Experimental studies of transcatheter portal embolization

The effects of transcatheter portal embolization (TPE) on energy charge (EC) and hepatic blood flow of the rat liver (HBF) were investigated. The antitumor effects on minimal tumor nodules inoculated into the rat liver via the portal vein were evaluated by the alphafetoprotein (AFP) levels and survival period after TPE. The EC of the embolized lobes was significantly decreased after TPE, as compared with the control groups, but was restored 3h later. The HBF of the embolized lobes was reduced 1h after TPE, but was restored in 1 day when TPE was performed by means of temporary embolus. When permanent embolus was used for TPE, decreased HBF persisted for at least seven days. On the other hand, HBF of the non-embolized lobes was not altered in both groups. When TPE was performed after TAE using temporary embolus, the intervals of 14 days were required for normal liver tissue to be preserved. TPE performed 3 days after inoculation of cancer cells into the rat liver caused prolongation of the survival period and decrease in the level of AFP. These results indicate that TPE does not produce marked damage to the liver and has antitumor effects on minimal tumor nodules. TAE followed by TPE may be useful for therapy of unresectable liver tumor.     

Postchemotherapy retroperitoneal residual mass in infantile yolk sac tumor

BACKGROUND: Persistent postchemotherapy retroperitoneal residual mass with normalization of alpha-fetoprotein (AFP) in infantile yolk sac tumor is rare. METHODS/RESULTS: A 38-month-old boy with recurrent yolk sac tumor was treated with cisplatin-based combination chemotherapy. After chemotherapy, the retroperitoneal lymph node metastasis, 7 x 6 cm in size, decreased to 2 x 2 cm. Serum AFP levels returned to normal. The retroperitoneal residual mass was resected and histologically showed complete necrosis without viable cancer cells. CONCLUSION: The patient has remained free of disease for 36 months after operation.     

集束电极射频肝癌原位灭活治疗的临床研究

目的 研究射频（Radio frequency,RF)技术肝癌原位灭活治疗的方法及疗效。方法 在B型超声引导下将中空金属钛多极穿刺针经皮直接穿刺置入癌灶中心,分点一次或多次对癌体进行射频热毁损治疗。射频输出功率由10W每隔1min增加10W,加到90W,治疗时间设定为15min。术后观察患者的甲胎蛋白（a-fetoprotein,AFP) 、B型超声（癌体大小、回声、血流）、计算机X线断层摄影术（computered tomography,CT)图像及病理学变化。结果 本组甲胎蛋白（AFP）高于正常者（153例）射频治疗1周后复查119／153（77．8％）下降为正常;14－28d和经过第2次治疗后144／153（94．1％）下降为正常;B型超声和CT图像上表现为癌灶无增大、缩小和液化,多普勒超声观察癌灶内无血流信号;术后病理学复查示治疗区为坏死组织伴血管血栓形成,142例患者术前伴疼痛,治疗后121／142（85．2％）疼痛消失,21／42（14．8％）疼痛缓解。本组术后出现腹水26／180（14．4％）、一次性黄疸16／180（8．9％）。结论 射频原位灭活是创伤小、安全、有效的肝癌治疗方法。     

经皮经肝选择性门静脉栓塞化疗术在原发性肝癌合并门静脉癌栓治疗中的应用

目的探讨选择性门静脉栓塞化疗对原发性肝癌的治疗效果。方法对38例合并门静脉瘤栓的原发性肝癌患者在行肝动脉栓塞化疗（TAE）基础上,联合应用经皮经肝选择性门静脉栓塞化疗术（SPVE）。33例为块状型,5例为结节型,其中直径大于10cm24例,5～10cm11例,小于5cm3例,肿瘤位于肝右叶29例,肝左叶6例,左右叶3例。血清AFP检测＞400ug／L21例,在200ug／L～400ug／L之间6例,（一）／＜200ug／L11例。门静脉瘤栓位于右支19例,左支者7例,右支＋主干6例,左支＋主干2例,左右支＋主干4例。结果治疗后门静脉瘤栓消失和缩小率为68．4％,肿瘤缩小率为76．3％,AFP转阴14例,4例呈一过性转阴或下降,总有效率为85．7％。9例获二期手术切除,术后病理证实,门静脉癌栓坏死率100％。术后随访,1年,3年存活率分别为73．7％和18．4％,远比单纯TAE治疗组高。结论选择性门静脉栓塞化疗是治疗肝癌合门静脉癌栓的有效方法。     

Real-time quantification of AFP mRNA to assess hematogenous dissemination after transarterial chemoembolization of hepatocellular carcinoma

OBJECTIVE: To determine whether the number of hepatocytes containing AFP mRNA shed into the bloodstream during transarterial chemoembolization (TAE) affects the incidence and pattern of recurrence of hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We developed a Taqman procedure to quantify AFP mRNA prospectively in 52 consecutive patients before and after TAE. Results are expressed in hepatocytes /mL. RESULTS: Thirteen of the patients (24.5%) were positive for AFP mRNA (42 +/- 19 hepatocytes/mL) before TAE and 13 (24.5%) (80 +/- 32 hepatocytes/mL) after TAE; the difference was not significant. The presence of AFP mRNA in the bloodstream before TAE was associated with larger nodules (85.2 +/- 73.8 mm versus 34.8 +/- 26.1 mm; P = 0.006). Six of the patients were excluded from the analysis because they underwent curative surgery or were lost to follow-up. The circulating levels of AFP mRNA released in the 46 remaining patients after TAE did not affect metastasis-free survival. A significant number of extrahepatic metastases were found in patients exhibiting at least 1 AFP mRNA-positive blood sample either before or after TAE. However, the TAE procedure did not increase the risk of extrahepatic recurrences. CONCLUSION: Cells containing AFP mRNA are inconsistently released into the circulation during TAE. The amount of these cells released does not affect the recurrence of HCC.     

A case of renal cell carcinoma producing alpha-fetoprotein

Renal cell carcinoma (RCC) producing alpha-fetoprotein (AFP) is a rare condition with only 11 cases reported in Japan to our knowledge. A 69-year-old man was admitted to our hospital for further examination of an incidental right renal tumor. Laboratory tests showed markedly increased serum level of AFP whereas both HBs antigen and anti-HCV antibody were negative. Computed tomography and magnetic resonance imaging imagings showed a right renal tumor but no tumor in liver, testis or lymph node. We performed right radical nephrectomy. Serum level of AFP declined within the normal range 7 weeks after nephrectomy according to its half-life curve. The tumor specimen was composed mainly of granular cells. Immunohistochemical examination of the tumor cells proved the presence of AFP in the cytoplasm. The possibility of AFP as a tumor marker of renal cell carcinoma in this case was presented.     

Hepatectomy after transcatheter arterial embolization (TAE) for hepatocellular carcinomas

Subjects of this study were 26 patients with hepatocellular carcinoma who underwent hepatectomy after TAE. They did not develop serious complications due to TAE. A suitable interval between TAE and the planned hepatectomy was about one month, based on AFP levels and the recovery of liver functions. Hepatic arteriography after TAE was useful to observe changes of the blood flow into the liver and the carcinoma, as well as to find intrahepatic metastases. It is also necessary for making final decisions on the strategy of the hepatectomy. The effects of TAE greatly depended on patterns of arterial blood feeding. When the tumor was less than 5 cm in diameter, had a capsule, and was fed by a single artery the necrotic rate was high. TAE was effective in intrahepatic metastases 0.5 cm or more in diameter, which were detectable by hepatic arteriography. TAE had little effect on intrahepatic metastases less than 0.5 cm in diameter, on intracapsular or extracapsular invasion, or on tumor embolus. For tumor embolus in the portal vein, since TAE and hepatectomy give poor results, other methods should be considered.     

AFP-producing urothelial carcinoma of the bladder: a case report

We report a case of urothelial carcinoma of the urinary bladder with concurrent alpha-fetoprotein (AFP) elevation. A 60-year-old male was admitted for gross hematuria. Subsequent analyses revealed elevated serum AFP levels (970.20 ng/ml). He had no history of hepatitis, and hepatobiliary disease was not detected on computed tomography or ultrasound. Carcino-embryonic antigen was normal. The patient underwent radical cystectomy and was found to have a high-grade urothelial carcinoma of bladder on pathology. In addition, immunohistochemical staining of the tumor cells showed strong AFP positivity. Postoperatively, serum AFP levels decreased gradually to normal. In summary, urothelial carcinoma of the urinary bladder with AFP elevation is rare, and the mechanism and prognosis require further exploration.     

经肝动脉化疗栓塞-冷循环微波刀序贯治疗老年肝癌患者的疗效分析

目的探讨经肝动脉化疗栓塞-冷循环微波刀序贯治疗（TACE-PPMCT）老年肝癌患者的疗效。方法对44例60岁以上原发肝癌患者（原发灶44个伴16个转移灶）行TACE1周后,在CT引导下行PPMCT,术后1个月行CT增强和DSA造影。观察术中、术后并发症的发生情况,比较治疗前后肿瘤直径的变化、AFP水平变化;术后随访6～18个月。结果除1例患者术中出现窦性心动过缓外,未见其他术中及术后并发症。术后1个月44个原发灶中36个完全坏死（81.82%）,6个不完全坏死（13.64%）,2个部分坏死（4.54%）;16个转移灶中12个完全坏死（75.00%）。术前AFP升高的32例患者中30例术后AFP下降,其中22例降至正常;另2例术后AFP升高。随访6～18个月,生存44例,复发转移8例,其中6例为术后12个月内出现。结论 TACE-PPMCT治疗老年原发性肝癌创伤小、并发症少、安全,疗效可靠。     

A case of chemotherapy induced necrosis of primary mediastinal germ cell tumor

A 17 year old male with mediastinal yolk sac tumor is herein reported. His chief complaint was anterior chest pain. Chest X-ray and chest CT indicated a 8 cm diameter mass in the anterior mediastinum. Laboratory analysis revealed 2,578 ng/ml for AFP and 54% for LDH I. HCG and CEA values were normal. Yolk sac tumor was cytologically suspected on needle aspiration specimen. Combined chemotherapy with CDDP, VP16, and PEP brought the AFP and LDH 1 values down to 10 ng/ml and 27%, respectively. The diameter of the mass decreased to 6 cm. The mass was removed together with the thymus and the right upper lobe of the lung. A post operative histological examination of the mass revealed total necrosis. Nine months after the initiation of the therapy, his AFP level was within normal limits. The patient is doing well.     

Immunological response of regional lymph nodes after cryosurgery in rats

At 7 days after MRMT-1 inoculation at the thigh of 5 week-old female SD rats, the tumor was treated cryosurgically by 2 cycle freezing, contact method at -170 degrees C. Weights of thymus and the spleen, histological findings of lumbar lymph nodes, PHA-induced blastogenesis of lymphocytes obtained from lumbar lymph nodes or peripheral blood, and resistance rate to tumor re-challenge were examined at 1, 3, 6, 10 and 17 week(s) after cryosurgery. Following results were obtained. (1) Weight of the thymus gradually decreased by 3 weeks after cryosurgery, while that of the spleen increased by 1 week, recovering the preoperative level at 7 weeks. (2) Paracortical hyperplasia of lumbar lymph nodes markedly increased at 1 week and sinus histiocytosis increased after 3 weeks, both keeping their high values till 10 weeks, while germinal center hyperplasia showed a high value at 2 weeks, thereafter decreasing gradually. (3) PHA-induced blastogenesis of lumbar lymph nodes significantly increased at 1 week, keeping its high value till 10 weeks. (4) PHA-induced blastogenesis of peripheral lymphocytes showed the lowest value at 3 weeks, then significantly increasing at 6 weeks. (5) Resistance rate to re-challenge showed the lowest value at 3 week, reading the highest level at 10 weeks after cryosurgery. From the above results, it was suggested that anti-tumor immunity induced by cryosurgery was at the lowest level at 3 weeks, and gradually increased starting at 6 weeks. Augmentation of helper T cell and cytotoxic T cell functions at the regional lymph nodes was also suggested to occur from 1 week to 10 weeks after cryosurgery.     

Clinical characteristics of pelvic fracture patients with gluteal necrosis resulting from transcatheter arterial embolization

Background: Transcatheter arterial embolization (TAE) can cause gluteal skin and muscle necrosis. However, the ultimate and typical signs of gluteal necrosis resulting from TAE have not yet thoroughly been investigated. Methods: From January 1995 to December 2003, 165 pelvic fractures were managed with TAE to control retroperitoneal bleeding at our level 1 trauma center. From these, 12 patients suffered gluteal muscle and skin necrosis. We reviewed the medical records of these 12 patients for age, gender, fracture type, embolic sites, computed tomography (CT) findings, serum creatine kinase level, site of skin necrosis, time from injury to skin necrosis, treatment, and outcome. Results: All 12 patients underwent TAE of the bilateral internal iliac arteries with gelatin sponge slurries. One patient suffered from an infection of the gluteal muscle from an open fracture site. Five patients presented with signs of gluteal soft tissue injuries on admission. Of these, four had skin abrasions and three revealed fluid or air collection under the gluteal skin on CT. The remaining six patients showed no evidence of soft tissue injuries on admission, and the lesions appeared between 2 days and 7 days after their admission. In these six patients, low-density areas (LDAs) of gluteal muscle with a clear border on the CT were observed following the appearance of skin lesion. The skin necrosis was located in the center of either or both buttocks, and signs of ischemia were clearly demarcated from the adjacent normal tissue. Four of 12 patients died from sepsis, three of whom suffered from uncontrollable gluteal infections that had been pointed out as LDAs on the CT. Conclusions: In every patient with gluteal necrosis associated with pelvic fracture following TAE, initial traumatic contusion cannot be ruled out as contributing to the development of the necrosis. However, for patients who undergo TAE of the bilateral internal iliac artery and who show clear-border LDAs on CT, skin necrosis centered on the buttock, and the delayed appearance of a skin lesion, careful attention must be given in the event of an arterial obstruction due to TAE.     

经导管栓塞联合射频消融对兔VX2肝肿瘤的干预效果

目的 探讨经导管动脉栓塞术（TAE）联合射频消融（RFA）对兔VX2肝肿瘤的干预效果。方法 将兔VX2肝肿瘤模型分为4组,每组15只。对TACE+RFA组于TACE治疗15 min后行RFA,TAE+RFA组TAE治疗15 min后行RFA,RFA组仅给予RFA,TACE组仅给予TACE。分别于术前1天及术后3、7天检测血清天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）,术后7天检测肿瘤生长率、肿瘤坏死率及Suzuki评分;术后1、3、7天采用免疫组织化学法检测坏死区或凝固区周围肝组织热休克蛋白70（HSP70）表达,计算肝细胞凋亡指数及增殖指数。结果 TACE+RFA组术后3、7天血清ALT、AST水平均高于其他3组（P均<0.05）。术后7天,TACE+RFA组Suzuki评分高于其他3组,TACE+RFA组、TAE+RFA组肿瘤生长率低于RFA组和TACE组、肿瘤坏死率高于RFA组和TACE组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝组织HSP70表达均逐渐升高,TACE+RFA组术后1、3、7天均高于其他3组,术后1、3天TAE+RFA组均高于TACE组和RFA组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝细胞凋亡指数均逐渐降低,TACE+RFA组术后1、3、7天均高于其他3组,TACE组术后1、3天均高于TAE+RFA组、RFA组（P均<0.05）。4组术后3天肝细胞增殖指数均高于术后1、7天,TAE+RFA组术后1、3、7天均高于其他3组,RFA组术后1、3天均高于TACE+RFA组和TACE组（P均<0.05）。结论 TACE+RFA、TAE+RFA抑制兔VX2肝肿瘤生长效果优于单独应用TACE、RFA;TAE+RFA对肝损伤更小,促进肝细胞增殖、抑制其凋亡的效果更好。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融(radiofrequencyablation,RFA)治疗315例肝肿瘤病人的病例资料,探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺,RFA联合肝动脉栓塞(TAE)、选择性门静脉栓塞(SPVE)治疗直径5~13cm的大肝癌,及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5.1%,无一例住院期间死亡。AFP阳性的169例肝癌病人中,RFA后有124例(73.6%)明显降低,其中有95例(56.2%)转阴。半年生存率为89.5%,1年生存率为80.1%,18个月生存率为61.4%,24个月生存率为48.3%,>36个月生存率为35.6%。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期(含大肝癌)的病人,疗效明显,总并发症发生率低。     

Resection of hepatocellular carcinoma after transcatheter arterial embolization. Reevaluation of the advantages and disadvantages of preoperative embolization

Hepatocellular carcinomas (HCCs) were resected in eight patients who had preoperative transcatheter arterial embolization (TAE) and in 25 patients without preoperative TAE. Three patients in the former group had ruptured HCCs before operation. Two of the former group and three of the latter group were found to have recurrences after a follow-up of 1 1/2 years. Although preoperative TAE resulted in significantly increased tumor necrosis, it increased the risk of gangrenous change of the gallbladder, induced adhesion of the hepatoduodenal ligament, and was not effective in reducing operative blood loss or operative time if the vessel selected for TAE was inadequate. Pathologic examination revealed tumor emboli still existing in the intrahepatic veins. Daughter nodules and capsular invasion by tumor cells were not affected by TAE. Transcatheter arterial embolization seems to be effective in controlling bleeding from ruptured HCC prior to staged resection of the tumor.     

B超引导下射频热凝固治疗肝癌

目的：探讨B超引导下射频热凝固（RFA）治疗肝癌的及疗效。方法：B超引导下将多极射频针穿刺入瘤体,采用分区定点使凝固区在三维空间上完全覆盖并超出肿瘤边缘1cm。术后检测AFP,B超或CT或肝穿细胞学检查或肝动脉造影。结果：1月内复醒：AFP20例升高18例降至正常,B超或CT检查9例瘤体增大,8例无变化,其余缩小,6例肝穿1例瘤体边缘有活瘤细胞;8例肝动脉造影1例肝边缘和瘤内不同区域有散在血供3月复查：25例瘤体明显缩小。结论：RFA治疗只有方法得当,能有效灭活肿瘤。     

恩替卡韦联合介入治疗乙型肝炎相关原发性肝癌的临床研究

目的：探讨恩替卡韦联合介入方法治疗乙型肝炎相关原发性肝癌（HBVR-HCC）的临床疗效。 方法：选择2007年2月—2011年2月85例确诊为HBVR-HCC、没有手术治疗适应证的患者,其中44例采用恩替卡韦联合肝动脉段性化疗栓塞（TACE）治疗（观察组）,41例单纯采用TACE治疗（对照组）,分析两组治疗前和治疗后4、12、24、48周HBV-DNA水平、肝功能、AFP水平和Child-Pugh评分,并比较两组的临床疗效、不良反应以及生存状况。 结果：随治疗时间延长,观察组HBV-DNA水平逐渐降低,而对照组逐渐升高,两组差异在治疗后各时间点均有统计学意义（均P<0.05）;两组谷丙转氨酶（ALT）与AFP水平、逐渐降低,但观察组在治疗24周后的降低程度明显优于对照组（均P<0.05）;两组Child-Pugh评分逐渐升高,但观察组在治疗24周后的升高程度低于对照组（P<0.05）。观察组HCC的治疗有效率明显高于对照组,并发症和不良反应均明显低于对照组（均P<0.05）。两组的1年生存率的差异无统计学意义（P>0.05）,但观察组2年生存率和中位生存期优于对照组（均P<0.05）。 结论：TACE对HBV活动存在激发作用,抗病毒联合TACE治疗HBVR-HCC可有效控制HBV,改善患者的肝功能,提高临床疗效,且不增加毒副作用。     

Effect of postoperative chemotherapy on the serum alpha-fetoprotein level in hepatoblastoma

Purpose

It is generally accepted that postoperative chemotherapy does not affect the serum alpha-fetoprotein (AFP) level. The authors report on 3 patients who supposedly showed chemotherapy-related changes in their AFP levels after operation.

Methods

This study included 3 patients with hepatoblastoma (1 case of PRETEXT III and 2 cases of PRETEXT IV).

Results

One patient with PRETEXT III underwent a complete tumor resection, and the postoperative AFP level decreased until it reached the normal range. However, he consistently exhibited a transient, 2- to 3-fold increase in the AFP after each course of chemotherapy for 3 courses. The chemotherapy regimen had to be stopped because of drug-induced encephalopathy, but he has been followed up for 5 years without any evidence of recurrence, and his AFP level has also remained stable and in the normal range. Two patients with PRETEXT IV, who underwent a curative tumor resection, also showed similar chemotherapy-related changes in AFP levels. Both of these cases were observed only after the administration of routine postoperative chemotherapy instead of administering further high-dose chemotherapy. The AFP level remained stable for 17 months and 7 months after the cessation of chemotherapy in 2 cases, respectively.

Conclusions

Regarding the postoperative chemotherapy of hepatoblastoma, we have to pay close attention to both the AFP status during chemotherapy as well as the absolute AFP level.     

甲胎蛋白岩藻糖指数对肝癌复发的预测作用

肝癌是术后复发率较高的癌肿之一，为了探讨血清AFP岩藻糖指数对肝癌复发的预测作用，本文以18例术后AFP未能转阴的肝癌患者的对象，研究手术前后血清AFP岩藻糖指数的型，并结合随访结果进行队分析，结果表明，2例术前AFP及岩灌糖指数均较低，术后两值无明显变化，1年后未见复发；5例术前两值较高，术后两值明显降低，1年后亦无1例复发；11例发后AFP明显降低，甚至达很低水平，但岩藻指数为化不大，其中7．例在半年内复发，1例在9个月复发，提示AFP岩藻糖指数是肝癌的特异性敏感指数。观察肝癌术后AFP岩藻糖指数变化，有助于我们判断肝癌是否得到根治切除或余肝是否存在肝硬变活动，从,而准确地疗效，预测复发。     

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: Report of a case

We herein present a case of resected synchronous solitary liver metastasis from alpha-fetoprotein (AFP)-producing early gastric cancer. A 61-year-old woman, who was diagnosed at a routine medical checkup as having early gastric cancer with a liver tumor, came to our hospital for surgery. Her serum AFP level was high at 910ng/ml. An examination was performed to determine whether the liver tumor was primary hepatocellular carcinoma or metastasis from early gastric cancer. She had no evidence of either a hepatitis B or C virus infection, and her liver function was normal. A biopsy specimen from the gastric cancer predominantly revealed moderately differentiated adenocarcinoma, but a focally trabecular pattern compatible with AFP-producing gastric cancer was also observed. Preoperatively, it was concluded that the liver tumor was metastasis from an AFP-producing early gastric cancer. We thus performed distal gastrectomy and a posterior segmentectomy of the liver. Her serum AFP level decreased to the normal range within 2 weeks after the operation. An immunohistological examination revealed that AFP-positive cells were present in both the gastric cancer and liver tumor. One year after the operation, there was no sign of recurrence.