不同治疗方法对原发性肝癌疗效的评价

目的 :探讨双介入方法治疗原发性肝癌的应用价值。方法 :选择 1999年 8月～ 2 0 0 1年 10月进行介入治疗的原发性肝癌患者 78例 ,其中 ,单纯行TACE 4 1例 (TACE组 ) ,行TACE和PEI双介入治疗 37例 (双介入组 )。全部病例定期做CT检查和AFP测定 ,观察肿瘤客观疗效。结果 :TACE组肿瘤客观有效率 (CR PR) 35 .3%。AFP下降幅度 5 6 . 1% ,2年生存率 5 0 % ;双介入组客观有效率 6 4 . 5 % ,AFP下降幅度 78 6 % ,2年生存率 6 1 .3%。二组间有显著差异 (P <0. 0 5 )。结论 :双介入方法治疗原发性肝癌疗效肯定 ,优于单纯应用TACE。     

TACE联合调强放疗对不可切除原发性肝癌的疗效研究

目的对不可切除的原发性肝癌经动脉化学栓塞(TACE)联合调强放疗(IMRT)治疗后病人的生存率、局部无进展生存期(LPFS)和不良反应进行分析,并探讨联合治疗的安全性和有效性。方法回顾性分析2013年1月—2015年12月于上海东方肝胆外科医院放疗科接受治疗的98例不可切除的原发性肝癌病人,其中男66例,女32例,年龄34～79岁,平均(57.7±4.5)岁。随机分为单纯TACE治疗组49例,TACE联合IMRT组49例,每6个月复查,随访时间2年。单纯TACE治疗组与联合治疗组首要的观察指标包括肿瘤局部控制率、总生存期(OS)和LPFS。次要的观察指标为不良反应发生率,包括乏力、肝肾功能损伤、骨髓抑制反应及胃肠道反应。2组间数据的比较采用χ~2检验。采用Kaplan-Meier法绘制生存曲线,2组间生存指标比较采用log-rankχ~2检验。结果截至2017年12月底,中位随访时间12个月(1～24个月),共有53例病人死亡(TACE组死亡31例,TACE联合IMRT组死亡22例),45例病人生存。TACE联合IMRT组的治疗总有效率、总生存率和中位生存时间、LPFS均高于单纯TACE治疗组(均P0.05)。联合治疗组不同级别中性粒细胞减少和血小板减少的发生率均高于单纯TACE治疗组(均P0.05),2组间肝肾功能损伤和胃肠道的不良反应发生率差异均无统计学意义(均P0.05)。结论虽然联合治疗组比单纯TACE治疗组的不良反应发生率高,但能够提高不可切除的原发性肝癌病人的生存率,延长中位生存时间和LPFS,TACE联合IMRT可以作为一种可靠而有效的治疗方法。     

氩氦刀联合肝动脉介入治疗原发性肝癌的免疫效应研究

目的通过比较单纯氩氦刀治疗、单纯肝动脉化疗栓塞治疗（TACE）和氩氦刀联合TACE治疗原发性肝癌前、后的甲胎蛋白（AFP）及T淋巴细胞亚群的变化,探讨氩氦刀联合TACE治疗原发性肝癌的临床价值。方法①将99例原发性肝癌患者随机分为3组,氩氦刀治疗组（A组）、TACE组（B组）和联合组（C组）,3组患者性别、年龄、病理比较差异无统计学意义,有可比性。②通过治疗前、后AFP及外周血T淋巴细胞亚群测定评价。结果3组治疗后与治疗前AFP比较差异均有统计学意义（P〈0．05）;C组与A、B组比较差异有统计学意义（P〈0．05）。3组治疗后T淋巴细胞哑群（Th、Ts及Th／Ts）与治疗前比较差异均有统计学意义（P〈0．01）;C组与A、B组比较差异有统计学意义（P〈0．01）。结论从AFP及T淋巴细胞弧群指标分析,氩氦刀联合TACE治疗组AFP下降和T淋巴细胞亚群变化好于其他单纯治疗组。     

Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres

Purpose

To investigate the efficacy of transarterial chemoembolization (TACE) with microspheres (HepaSphere) loaded with doxorubicin in patients with hepatocellular carcinoma (HCC).

Materials and methods

From April to December 2013, 50 patients with HCC were treated by selective TACE using HepaSphere microspheres loaded with doxorubicin. The size of the lesions was from 2 to 9 cm (mean 5.2).

Results

All of the procedures were technically successful, and there were no major complications. At 1-month follow-up, there was complete tumor response in 48%, partial response in 42%, stable disease in 10%, and there were no cases of disease progression. At 3-month follow-up, complete tumor response was observed in 42%, partial response in 38%, stable disease in 16%, and progressive disease in 4%. At 6-month follow-up, there was complete response in 40%, partial response in 36%, stable disease in 10% and progressive disease in 14%.Within the initial 6-month follow-up, TACE with HepaSphere was successfully repeated once in 3 patients, whereas 2 patients underwent the procedure twice.

Conclusion

Chemoembolization using doxorubicin-loaded HepaSphere is a safe and effective treatment of HCC as demonstrated by the low complication rate, and increased tumor response. When complete tumor response is not achieved, additional treatments can be performed without difficulties.     

化疗栓塞联合替拉扎明治疗肝癌的研究进展

【摘要】 肝癌TACE后肿瘤复发率较高,这可能与栓塞后肿瘤缺氧及残存肿瘤细胞缺氧应答有关。替拉扎明是一种靶向缺氧细胞毒性药物,可以增强肿瘤放疗和化疗效果。TACE联合替拉扎明治疗肝癌有望达到协同抗肿瘤作用。本文就TACE治疗肝癌的原理与不足、替拉扎明靶向缺氧细胞毒性治疗机制及现状、TACE联合替拉扎明治疗肝癌的可行性及研究进展进行综述。     

Radiomic advances in the transarterial chemoembolization related therapy for hepatocellular carcinoma

Radiomics is a hot topic in the research on customized oncology treatment,efficacy evaluation, and tumor prognosis prediction. To achieve the goal of mining the heterogeneity information within the tumor tissue, the image features concealed within the tumoral images are turned into quantifiable data features.This article primarily describes the research progress of radiomics and clinicalradiomics combined model in the prediction of efficacy, the choice of treatment modality, and survival in tran...     

Percutaneous radiofrequency ablation combined with previous bronchial arterial chemoembolization and followed by radiation therapy for pulmonary metastasis from hepatocellular carcinoma

A 56-year-old man had a lung metastasis from hepatocellular carcinoma 4.7 cm x 3.4 cm in size located directly adjacent to the pulmonary hilar vessels. The tumor was treated with radiofrequency ablation combined with earlier bronchial arterial chemoembolization and subsequent radiation therapy. A complete remission of the tumor has been observed for 6 months since completion of therapy. Considering that complete treatment of such an intermediate-sized tumor adjacent to the large vessels is usually difficult with radiofrequency ablation alone, this result suggests a possible role for combined therapy for pulmonary neoplasms.     

肝动脉化疗栓塞联合索拉非尼治疗中晚期肝细胞癌的临床疗效观察

目的 探讨经导管肝动脉化疗栓塞(TACE)联合索拉非尼治疗中晚期肝细胞癌的疗效和安全性.方法 回顾性对比分析2008年7月至2010年11月收治的TACE后口服索拉非尼的44例中晚期肝细胞癌患者(联合组),和同期仅行TACE的44例中晚期肝细胞癌患者(介入组)的疗效.疗效判断采用修正后的实体瘤治疗疗效评价标准(mRECIST),观察患者从TACE治疗开始至疾病进展时间(TTP)、总生存期(OS)、不良事件.结果采用Kaplan-Meier法和Log-rank检验进行生存评估.结果 随访至2011年1月,联合组24例患者存活(54.5％),20例(含失访)死亡(45.5％);介入组13例存活(29.5％),31例(含失访)死亡(70.5％);两组均没有完全缓解(CR)病例,联合组部分缓解1例、病灶稳定24例、疾病进展19例,介入组病灶稳定21例、疾病进展23例.疾病控制率(DCR)联合组为56.8％(25/44),介入组为47.7％(21/44),两者差异无统计学意义(x2=0.729,P=0.393).中位OS联合组为21.0[95％可信区间(CI):14.9 ～27.1]个月,介入组为10.0(95％ CI:6.4 ～13.6)个月,两者差异有统计学意义(x2=7.436,P=0.006);中位TTP联合组为11.0(95％ CI:8.7 ～13.3)个月,介入组为6.0(95％ CI:3.9 ～8.1)个月,两者差异也有统计学意义(x2=10.437,P=0.001).联合组不良反应主要是手足皮肤反应、食欲下降、发热,乏力、腹泻等;单纯介入组不良反应主要是发热、食欲下降、恶心呕吐、乏力等.其中手足反应、脱发、腹泻的发生率联合组高于单纯介入组(P值均＜0.05),两组不良反应主要是1～2级,经对症处理后大部分能够缓解.结论 TACE联合索拉非尼治疗中晚期肝细胞癌较单用TACE治疗能够延长患者OS和TTP,但DCR两组无差异.     

肝癌节段性栓塞化疗与常规栓塞化疗的比较研究

目的 比较节段性栓塞化疗与常规栓塞化疗治疗肝癌的临床效果及其对肝的影响。方法 ３８例肝癌行节段性栓塞化疗,６３例行常规栓塞化疗。两组病例在肿瘤大小,部位,数目,临床分期,肿瘤血供,肝功能,是否合并肝硬化,化疗药物剂量及治疗次数等方面无显著性差异。节段组６例,常规组１０例分别于栓后４－８周行手术切除。     

Radiofrequency ablation combined with transarterial chemoembolization for subcapsular hepatocellular carcinoma: A prospective cohort study

Objective

This study evaluated the safety and efficacy of using radiofrequency ablation combined with transarterial chemoembolization to treat hepatocellular carcinoma in a subcapsular location, given the increased risk of complications when using radiofrequency ablation alone.

Materials and methods

From January 2000 to December 2011, 1213 patients with unresectable hepatocellular carcinoma (up to three nodules) were screened. Of these, 132 patients with 132 subcapsular nodules (mean size, 3.0 cm; range, 1.2–5.0 cm) were enrolled in the study. After transarterial chemoembolization, percutaneous radiofrequency ablation was performed under ultrasound or C-arm cone-beam computed tomography guidance, on the same day or within 3 days. Local recurrence and survival curves were obtained using the Kaplan–Meier method.

Results

Technical success of treatment was achieved in 130 patients (98.5%). Major complications, including pleural effusion, secondary peritonitis, and liver abscess, occurred in 3 patients (2.3%); the incidence of complications was associated with the number of needle insertions (1–2 vs. 3–4, P = 0.039, Fisher's exact test). No patients developed permanent sequelae, tumor seeding, or tumor bleeding. The 3-year local recurrence rate was 9.7%. Local recurrence was associated with the pretreatment serum des-gamma-carboxy prothrombin level (≤200 mAU/mL vs. >200 mAU/mL, P = 0.019, log-rank test). The 3-, 5-, and 7-year overall survival rates in treatment-naïve cases (n = 82) were 79.3%, 60.6%, and 50.9%, respectively.

Conclusion

Combination therapy using radiofrequency ablation and transarterial chemoembolization was a safe and useful therapeutic option for patients with subcapsular hepatocellular carcinoma.     

经动脉化疗栓塞联合伽玛刀治疗原发性肝癌的疗效评价

目的评估经皮动脉化疗栓塞(TACE)联合伽玛刀治疗原发性肝癌的近期临床疗效。方法 259例原发性肝癌患者,随机分成A、B两组,A组(联合治疗组)135例采用TACE+伽玛刀治疗,B组(对照组)124例采用TACE治疗。完成治疗3个月后复查肿瘤大小,所有病例随访2年。结果 259例患者全部完成治疗,A、B两组总有效率(CR+PR)分别为83.7%、50.8%;6、12、18、24个月的生存率分别为96.2%、85.9%、71.2%、54.1%和82.3%、65.3%、524%、33.1%,差异有统计学意义;不良反应无明显差异。结论 TACE联合伽玛刀治疗原发性肝癌有较好的近期效果,优于单纯介入治疗,远期疗效尚待进一步观察。     

化疗栓塞联合质子放射治疗肝癌合并门脉主干癌栓的临床应用

目的 探讨栓塞化疗联合质子放射治疗肝癌合并门脉主干癌栓的临床效果.方法 46例肝癌合并门静脉癌柃患者,接受介入栓塞化疗与质子联合治疗,将质子放射治疗分程并与介入治疗交替进行.评价其近期疗效、放射反应、随访生存率.结果 有效率91.3%,门脉癌栓消失率45.6%,肝功能恢复良好,AFP水平显著下降;放疗中或放疗后无一例发生明确的急慢性放射性肝损伤或放射性肝病;1、6个月,1、2年生存率分别为100%、89.1%、52.2%、21.4%.中位生存期17.6个月.结论 对于合并门脉癌栓形成的晚期肝癌患者,介入联合质子放射治疗是一种新的安全有效方法.     

膈下肝癌经肝动脉化疗栓塞联合射频消融的临床疗效分析

【摘要】　目的?评估经肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗膈下肝癌的安全性与有效性。方法?选取2014年3月至2018年11月行TACE联合RFA治疗的膈下肝癌患者55例。随访期间评估所有患者术后肿瘤反应及生存率,比较治疗前后血生化、AFP及肝功能指标变化,并总结患者术后并发症的发生情况。结果?在55例肝癌患者共61处膈下病灶中,30处病灶（49.2%）完全缓解（CR）,24处病灶（39.3%）部分缓解（PR）,7处病灶（11.5%）疾病稳定（SD）,无病灶疾病进展（PD）。客观反应率（ORR）为88.5%,疾病控制率（DCR）为100%,所有患者均获益。治疗前后肝功能及血生化指标无明显差异（P＞0.05）,但术后AFP值明显下降,差异具有统计学意义（t?=3.277,P＜0.05）。所有患者在围手术期未出现严重并发症。结论?TACE联合RFA对膈下肝癌疗效显著。在RFA治疗过程中出现的疼痛,通过术前静脉滴注氟比洛芬酯或地佐辛并联合利多卡因局麻,术中加入适量利多卡因与0.9%NaCl溶液1:1稀释液经进水孔对肿瘤病灶进行灌注麻醉,必要时给予吗啡肌注,可显著缓解患者疼痛。     

球囊辅助TACE术治疗肝癌1例

临床资料 患者男,28岁.因“腹胀、腹泻1个月余,血便1d”入院.既往有慢性乙型肝炎病史.入院体检:T 37.1℃,HR 90次/min,R 20次/min,BP 112/66 mmHg.门诊CT提示:①考虑肝左叶原发性肝癌并肝内转移或多中心型肝癌;②腹膜后淋巴结转移,并肝动脉-门静脉瘘;③疑左侧肾上腺转移,建议结合临床;④肝硬化,脾肿大,腹水.入院后予以抑酸、止血、降门脉压等对症支持治疗,并完善胃镜检查.     

经导管肝动脉化疗栓塞术联合微波消融治疗肝癌的精准护理研究

目的：探讨精准护理在经导管肝动脉化疗栓塞术（TACE）联合微波消融（MWA）治疗肝癌患者中的应用效果。 方法：将我院介入血管外科2016年11月至2017年10月收治60例TACE联合MWA治疗的肝癌患者,按前后时间顺序分为对照组（30例）和观察组（30例）,对照组采取常规护理,观察组在对照组的基础上,采用精准护理方法,对比两组患者术后尿储留、恶心呕吐、腰酸背痛、失眠发生率,健康知识知晓率和护理满意率。 结果：观察组患者的术后尿储留、恶心呕吐、腰酸背痛、失眠发生率明显低于对照组（P<0.05）;健康知识知晓率和护理满意率高于对照组（P<0.05）。 结论：精准护理方法运用于TACE联合MWA治疗肝癌患者中,可显著降低术后不良反应的发生,增加介入治疗术后整体舒适度,提高健康知识知晓率和护理满意率。     

动脉化疗栓塞辅助手术切除对肝癌患者长期生存的研究

目的 评价动脉化疗栓塞(transarterial chemoembolization,TACE)对可切除肝癌患者生存期的影响.方法 回顾性分析386例因肝癌行部分肝切除术患者的临床资料.全部病例经术后病理证实.根据是否辅以TACE治疗分为TACE组(230例)和非TACE组(156例).TACE组再根据手术与TACE的先后关系分3个亚组:仅术前行TACE者71例为术前TACE组,仅术后行TACE者86例为术后TACE组,术前术后均行TACE者73例为联合TACE组.为比较TACE对肿瘤坏死的影响,术前未行TACE者242例归为A组(非TACE组+术后TACE组),术前行TACE者144例归为B组(术前TACE组+联合TACE组).应用寿命表计算累积生存率,以Kaplan-Meier生存曲线进行生存分析.采用X2检验比较A、B两组肿瘤的坏死率.结果 B组(18/144)较A组(0/242)有较高的肿瘤完全坏死率(P＜0.01).肿瘤完全坏死患者的累积生存率优于不完全坏死者(P＜0.01).患者1、3、5、10年累积生存率:联合TACE组分别为90.4%(66/73)、72.9%(42/73)、51.9%(22/73)和25.4%(2/73),术前TACE组分别为74.0%(50/71)、46.2%(28/71)、27.3%(5/71)和0(0/71),术后TACE组分别为88.0%(73/86)、59.6%(39/86)、36.7%(11/86)和0(0/86),非TACE组分别为75.8%(110/156)、63.4%(48/156)、31.0%(13/156)和23.9%(10/156).联合TACE组疗效最好,优于非TACE组及单纯术前TACE组和术后TACE组(P值均＜0.05).术前或术后TACE组累积生存率与非TACE组比较差异无统计学意义(P值均＞0.05).结论 术前联合术后TACE辅助手术部分肝切除可提高肝癌患者的累积生存率,仅单一术前或术后TACE对患者的远期生存无显著影响.     

High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: Long-term follow-up and clinical analysis

ObjectiveHigh-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) has been used to treat unresectable HCC, but its long-term effects and major prognostic factors remain to be determined. The purpose of this study was to assess its long-term effects and find major prognostic factors to help us select eligible patients in the future.Methods73 patients with unresectable HCC received follow-up after HIFU + TACE. The variables of sex, age, AFP level, liver function, tumor location, tumor number, tumor size, TNM staging (5th edition), TNM staging (6th edition), portal vein invasion, ultrasonic pathway of HIFU, TACE session and ablation response were evaluated by univariate analysis. Those variables with significant difference were assessed by multivariate analysis.ResultsThe mean follow-up time was 11.7 ± 11.1 months (range, 1–60 months). The median survival time and overall survival rates of 1, 2, 3-year were 12 months, 49.1%, 18.8%, 8.4%, respectively. 45.2% patients achieved complete ablation. At the end of follow-up, 51 patients (69.9%) died from tumor progression (27 patients), liver function failure (18 patients), hemorrhage of upper digestive tract (3 patients) and infection (3 patients). 1 with liver abscess, 2 with serious skin burns and 2 with rib fracture were observed after HIFU. On univariate analysis, age (P = 0.017), tumor size (P = 0.000), tumor number (P = 0.039), the 5th edition of TNM staging (P = 0.023), portal vein invasion (P = 0.02) and ablation response (P = 0.000) had significant difference. On multivariate analysis, ablation response (P = 0.001) and tumor size (P = 0.013) were major prognostic factors.ConclusionHIFU combined with TACE is a safe method with a low rate of severe complications. As major prognostic factors, ablation response and tumor size may help us predict the survival and select eligible patients clinically.     

Single-session combined radiofrequency ablation and transarterial chemoembolization in the treatment of hepatocellular carcinoma

Aim of the study

To evaluate the efficacy of the combined use of both transarterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) in a single session for the treatment of large (≥3?cm in diameter) hepatocellular carcinoma.