatment of unresectable hepatocellular carcinoma (HCC).METHODS: A retrospective review was undertaken of patients with unresectable HCC undergoing cTACE from May 2003 to November 2011. A total of 107 patients were treated with at least one cTACE session. Irinotecan (CPT-11) was used as a chemotherapeutic agent in 24 patients, gemcitabine (GEM) in 24 and doxorubicin in 59.RESULTS: The time to progression and overall survival rates were significantly superior in patients treated with CPT-11 compared with the GEM or doxorubicin treated groups (11.4, 8.2, 9.5 mo, P = 0.02 and 21.7, 12.7, 14.5 mo, P = 0.004, respectively). Subgroup analysis showed that for intermediate-stage HCC, CPT-11 resulted in a significantly longer time to progression and overall survival compared with the GEM or doxorubicin treated groups (P = 0.022; P = 0.003, respectively). There were no significant differences in adverse events among the three groups (P > 0.05).CONCLUSION: For patients treated with cTACE, the chemotherapeutic agent CPT-11 was significantly associated with improved overall survival and delayed tumor progression compared with GEM or doxorubicin. There were no significant differences in clinical adverse events between the three agents. CPT-11 thus appears to be a promising agent when combined with cTACE for the treatment of HCC.     

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

AIM:To investigate the efficacy and safety of transarterial chemoembolization(TACE)-based multimodal treatment in patients with large hepatocellular carcinoma(HCC).METHODS:A total of 146 consecutive patients were included in the analysis,and their medical records and radiological data were reviewed retrospectively.RESULTS:In total,119 patients received TACE-based multi-modal treatments,and the remaining 27 received conservative management.Overall survival(P<0.001)and objective tumor response(P=0.003)were significantly better in the treatment group than in the conservative group.After subgroup analysis,survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group(P=0.002)but also in the surgical treatment group compared with the loco-regional treatment-only group(P<0.001).Multivariate analysis identified tumor stage(P<0.001)and tumor type(P=0.009)as two independent pre-treatment factors for survival.After adjusting for significant pre-treatment prognostic factors,objective response(P<0.001),surgical treatment(P=0.009),and multi-modal treatment(P=0.002)were identified as independent post-treatment prognostic factors.CONCLUSION:TACE-based multi-modal treatments were safe and more beneficial than conservative management.Salvage surgery after successful downstaging resultedin long-term survival in patients with large,unresectable HCC.     

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation

AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC)<5 cm in diameter eligible for radiofrequency ablation (RFA). METHODS: The treatment-related mortality, morbidity, long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated. RESULTS: Of the 748 patients treated with TACE between January 1990 and December 2002,114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high a-fetoprotein level (AFP) and the size of the largest tumor >3 cm in diameter were adverse prognostic factors in multivariate analysis. CONCLUSION: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.     

Analysis of aggressiveness factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization

AIM To investigate novel predictors of survival in hepatocellular carcinoma(HCC) patients following transarterial chemoembolization(TACE).METHODS One hundred sixty seven patients with un-resectable HCC were retrospectively analyzed to identify factors that might contribute to their HCC biology and aggressiveness. We correlated routine laboratory results(total bilirubin, AST, ALKP, GGTP, albumin etc.) to maximum tumor diameter, number of tumor nodules, portal vein thrombosis and blood alpha-fetoprotein levels. These 4 parameters were previously combined to form an aggressiveness index(AgI). We used The Wilcoxon ranksum(Mann-Whitney), to test the correlation between the AgI categories and liver function parameters. The Cox proportional hazards model was applied to evaluate the categories of AgI associated with overall survival. RESULTS The AgI was strongly correlated with survival in this novel patient population. Three year survival probability for AgI or 4 was 42.4% vs 61.8%; P 0.0863 respectively. Several factors independently correlated with AgI using univariate multiple logistic regression of AgI with 8 laboratory parameters. Lower albumin levels had an OR of 2.56(95%CI: 1.120-5.863 P 0.026), elevated Alkaline phosphatase and gamma glutamyl transpeptidase(GGTP) had ORs of 1.01(95%CI: 1.003-1.026, P 0.017) and 0.99(95%CI: 0.99-1.00, P 0.053) respectively. In a Cox proportional hazard model combining mortality for AgI score and liver function parameters, only GGTP levels and the AgI were independently associated with survival. An AgI 4 had HR for mortality of 2.18(95%CI: 1.108-4.310, P 0.024). GGTP's single unit change had a HR for mortality of 1.003(95%CI: 1.001-1.006, P 0.016). These were considered in the final multivariate model with the total cohort. An AgI 4 had a HR for mortality of 2.26(95%CI: 1.184-4.327, P 0.016). GGTP had a HR of 1.003(95%CI: 1.001-1.004, P 0.001).CONCLUSION Our study validates the AgI in a new population with un-resectable HCC patients undergoing TACE. The analysis establishes a correlation between GGTP and the AgI.     

Re-evaluation of lipiodolized transarterial chemoembolization therapy for intrahepatic recurrence of hepatocellular carcinoma after curative liver resection

Background/Purpose

While lipiodolized transarterial chemoembolization (lip-TACE) is effective for treating unresectable hepatocellular carcinoma (HCC), its effect for treating recurrent HCC after curative liver resection needs to be clarified.

Methods

Of 163 patients who had undergone curative liver resection between 1992 and December 2003, 65 patients (39.8%) had recurrent HCC in the liver without extrahepatic recurrence and were indicated for lip-TACE. The overall survival rate after lip-TACE was calculated, and its correlation with factors such as the histology of the primary HCC and background noncancerous tissue were analyzed.

Results

The overall survival rates after lip-TACE after the detection of the first recurrent HCC were 82.6%, 44.5%, and 24.8% at 1, 3, and 5 years, respectively. The factors affecting patient survival after lip-TACE were microscopic portal venous involvement of HCC at liver resection, grade of inflammation in the noncancerous liver parenchyma, and recurrence within 1 year after the initial liver resection. Multivariate analysis showed that the period between the resection and first recurrence had the highest hazard ratio.

Conclusions

Lip-TACE is a reasonable procedure for treating recurrent HCC in selected patients who are not eligible for hepatic re-resection. When HCC recurred within 1 year from the primary liver resection, the effect of lip-TACE on patient survival was limited.

     

Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization

INTRODUCTION Hepatocellular carcinoma (HCC) is a major global health problem involving more than 500 000 new cases a year. Several treatment modalities, such as liver transplantation (LT), surgical resection, radiofrequency ablation (RFA), and percutaneou…