经导管肝动脉化疗栓塞术后原发性肝细胞癌残留状态的增强CT与超声造影比较

背景经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization, TACE)是通过微导管选择性插入至肿瘤主要供血动脉后,栓塞动脉及注入化疗药物使肿瘤发生缺血坏死,从而发挥灭活肿瘤作用.有效的TACE治疗势必引起肿瘤微循环血流灌注状态改变,而超声造影能准确反映肿瘤组织的血流灌注过程,从而实现对TACE疗效的准确评估.目的探讨运用增强CT(contrast-enhanced CT, CECT)、超声造影(contrast-enhanced ultrasound, CEUS)判定TACE后原发性肝细胞癌(hepatocellular carcinoma, HCC)残留状态的临床应用价值.方法 选取2016-09/2019-03期间,在浙江省肿瘤医院行TA C E术治疗的71例患者作为研究对象,共125个病灶.所有患者TACE术后1 mo均行CEUS、CECT检查,以同期数字减影血管造影(digital subtraction angiography,DSA)检查结果作为"金标准",比较CEUS与CECT在评估TACE疗效中的应用价值.结果 DSA发现病灶残留97个,无残留28个;CEUS判定病灶残留的准确度、灵敏度、特异度分别为96.00%、96.91%、92.86%;CECT判定病灶残留的准确度、灵敏度、特异度分别88.00%、87.63%、89.29%; CEUS判定病灶残留的准确度、灵敏度均高于CECT,差异有统计学意义(P0.05).结论 CEUS能显示TACE术后HCC病灶组织的血流灌注状态,在判定病灶残留方面优于CECT,可为临床评估TACE术后疗效提供新的有效手段.     

经导管肝动脉化疗栓塞术治疗肝细胞癌疗效及复发预测

目的 探讨肝细胞癌(HCC)患者经导管肝动脉化疗栓塞术(TACE)前、术后脱γ-羧基凝血酶原(DCP)、甲胎蛋白异质体(AFP-L3)、甲胎蛋白(AFP)的变化及其与预后关系.方法 纳入96例接受TACE作为初始治疗的HCC患者,分别于术前,术后4～5周及术后6～12个月检测血清DCP、AFP-L3、AFP等水平.根据...     

经肝动脉化疗栓塞治疗肝细胞癌：使用不同栓塞剂患者生存期的对比

目的：HCC的经动脉化疗栓塞（TACE）最理想的栓塞剂还没有被确定。这项研究报导了使用明胶海绵粉末和聚乙烯醇（PVA）行TACE术治疗肝细胞癌的结果。[第一段]     

经导管肝动脉栓塞化疗的并发症及其防治

经导管肝动脉栓塞化疗 (TACE)已被公认为有手术切除指征原发性肝癌的首选治疗手段。1 995年 1 0月～ 2 0 0 0年 3月 ,我们对 1 2 6例中晚期肝癌患者进行了 TACE治疗 ,现将该手术并发症及其防治报告如下。1　材料与方法1 .1　临床资料　本组 1 2 6例 ,男 1 0 5例 ,女 2 1例 ,年龄 9～ 73岁 ,平均 49.5岁 ,原发性肝癌1 1例 ,转移性肝癌 1 4例。共行 TACE2 92次 ,平均 2 .3次 /例 ,化疗药物为 5氟尿嘧啶 (5 -FU) 1 0 0 0～ 1 2 5 0 mg,丝裂霉素 (MMC) 8-1 6 mg,顺铂 (DDP) 6 0～ 1 0 0 mg,部分患者使用了阿霉素 (ADM) 40～ 6 0 mg或…     

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。     

经导管动脉化疗栓塞术治疗肝母细胞瘤

1992～2002年我们对9例肝母细胞瘤患者于手术切除前施行了经导管动脉化疗栓塞术(TACE)，现报道如下。     

肝癌患者经导管动脉化疗栓塞术后栓塞后综合征的危险因素分析

目的 研究肝细胞癌(HCC)患者经导管动脉化疗栓塞术(TACE)并发栓塞后综合征(PES)的危险因素。方法 研究对象选取我院2018年10月到2022年2月间接受TACE治疗的HCC患者424例,根据术后有无出现PES将其分为PES组和非PES组,分别264例和160例。统计所有患者性别、年龄等个人资料,以及肿瘤病因、类型等疾病资料和疾病治疗数据,同时单因素和多因素Logistic回归分析HCC患者TACE治疗后PES发生的危险因素。结果 单因素分析结果显示,PES组患者的白蛋白、AFP、ECOG评分、MELD评分、栓塞剂类型、载药种类、微球种类、微球最大直径比例和阿霉素载药剂量均明显高于非PES组(P<0.05)。多因素Logistic回归分析显示,白蛋白、ECOG评分、载药微球、栓塞剂类型(微球+混合)、药载剂量(阿霉素>75mg)均是TACE患者术后PES发生的独立危险因素(P<0.05)。结论 HCC患者TACE术后PES发生受白蛋白、ECOG评分、栓塞剂类型、药载剂量等因素独立影响,加强患者营养支持,以及合理选择栓塞剂类型和控制载药剂量,对早期预防和治疗PE...     

载药微球经动脉化疗栓塞术治疗肝细胞癌的药物选择新进展

［摘要］　肝细胞癌是发病率和死亡率较高的恶性肿瘤类型,如何有效提高肝细胞癌治疗效果是临床亟需解决的重要问题。经动脉化疗栓塞术（TACE）是中期肝细胞癌和不可外科手术的早期肝细胞癌的首选治疗方式。载药微球经动脉化疗栓塞术是临床常见的经动脉化疗栓塞类型。与传统TACE相比,载药微球经动脉化疗栓塞术可有效减少不良反应的发生,但未显著提高生存期限,如何有效提高载药微球经动脉化疗栓塞术的疗效是值得关注的问题。随着靶向及免疫药物在肝细胞癌治疗中的疗效不断明确,突破只能负载水溶性好的化疗药物的局限,探索新的载药性能是载药微球的新选择,也是提高载药微球经动脉化疗栓塞术整体疗效的新方向。     

Biliary phenotype of hepatocellular carcinoma after preoperative transcatheter arterial chemoembolization

Background and Aim: Transcatheter arterial chemoembolization (TACE) is now the mainstay of treatment for non‐curative hepatocellular carcinoma (HCC), and hoped to have chemotherapeutic and ischemic effects; however, the histopathological changes of HCC caused by TACE have not been sufficiently discussed so far. We aimed to assess the morphological and immunohistochemical features of HCC treated with TACE by immunostaining cytokeratin (CK) 7, CK14, CK19 and vimentin, and to correlate these data with observed clinicopathological characteristics. Methods: Eighty cases of surgically resected HCC with preoperative TACE and 146 cases of HCC resected without TACE as a control were analyzed. Results: The incidences of intrahepatic metastasis, poorly differentiated histology, multinucleated giant cells, mitotic figures and cytoplasmic inclusion bodies in the TACE group were significantly higher than those in the non‐TACE group. The TACE group showed reactivity for CK7 in 56.3% (45/80) of patients, CK14 in 12.5% (10/80), CK19 in 23.8% (19/80) and vimentin in 6.3% (5/80) of patients. CK19 expression in the TACE group was significantly higher than in the non‐TACE group (P = 0.0423). There was no correlation between immunoreactivity and the number of times TACE was carried out, but the expression of CK19 and vimentin in the massive necrotic group was higher than that in the mild necrotic group (P = 0.0197, P = 0.0229, respectively). Only TACE was an independent determinant of CK19 expression in all cases by multivariate analysis. Conclusions: These results suggest that preoperative TACE may have an impact on the biliary phenotype of HCC. Some post‐therapeutic HCC patients might develop HCC with a biliary phenotype indicating more aggressive malignancies.     

Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma

Aim:  To evaluate the histopathologic findings in the surgical specimen of hepatocelluar carcinoma after transcatheter arterial chemoembolization (TACE) at the most distal portion of the sub-subsegmental artery of the liver (ultraselective TACE).
Methods:  Histolopathologic findings from nine tumors with a mean diameter of 3.1 cm ± 1.7 from patients who underwent hepatectomy after ultraselective TACE were evaluated, especially with regard to the relationship between peritumoral liver parenchymal necrosis and portal vein visualization during TACE. Portal vein visualization was classified into three grades by a spot digital radiograph obtained just after TACE: 0, no obvious portal vein visualization; 1, visualization of the portal vein adjacent to the tumor; and 2, visualization in the whole embolized area or extending into the surrounding non-embolized areas. Unenhanced computed tomography (CT) was obtained 1 week later and surgical resection was performed 37 ± 6.3 days after ultraselective TACE.
Results:  Portal vein visualization during TACE was classed as grade 1 in 5 tumors and grade 2 in 4. Histopathologically, complete tumor necrosis was observed in 7 tumors (77.8%). In 2 tumors (1 of grade 1, the other grade 2), a small viable portion or viable daughter nodule was seen. Macroscopic parenchymal necrosis adjacent to the tumor was observed in all 4 grade 2 tumors including gas-containing areas on CT obtained 1 week after TACE.
Conclusions:  Ultraselective TACE induces not only complete tumor necrosis but also peritumoral parenchymal necrosis, similar to that after radiofrequency ablation, when the portal veins are markedly visualized during the TACE procedure.     

Multidetector-row computed tomography in the management of hepatocellular carcinoma with transcatheter arterial chemoembolization

With the introduction of spiral computed tomography and the development of novel imaging technology in recent years, multidetector-row computed tomography (MDCT) has increasingly been used for the diagnosis of various lesions, especially hepatocellular carcinoma (HCC), due to its volume acquisitions, short scanning time, and especially its double-phase scanning nature, which takes advantage of the dual blood supply of liver. Multidetector-row computed tomography is used to classify HCC into several types based on the blood supply and the histological characteristics of HCC. The evaluation of HCC by MDCT provides crucial clues for the doctors to adopt correct clinical management strategies such as the selection of the appropriate dose of lipiodol before transcatheter arterial chemoembolization (TACE) and the prediction of the prognosis of HCC after TACE. The MDCT scanning allows doctors to choose the region of interest and to evaluate the blood supply according to the lipiodol uptake in order to decide whether there is recrudescence and whether a repeated therapy should be taken. This review describes MDCT, its biphasic scanning, its evaluation of blood supply in HCC and the subsequent classification of HCC, its therapeutic significance before TACE and the prognostic value after TACE.     

Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization

BACKGROUND AND AIMS: The aim of this study was: (i) to define the characteristics of hepatocellular carcinoma (HCC) associated with recurrences following initial remission by transcatheter arterial chemoembolization (TACE); (ii) to evaluate the patterns of recurrences; and (iii) find a better surveillance method of detecting recurrent HCC. METHODS: Out of 230 consecutive HCC patients who underwent TACE, 77 with initial remission were followed prospectively for at least 12 months. We compared the recurrence rates according to the characteristics of the tumors and analyzed the locations of the recurrent HCC. The diagnostic efficacies of CT scans with serum AFP, angiography and Lipiodol CT scan in detecting recurrent HCC were also evaluated. RESULTS: Recurrent HCC was detected in 40 patients during a median period of 27 months. The recurrence rate of multinodular HCC was higher than the single nodular type. All six patients with portal vein thrombosis recurred. Even though 45% of recurrences were adjacent to original tumors, 63% were separated from them (8% at both). Hepatocellular carcinoma with heterogeneous Lipiodol uptake tended to recur at the site adjacent to the original tumors more frequently than HCC with homogeneous Lipiodol uptake. Only 18 of 40 recurrent HCC were initially detected by serum alpha-fetoprotein (AFP) and CT scans: 19 by angiography and three only by Lipiodol CT scan. CONCLUSION: Our data indicated that HCC of the multinodular type and with portal vein thrombosis recur more frequently following initial remission by TACE. It is also suggested that regular angiography in addition to serum AFP and CT scan may be valuable in detecting recurrent HCC. Other treatment modalities may need to be combined to ablate tumors completely and to therefore reduce recurrences, especially in HCC with heterogeneous Lipiodol uptake.     

Comparative study of cisplatin and epirubicin in transcatheter arterial chemoembolization for hepatocellular carcinoma

Aim: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable hepatocellular carcinoma (HCC). However, it is unclear which chemotherapeutic agent should be selected for TACE. The aim of this study was to compare the efficacy of cisplatin (CDDP) with that of epirubicin (EPI) in TACE for patients with unresectable or relapsed HCC. Methods: We performed a historical cohort study involving 131 patients treated with a first TACE, defined as either an initial treatment for previously untreated HCC or a first treatment for relapsed HCC after curative resections or ablations. Efficacy was estimated as the response rate (RR) and it was adjusted for the confounding factors that were defined in this study. Results: The RR were 62.5% (20/32) for the first TACE with CDDP and 51.5% (51/99) for that with EPI. In the adjusted analysis for a history of hepatectomy, percutaneous treatment combined with TACE and tumor factors, the odds ratio was 1.72 (95% confidence interval [CI] = 0.70–4.48). However, a test for interaction between the number of tumors and the chemotherapeutic agent was statistically significant (P = 0.016). In multiple HCC, the RR were 66.7% (10/17) for CDDP and 39.6% (30/46) for EPI. The odds ratio was 4.11 (95% CI = 1.14–17.2). Conclusion: CDDP may be more effective than EPI in TACE for multiple HCC. A randomized controlled study is needed to clarify the efficacy of CDDP in TACE in patients with multiple HCC.     

Efficacy of platinum analogue for advanced hepatocellular carcinoma unresponsive to transcatheter arterial chemoembolization with epirubicin

Aim:  Hepatocellular carcinoma (HCC) often shows resistance to transcatheter arterial chemoembolization (TACE). Such patients often have a poor prognosis and are unresponsive to other forms of therapy. The aim of this retrospective study was to determine the response to TACE using platinum analogues in patients deemed resistant to TACE using epirubicin.
Methods:  We studied 152 consecutive patients with advanced HCC resistant to TACE using epirubicin. All cases were treated with platinum analogue using transcatheter arterial chemotherapy with or without embolization.
Results:  Computed tomography at 3 months after therapy showed complete response (CR) in 6 patients (4.0%), partial response (PR) in 28 (18%), stable disease (SD) in 35 (23%), and progressive disease (PD) in 83 (55%). The cumulative survival rates for PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization (81.8% at first year, 53.9% at second year, and 33.1% at third year) were significantly higher than those of SD/PD patients (36.6%, 17.5% and 7.4%, respectively) ( P  < 0.001). The 50% survival period was extended almost 1.4 year in PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization.
Conclusion:  Our retrospective study is the first to report the efficacy of platinum analogues for advanced HCC unresponsive to TACE using epirubicin.     

Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma(HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer(BCLC) guidelines. Recently, balloon-occluded TACE(B-TACE) was developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion(LE) accumulation in HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials; it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of BTACE.