Surgical management of liver metastases from uveal melanoma: 16 years' experience at the Institut Curie

Background

Uveal melanoma is characterised by a high prevalence of liver metastases and a poor prognosis.

Aim

To review the evolving surgical management of this challenging condition at a single institution over a 16-year period.

Patients and Methods

Between January 1991 and June 2007, among 3873 patients with uveal melanoma, 798 patients had liver metastases. We undertook a detailed retrospective review of their clinical records and surgical procedures. The data was evaluated with both uni- and multivariate statistical analysis for predictive survival indicators.

Results

255 patients underwent surgical resection. The median interval between ocular tumour diagnosis and liver surgery was 68 months (range 19–81). Liver surgery was either microscopically complete (R0; n = 76), microscopically incomplete (R1; n = 22) or macroscopically incomplete (R2; n = 157). The median overall postoperative survival was 14 months, but increased to 27 months when R0 resection was possible.With multivariate analysis, four variables were found to independently correlate with prolonged survival: an interval from primary tumour diagnosis to liver metastases >24 months, comprehensiveness of surgical resection (R0), number of metastases resected (≤4) and absence of miliary disease.

Conclusions

Surgical resection, when possible, is able to almost double the survival and appears at present the optimal way of improving the prognosis in metastatic uveal melanoma. Advances in medical treatments will be required to further improve survival.     

Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection

IntroductionPatients with a single small Hepatocellular Carcinoma (HCC) may be definitively treated by Radiofrequency ablation (RFA) with a very low rate of peri-operative morbidity. However, results are still controversial comparing RFA to Liver Resection (LR).MethodsAll consecutive patients treated by RFA or LR for a single untreated small HCC on liver cirrhosis between January 2006-December 2016 were enrolled. Patients were matched 1:1 basing on: age, MELD-score, platelet count, nodule's diameter, HCV status, α-fetoprotein level, and Albumin-Bilirubin score. First analysis compered LR to RFA. Second analysis compared Laparoscopic LR (LLR) to RFA.ResultsOf 484 patients with single small HCC, 91 patients were selected for each group after a 1:1 propensity score matching (PS-M). The 5-years OS was 70% and 60% respectively for LR and RFA group (P = 0.666). The 5-year RFS was 36% and 21% respectively for LR and RFA group (P < 0.001). Patients treated by LR had a significantly longer hospital stay and higher complications rate. Comparing 50 cases of LLR and 50 of RFA, the 5-years OS was 79% and 56% respectively for LLR and RFA group (P = 0.22). The 5-year RFS was 54% and 19% respectively for LR and RFA group (P < 0.001). Post-operative complications were not significantly different.ConclusionsLLR confers similar peri-operative complications rate compared to RFA. LLR should be considered as a first-line approach for the treatment of a single small HCC as it combines the effectiveness of open LR and the safety profile of RFA.     

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Objective:To investigate the application of contrast enhanced ultrasound(CEUS) in planning and guiding for radiofrequency ablation(RFA) for metastatic liver carcinoma(MLC).Methods:One hundred and thirty-five patients with clinically and pathologically diagnosed MLC(from gastrointestinal tumors) were included in the present study,and 104 of them had received CEUS prior to RFA to assess the number,size,shape,infiltration,location and enhancing features of the lesions.Among the 104 patients,21(20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS.The remaining 83 patients with 147 lesions underwent RFA(group A).During the same period,other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast(group B).The patients underwent follow-up enhanced CT at the 1st month,and then every 3-6 months after RFA.The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.Results:In group A,72 of 147 MLC lesions(48.9%) showed increased sizes on CEUS.Among them,48 lesions(66.6%) appeared enlarged in arterial phase,and 24(33.3%) showed enlarged hypoechoic area in parenchymal phase.CEUS showed total 61 additional lesions in 35 patients(42.1%)(ranged from 8 to 15 mm) compared with conventional ultrasound(US),and 42(68.8%) of them were visualized in parenchymal phase only.There were total 208 lesions in group A underwent RFA with CEUS planning,and the tumor necrosis rate was 94.2%(196/208).In this group,local recurrence was found in 16 lesions(7.7%) during 3-42 months’ following up,and new metastases were seen in 30 cases(36.1%).For group B,the tumor necrosis rate was 86.3%(88/102),local recurrence in 17 lesions(16.7%),and new metastases in 13 cases(41.9%).Tumor early necrosis and recurrence rates were significantly different between the two groups(P=0.018,P=0.016,respectively).Conclusion: CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.     

Pilot study of hepatic intraarterial fotemustine chemotherapy for liver metastases from uveal melanoma: a single-center experience with seven patients

Background. Uveal melanoma is characterized by a high frequency of hepatic metastases. For patients with liver metastases, who have a median survival of 5 to 7 months, surgery and systemic conventional chemotherapy have little to offer. Methods. Between February 1995 and July 1999, seven patients with isolated hepatic metastases from uveal melanoma were enrolled into a pilot trial of intraarterial fotemustine therapy. An implantable Port-A-Cath catheter was inserted into the hepatic artery for regional chemotherapy via the gastroduodenal artery. Fotemustine 100 mg/m² was administered intraarterially over a 4-h period. The induction phase consisted of one administration per week for 4 weeks, followed by a 5-week rest period. Maintenance therapy with administration of fotemustine every 3 weeks continued until progression or toxicity. Results. Ten patients were evaluated for the trial. One patient was not eligible because of impaired liver function, and in two patients implantation of the port system was not possible for anatomic reasons. Seven patients received a median of 16 treatment cycles (range, 4–28) and all were evaluable for response. Two patients achieved a partial response (PR), three had stable disease (SD), and tumor progressed in two patients (PD). The median survival time from diagnosis of liver metastasis was 24 months (range, 4 to 50+ months). Two patients survived for more than 2 years and two patients are still alive. The toxicity was low and the treatment could be administered on an outpatient basis. Conclusion. Intraarterial fotemustine treatment of uveal melanoma metastatic to the liver is well tolerated, and in some patients is associated with prolonged survival. Received: May 22, 2000 / Accpted: October 13, 2000     

Assessment of systemic inflammatory response (SIR) in patients undergoing radiofrequency ablation or partial liver resection for liver tumors

Introduction

Local therapies for liver tumors are considered to be safe. However, cryoablation (CA) has been associated with an exaggerated systemic inflammatory response (SIR). Aim of this study was to assess the degree of SIR after radiofrequency ablation (RFA) in comparison with major (MR) or minor (mR) liver resection.

Material and methods

Thirty-nine patients were treated with RFA (n = 11), MR (n = 10) or mR (n = 18). SIR parameters [white blood count (WBC) and C-reactive protein (CRP)], proinflammatory mediators [IL-6, TNF-α and sPLA2], liver damage parameters [AST/ALT] and platelet counts were determined at different time points. The volume of ablated liver was calculated on the first CT after RFA in order to correlate ablated liver volume with liver enzyme release and SIR. All data are expressed as median values with quartiles [25%, 75%].

Results

RFA induced a moderate SIR, as demonstrated by a significant elevation of CRP (77 mg/L vs 3 mg/L), IL-6 (96 pg/ml vs 4 pg/ml) and sPLA2 (41 ng/ml vs 7 ng/ml, p < 0.05).Peak point values of SIR (WBC and CRP at 24 vs 48 h and 48 vs 72 h) and proinflammatory response parameters (24 vs 48 h) occurred earlier after RFA than after mR or MR. Time-to-time comparison revealed even increased levels of CRP (77 mg/L [59, 160]) 24 h after RFA when compared to patients undergoing major or minor resection (50 mg/L [28, 66] and 59 mg/L [24, 91], respectively) and increased levels of IL-6 (67 pg/ml [42, 131]) 4 h after RFA when compared to patients undergoing minor resection (29 pg/ml [20, 55]). Postoperative levels of AST and LDH correlated significantly with the ablated liver volume 1 h after RFA (RC = 0.860 and RC = 0.868, respectively, p < 0.05).

Conclusion

RFA induced a moderate SIR of the same magnitude as in patients undergoing partial liver resection. None of the patients showed signs of an exaggerated SIR, as has been reported after cryoablation.     

Results of liver resection in combination with radiofrequency ablation for hepatic malignancies

Introduction

Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC).

Patients and methods

RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection.

Results

Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1–26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2–18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%.

Conclusion

RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.     

数字减影血管造影在射频切除肝脏恶性肿瘤疗效评价中的作用

目的探讨数字减影血管造影(DSA)在射频切除(radiofrequency ablation,RFA)肝脏恶性肿瘤中的作用.方法通过65例肝脏恶性肿瘤射频切除后DSA检查,观察其在RFA疗效评价中的作用.结果33例显示新生肿瘤血管及肿瘤染色消失,瘤区显缺损状态,注入超薄碘油乳剂无聚集;32例显示新生肿瘤血管及肿瘤染色仍较丰富,中央显缺损区,周边见多处肿瘤血管及肿瘤染色残留,注入超薄碘油乳剂见团状、片状、月亮型或环圆状聚集.结论DSA在RFA中可直接了解新生肿瘤血管及肿瘤染色变化情况,是RFA可靠的疗效评价指标.     

Preoperative staging of liver metastases from uveal melanoma by magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET)

Background

Microscopically complete (R0) resection of metastases from uveal melanoma prolongs median overall survival compared to incomplete surgery. The aim of this study was to compare the sensitivity of dynamic-enhanced magnetic resonance imaging (MRI) with fluorodeoxyglucose-positron emission tomography (FDG-PET) in the preoperative diagnosis of liver metastases from uveal melanoma.

Patients and methods

Fifteen consecutive patients (mean age: 56 years) underwent FDG-PET and liver MRI. Extrahepatic metastatic disease was excluded by whole body computed tomography and bone scintigraphy. MRI and FDG-PET were performed with a mean of 19 days (range: 1–30) before surgery. Imaging findings were compared with surgical (including intraoperative ultrasonography) and histological findings on a lesion by lesion analysis.

Results

R0 resection was performed in 12 patients. A total of 28 lesions were resected with 27 histologically proven metastases. Nine lesions were smaller than 5 mm, 7 measured 5–10 mm and 11 were larger than 10 mm. Sensitivity and positive predictive value were 67% and 95% for MRI compared to 41% and 100% for FDG-PET. The difference between the two modalities was statistically significant (p = 0.01; McNemar test). In remaining 3 patients, diffuse miliary disease (>10 capsular lesions) was discovered intraoperatively, and was suspected on preoperative MRI in 2 cases. Only one extrahepatic lesion identified by FDG-PET was falsely positive.

Conclusions

In this preliminary study, MRI was superior to FDG-PET for staging of liver metastases from uveal melanoma. Although miliary disease was suggested by MRI in some cases, preoperative confirmation remains imperfect.     

增强CT和超声造影检查在肝癌射频消融中的应用价值

目的:探讨肝癌射频消融(radiofrequency ablation,RFA)手术前后,对比增强计算机体层摄影术(contrastenhanced computed tomography,CECT)和对比增强超声检查(contrast-enhanced ultrasonography,CEUS)在判断肿瘤病灶中的应用价值.方法:对2008年5月-2010年9月接受RFA的90例肝癌患者(原发性肝癌65例,转移性肝癌25例)的临床资料进行回顾性分析.共104个肝内肿瘤病灶在B超或CT引导下行RFA.RFA术前1周及术后1个月行CECT和CEUS,评价CECT和CEUS在术前肿瘤病灶检出及术后疗效评价中的作用.结果:RFA治疗前,CECT共检出93个肝内肿瘤病灶,CEUS共检出96个肝内肿瘤病灶,CECT结合CEUS共检出104个肝内肿瘤病灶.RFA治疗后1个月,CECT显示90个病灶无增强表现,CEUS显示91个病灶无增强表现,CECT结合CEUS显示86个病灶无增强表现:CECT检出5个肝内新发肿瘤病灶,CEUS检出8个肝内新发肿瘤病灶,CECT结合CEUS检出11个肝内新发肿瘤病灶.结论:CECT结合CEUS可提高RFA治疗前肝内肿瘤病灶检出率及RFA治疗后肝内残留肿瘤和新发肿瘤病灶的检出率.     

Results after simultaneous surgery and RFA liver ablation for patients with colorectal carcinoma and synchronous liver metastases

BackgroundApproximately 20% of patients with colorectal cancer present with synchronous liver metastases (sCRLM). These patients can be treated with a “one-step procedure” or staged resection, with or without radiofrequency ablation (RFA). Colorectal surgery in combination with intraoperative RFA leads to concerns regarding postoperative complications and survival. The purpose was to evaluate the one-step procedure with or without RFA in patients with sCRLM.Materials and methodsBetween January 2000 and September 2018, patients with sCRLM were selected in two tertiary referral centers and retrospectively analyzed. Postoperative morbidity and survival were analyzed.ResultsFrom a total of 410 patients presenting with sCRLM, 329 patients underwent a staged resection and 81 a one-step procedure. The 3-year overall survival (OS) was respectively 66% and 69% for one-step procedure and staged resection (P = 0.24). A total of 18 patients underwent RFA during the one step procedure. No significant differences were shown in postoperative complications whether intraoperative RFA was used in patients with sCRLM. In the one-step procedure, the 3-year OS was respectively 43% and 72% wheter patients did or did not receive RFA (P = 0.19).ConclusionOS for patients with sCRLM was similar for both one-step procedure and staged resection. Intraoperative RFA for sCRLM is technically safe.     

Minimally invasive surgery versus percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma: Results from a high-volume liver surgery center in East Asia

Background & aimsThe outcomes of minimally invasive surgery (MIS) vs. percutaneous radiofrequency ablation (RFA) in treating early-stage hepatocellular carcinoma (HCC) remain inconclusive. This study thus aimed to compare the outcomes of both treatments for early-stage HCCs.MethodsThis retrospective study consecutively enrolled patients with newly diagnosed early-stage HCCs treated with MIS or percutaneous RFA between 2011 and 2018. Outcomes were compared between the MIS and RFA groups both before and after 1:1 propensity score matching (PSM).ResultsA total of 119 and 481 patients underwent MIS and percutaneous RFA, respectively. Patients undergoing percutaneous RFA exhibited older age (p = 0.007) and higher rates of Child–Pugh class B (p < 0.001) and multifocal disease (p < 0.001). The median overall survival (OS) was 73.7 months in the MIS group, which was significantly higher than that for the RFA group of 65.1 months (p = 0.003). 50% HCC recurrence after MIS was not reached. The mean recurrence-free survival (RFS) was 49.6 months for the MIS group, which was significantly higher than the RFA group of 41.3 months (p < 0.001). On multivariate analysis, age ≥65 (HR: 1.61; 95% CI: 1.13–2.31, p = 0.009), RFA (HR: 2.21; 95% CI: 1.14–4.29, p = 0.019), and Child–Pugh class B (HR: 2.03; 95% CI: 1.29–3.21, p = 0.002) remained risk factors for OS, and RFA (HR: 2.18; 95% CI: 1.42–3.35; p < 0.001) remained a risk factor for RFS. After PSM, 103 patients were included in each group. No significant difference in OS was identified (p = 0.198), but RFS was higher in the MIS group than the RFA group (p = 0.003). Severe postoperative complications occurred at the same rate (1%) in both groups (p > 0.99).ConclusionAfter PSM, severe postoperative complication and OS rates were found to be comparable between the MIS and RFA groups, but RFS was higher in the MIS group than the RFA group, suggesting that MIS may have better outcomes for patients with early-stage HCC.     

左、右半结肠癌肝转移患者射频消融治疗疗效及生存的对比分析

目的:探讨原发部位分别位于左、右半结肠的结肠癌肝转移患者行超声引导下肝转移瘤射频消融术后的生存差异及预后影响因素分析。方法:回顾性分析2010年1月至2015年12月于我科行射频消融治疗的结肠癌肝转移患者100例,其中左半结肠癌62例,右半结肠癌38例,分析原发部位不同的结肠癌肝转移患者在进行超声引导下射频消融治疗后的生存情况。结果:左半结肠癌肝转移患者射频消融术后1、3、5年总体生存率及中位生存期均高于右半结肠癌肝转移患者（88.71% vs 73.68%、62.90% vs 30.02%、49.72% vs 26.33%、55个月 vs 23个月）,且二者生存曲线差异具有统计学意义（P＜0.05）。经Log-rank检验及COX多因素分析,左、右半结肠癌肝转移患者射频消融治疗术后的生存情况存在差异。此外,原发灶淋巴结转移情况、患者术前CA199水平及原发灶分化程度是患者射频消融治疗术后生存情况的影响因素。结论:左半结肠癌肝转移患者射频消融术后整体生存率明显高于右半结肠癌肝转移患者,左半结肠癌与右半结肠癌肝转移患者在射频消融治疗术后生存状况存在明显差异。     

Microwave ablation for colorectal cancer metastasis to the liver: a single-center retrospective analysis

BackgroundThe purpose of this study is to evaluate the safety and intermediate-term efficacy of percutaneous microwave (MW) ablation for the treatment of colorectal liver metastases (CRLM) at a single institution.MethodsA retrospective review was performed of all CRLM treated with MW ablation from 3/2011 to 7/2020 (102 tumors; 72 procedures; 57 patients). Mean age was 60 years (range, 36–88) and mean tumor size was 1.8 cm (range, 0.5–5.0 cm). The patient population included 19 patients with extra-hepatic disease. Chemotherapy (pre- and/or post-ablation) was given in 98% of patients. Forty-five sessions were preceded by other focal CRLM treatments including resection, ablation, radiation, and radioembolization. Kaplan-Meier curves were used to estimate local tumor progression-free survival (LTPFS), disease-free survival (DFS), and overall survival (OS) and multivariate analysis (Cox Proportional Hazards model) was used to test predictors of OS.ResultsTechnical success (complete ablation) was 100% and median follow-up was 42 months (range, 1–112). There was a 4% major complication rate and an overall complication rate of 8%. Local tumor progression (LTP) rate during the entire study period was 4/98 (4%), in which 2 were retreated with MW ablation for a secondary LTP-rate of 2%. LTP-free survival at 1, 3, and 5 years was 93%, 58%, and 39% and median LTP-free survival was 48 months. OS at 1, 3, and 5 years was 96%, 66%, 47% and median OS was 52 months. There were no statistically significant predictors of OS.ConclusionsMW ablation of hepatic colorectal liver metastases appears safe with excellent local tumor control and prolonged survival compared to historical controls in selected patients. Further comparative studies with other local treatment strategies appear indicated.     

Radiofrequency ablation with four electrodes as a building block for matrix radiofrequency ablation: Ex vivo liver experiments and finite element method modelling. Influence of electric and activation mode on coagulation size and geometry

PurposeRadiofrequency ablation (RFA) is increasingly being used to treat unresectable liver tumors. Complete ablation of the tumor and a safety margin is necessary to prevent local recurrence. With current electrodes, size and shape of the ablation zone are highly variable leading to unsatisfactory local recurrence rates, especially for tumors >3 cm. In order to improve predictability, we recently developed a system with four simple electrodes with complete ablation in between the electrodes. This rather small but reliable ablation zone is considered as a building block for matrix radiofrequency ablation (MRFA). In the current study we explored the influence of the electric mode (monopolar or bipolar) and the activation mode (consecutive, simultaneous or switching) on the size and geometry of the ablation zone.Materials and methodsThe four electrode system was applied in ex vivo bovine liver. The electric and the activation mode were changed one by one, using constant power of 50 W in all experiments. Size and geometry of the ablation zone were measured. Finite element method (FEM) modelling of the experiment was performed.ResultsIn ex vivo liver, a complete and predictable coagulation zone of a 3 × 2 × 2 cm block was obtained most efficiently in the bipolar simultaneous mode due to the combination of the higher heating efficacy of the bipolar mode and the lower impedance by the simultaneous activation of four electrodes, as supported by the FEM simulation.ConclusionsIn ex vivo liver, the four electrode system used in a bipolar simultaneous mode offers the best perspectives as building block for MRFA. These results should be confirmed by in vivo experiments.     

瑞芬太尼复合异丙酚静脉麻醉在肝癌射频消融术中的应用

背景与目的:经皮射频消融是治疗小肝癌的最新有效的微创手术,但手术的麻醉尚未得到重视,一般的局部麻醉或者单次使用镇痛药物均无法获得满意的效果.本研究将瑞芬太尼复合异丙酚应用于经皮射频消融治疗肝癌的麻醉,探讨其临床效果以及安全性.方法:选择射频治疗肝癌患者60例,随机分为瑞芬太尼复合异丙酚(R组)组与芬太尼复合异丙酚(F组)组,每组各30例.R组用微量泵输注瑞芬太尼0.1μg·kg-1·min-1,F组单次静注芬太尼1.5μg·kg-1,两组均以异丙酚微量泵维持麻醉.使用UT 4000型床边监护仪记录术前、手术开始时、手术开始后5 min及患者术后苏醒时的平均动脉压、心率、脉搏氧饱和度及呼吸频率,监测动脉血二氧化碳分压;记录患者苏醒时间;记录术中体动、呼吸暂停、胸肌强直次数.结果:R组患者的清醒时间[(5.0±1.8)min]显著短于F组[(10.7±3.0)min](P＜0.001).异丙酚用量R组[(172.0±37.3)mg]显著少于F组[(330.3±61.2)mg](P＜0.001).术中R组的平均动脉压下降明显低于F组(P＜0.05).术中体动R组(5例)少于F组(12例),呼吸暂停R组(12例)多于F组(6例).两组均未见胸肌强直.结论:肝癌射频消融术中应用微量泵静脉输注瑞芬太尼复合异丙酚麻醉效果确切、安全,但需要加强呼吸循环监护与管理.     

肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

目的 探讨肝细胞癌(HCC)射频消融(RFA)治疗后肿瘤残留的危险因素及预后.方法 回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料,分析可能与RFA后肿瘤残留有关的临床因素以及残留HCC的预后.结果 114例HCC患者经RFA治疗一次后,完全消融90例,肿瘤残留24例.90例肿瘤完全消融患者的中位生存期为40个月,24例肿瘤残留患者的中位生存期为29个月,二者差异无统计学意义(P=0.242).在24例肿瘤残留患者中,经再次治疗后达到无肿瘤残留者11例,其中位生存期为53个月;经再次治疗后仍有残留者13例,其中位生存期为28个月.RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较,差异无统计学意义(P=0.658);与再次治疗后仍有肿瘤残留患者的中位生存期比较,差异有统计学意义(P=0.012).多因素分析表明,肿瘤＞3 cm(P=0.007)和靠近大血管(P=0.042)是HCC经RFA治疗后肿瘤残留的独立危险因素.结论 肿瘤＞3 cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素.对未能达到完全消融的HCC患者,应积极采取进一步治疗措施,争取达到完全根治肿瘤,以改善预后.     

Apoptotic response of uveal melanoma cells upon treatment with chelidonine, sanguinarine and chelerythrine

The benzophenanthridine alkaloids sanguinarine, chelerythrine and chelidonine were reported previously to provoke cell death in a variety of tumor cells suggesting their potential application as anticancer agents. Here we tested their effects on a primary human uveal melanoma cell line, OCM-1. Flow cytometric analysis of annexin V binding/PI exclusion and DNA fragmentation disclosed that all these alkaloids could induce apoptosis in OCM-1 cells. Moreover, necrotic cell death was also observed upon alkaloid treatment. As it was also evidenced by light microscopic inspection of cellular morphology, chelidonine primarily caused apoptosis, while sanguinarine and chelerythrine were effective via a so-termed bimodal cell death (apoptosis and primary necrosis). The relative efficiencies of the two modes depended on the applied dose. This study is the first implication for the possible use of these alkaloids in the therapy of uveal melanomas, for which no really efficient therapeutic regimen is available so far.     

射频消融术和腹腔镜肝切除术治疗复发性肝癌的临床疗效及远期生存情况分析

目的探讨射频消融术(RFA)和腹腔镜肝切除术(LH)治疗复发性肝癌的临床疗效及远期生存情况。方法依据随机数字表法将58例复发性肝癌患者分为LH组(接受LH治疗)和RFA组(接受RFA治疗),每组29例。比较治疗前和治疗后4周两组患者的血清肝功能指标[总胆红素(TBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]和肿瘤标志物[癌胚抗原(CEA)、磷脂酰肌醇蛋白聚糖3(GPC3)、甲胎蛋白(AFP)]水平,比较两组患者术后并发症发生率及3年生存情况。结果治疗前,两组患者的血清TBIL、AST、ALT、CEA、GPC3、AFP水平比较,差异均无统计学意义(P﹥0.05)。治疗后4周,RFA组患者的血清ALT、AST水平均高于LH组,差异均有统计学意义(P﹤0.05)。LH组患者的并发症总发生率为20.69%,高于RFA组的3.45%,差异有统计学意义(P﹤0.05)。两组患者的3年无进展生存情况和总生存情况比较,差异均无统计学意义(P﹥0.05)。结论对于复发性肝癌,LH与RFA治疗具有相似的长期疗效,但RFA治疗的安全性较好。     

动脉化疗栓塞联合消融治疗肝转移瘤疗效分析

目的探讨动脉化疗栓塞与消融治疗联合治疗肝转移瘤的价值。方法选取25例不能外科切除的肝转移瘤患者,先经肝动脉化疗栓塞,然后再根据肿瘤大小、部位选择瘤内无水酒精注射、微波或射频消融治疗,观察联合治疗后生存期、肿瘤局控及CEA值变化。结果联合治疗后所有病例均未出现严重并发症,治疗后CEA值显著下降,平均生存期23.8月。结论化疗栓塞联合肿瘤消融治疗能有效灭活肿瘤组织,延长生存期,而治疗并发症较轻,值得进一步推广应用。