39例乳腺癌并肝转移诊治体会

目的：总结乳腺癌并肝转移的临床诊断及治疗特点。方法：回顾性分析2008年1月到2013年8月期间西安交通大学医学院第二附属医院收治的39例乳腺癌并肝转移患者的临床详细资料。结果：本文对39例乳腺癌并肝转移患者进行分析,随访3年余,生存27例,死亡12例,均死于肿瘤进展,中位疾病进展时间（PFS）为25个月,中位随访时间（MSR）为17个月,诊治过程中肿瘤反反复复,呈难治、多药耐药倾向。结论：乳腺癌并肝转移预后差,治疗棘手,关键在于早期发现、早期诊治。对于HER-2阳性患者,赫塞汀靶向治疗是一个有效的治疗选择;对于疗效较好的患者,维持治疗是非常必要的。通过积极综合治疗,可以延长生存期,提高生活质量。     

Diagnostic evaluation and survival analysis of colorectal cancer patients with liver metastases

Clinical features and their prognostic value were evaluated in 83 colorectal cancer patients with liver metastasis. The clinical features analysed included presenting symptoms and signs, liver function tests, extent of liver involvement, associated extrahepatic tumor growth, and physical condition of the patients. Overall median survival time after diagnosis of liver metastases was 8.4 months. Prognostic factors related to survival were symptoms, when referable to liver metastasis, and 5' Nt. Information is supplied to survey what selection of patients should be considered for various treatment options. A predominance of the patients showed bilobar liver involvement (79.6%), extrahepatic tumor growth (49.4%), or had an unresectable primary tumor (30.1%), thus leaving only 6% of the patients with liver metastases for surgical treatment with the intention of cure.     

An analysis of prospective outcome of re-resection for recurrent liver cancer and extrahepatic metastases,a follow-up of 267 cases

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results.     

Regional chemotherapy of colorectal cancer metastatic to the liver

Ninety-three patients with biopsy-proven colorectal cancer metastatic to the liver were treated with hepatic arterial infusion of 5-fluorodeoxyuridine (FUDR). There were 52 men and 41 women (median age, 60 years). Forty-two patients (45%) had failed prior systemic chemotherapy. Catheters were operatively placed and multiple catheters were used if dictated by hepatic arterial anatomy in order to obtain perfusion of the entire liver. The drug was delivered by a totally implanted INFUSAID model 400 pump and patients received cyclic therapy consisting of 2 weeks of 0.3 mg/kg/d FUDR alternating with 2 weeks of saline. Patients with extrahepatic tumor or patients whose hepatic tumor failed to respond to FUDR were given a 30 minute intraarterial infusion of mitomycin C, 15 mg/m2, every 6 to 8 weeks in addition to FUDR. Fifty of the 93 evaluable patients presented with metastatic tumor confined to the liver. Of these 50 patients, 83% demonstrated a significant reduction in tumor size with a median duration of response of 13 months and a median survival of 25 months from diagnosis of liver metastases. Twenty-four of these 50 patients remain alive. Forty-three patients presented with extrahepatic metastases in addition to their liver tumor, and 74% had a response with a median duration of 6 months and a median survival of 14 months. Only six patients of those presenting with extrahepatic tumor remain alive. None of the 93 patients died solely of uncontrolled liver tumor, and only 9 died as a result of uncontrolled liver metastases and disseminated extrahepatic tumor. The duration of survival for both groups was determined by the uncontrolled progression of extrahepatic tumor. In patients with metastatic colorectal cancer involving only the liver, hepatic arterial FUDR alone and with the addition of mitomycin C provided excellent control of hepatic tumor. Survival appeared to be prolonged in this uncontrolled study.     

Curative liver resection for metastatic breast cancer.

AIMS: Hepatic resection is a standard procedure in the treatment of colorectal liver metastases. Liver metastases are frequent in breast cancer, but resectional treatment is rarely possible and few reports have addressed the results of surgical treatment for metastatic breast cancer. The aim of our study was to analyse the outcome of patients with metastatic breast cancer after resection of isolated hepatic secondaries and possibly to identify selection criteria for patients who may benefit from surgery. METHODS: Between 1984 and 1998, 90 patients with a history of breast cancer and suspected liver metastases were referred for surgical evaluation. Fifty-four patients also had extrahepatic disease or metastases from another primary tumour; multiple liver metastases were not amenable to surgical treatment in 20 patients. Five patients were treated by regional chemotherapy via an intra-arterial port catheter; after liver resection two patients were found to have liver metastases from intercurrent colorectal cancer. Thus only nine liver resections for metastatic breast cancer could be performed with curative intent. RESULTS: No patient died post-operatively after liver resection. In the follow-up period, four of the nine patients who were treated with curative intent received systemic chemotherapy. At a median follow-up of 29 months, four patients died from tumour recurrence. Five patients are currently alive. Five-year survival in the resection group was calculated as 51% (Kaplan-Meier estimate). Node-negative primary breast cancer and a long interval between treatment of the primary and liver metastases appeared to be associated with long survival after liver resection. CONCLUSIONS: These observations suggest that careful follow-up and adequate patient selection could offer some patients with isolated liver metastases from breast cancer a chance of long-term survival.     

Hepatic undifferentiated (embryonal) sarcoma and rhabdomyosarcoma in children. Results of therapy

From July 1972 through September 1984, 8 of 44 children diagnosed as having primary malignant hepatic tumors, who were treated at St. Jude Children's Research Hospital, had undifferentiated (embryonal) sarcoma (five patients) or rhabdomyosarcoma (three patients). The natural history and response to multimodal therapy of these rare tumors are described. The pathologic material was reviewed and evidence for the differentiating potential of undifferentiated (embryonal) sarcoma is presented. At diagnosis, disease was restricted to the right lobe of the liver in three patients, was bilobar in four patients, and extended from the left lobe into the diaphragm in one patient. Lung metastases were present in two patients at diagnosis. All three patients with rhabdomyosarcoma had intrahepatic lesions without involvement of the biliary tree. Survival ranged from 6 to 73 months from diagnosis (median, 19.5 months); two patients are surviving disease-free for 55+ and 73+ months, and one patient recently underwent resection of a recurrent pulmonary nodule 22 months from initial diagnosis. Three patients died of progressive intrahepatic and extrahepatic abdominal tumors, and two patients, who died of progressive pulmonary tumor, also had bone or brain metastasis but no recurrence of intra-abdominal tumor. Six patients had objective evidence of response to chemotherapy. The authors suggest an aggressive multimodal approach to the treatment of these rare tumors in children.     

Treatment and outcome of brain metastasis as first site of distant metastasis from breast cancer

Twenty-eight consecutive patients with breast cancer were analyzedwho presented with a single brain metastasis asfirst site of distant metastasis. The response tosurgery with postoperative radiation therapy (RT) (9 patients)and to non-surgical therapy as first-line treatment was100% and 89% respectively with a significant differencein median recurrence-free intervals of 23 months andof 5 months respectively (p=0.033). Retreatmentof a local relapse by surgery (± RT,± chemotherapy) or by non-surgical treatment resulted ina response in 6 of the 7 operatedpatients and in 5 of the 6 non-operatedpatients with a median duration of response of7 months (range 2–20 months) and of 3months (range 2–4 months) respectively. The overall mediansurvival of the 28 patients with a singlebrain metastasis was 16 months (range 2–39 months).The median survival in the primarily operated patientswas 23 months, in the primarily not-operated group10 months, and in the never-operated group 9months. In comparison, the response to non-surgical treatmentin 20 consecutive patients who presented with multiplebrain metastases as first site of distant metastasiswas 55% with a median recurrence free intervalof 4 months. The median survival in thisgroup was 4 months, which was significantly shorterthan survival of patients with single brain metastasis(p=0.0036). These results suggest that breastcancer patients with a single brain metastasis asfirst presentation of relapse constitute a specific subgroupwith a favorable response to treatment and along survival especially if they can be treatedby surgery with postoperative RT.     

Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer

BACKGROUND: The prognosis of patients with liver metastasis from gastric cancer (LMGC) is dismal. The purpose of this study was to review our recent outcomes of hepatectomy for LMGC and to determine the suitable candidates for surgery. STUDY DESIGN: The outcomes of 37 patients with LMGC who underwent hepatectomy between 1990 and 2005 were assessed. No extrahepatic distant metastasis and feasibility of macroscopic curative resection were requisite indications for surgery. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. RESULTS: There was no in-hospital mortality. The median survival time and overall 5-year survival rate after hepatectomy of the patients with LMGC were 31 months and 11%, respectively. Intrahepatic recurrence following hepatectomy was found in 23 patients (62%). Variables independently associated with poor survival were bilobar metastasis (P = 0.002, CI = 1.9-16.3) and a maximum tumor diameter of >or= 4 cm (P = 0.006, CI = 1.4-7.7). The depth of the primary tumor and the timing of metastasis were not associated with survival. CONCLUSIONS: Surgical resection for LMGC may be indicated in patients with unilobar metastasis and/or tumors less than 4 cm in diameter. Synchronous metastasis is not a contraindication for hepatectomy.     

原发性肝癌术后复发和肝外转移灶再切除的疗效分析(附267例随访)

目的 原发性肝癌手术切除后，复发是大多数患者术后的死亡原因。本文旨在评价原发性肝癌术后复发和肝外转移灶再切除的疗效并总结经验。方法 对1960年1月到2000年7月的267例再切除的复发性肝癌患者的临床资料进行回顾性分析，其中205例行再次肝切除，51例行肝外转移癌切除，11例行复发性肝癌和肝外转移癌联合切除，并进行临床病理特征和手术类型和生存率的比较。结果 再次肝切除中，11．2％患者行左外叶切除术，4．4％行半肝切除术或扩大半肝切除术，68．3％行局部根治性切除，17．1％行亚段切除术。复发高峰(64．4％)在1-2年。二次手术后总的1，3，5和10年生存率为81．0％，40．3％，19．4％和9．0%，而三次手术后则为77．5％，29．8％，13．2％和6．61％。中位生存时间为44个月。附外转移癌的再切除也延长了生存期。结论 结果表明局部根治性切除和亚段切除适用于大多数再次肝切除。复发高峰可能与门静脉癌栓及手术因素相关。再手术切除不但适用于肝内复发癌也适用于肝外转移癌。鉴于目前化疗或非手术治疗均不能达到比再切除更满意的效果，因此，再切除是复发性肝癌的首选治疗方法。     

Management of hepatic metastasis of gastrointestinal carcinoid tumors

BACKGROUND: Hepatic resection, radiofrequency ablation, intra-arterial radiation therapy, and chemoembolization are all potential therapies in the treatment of metastatic carcinoid tumors of the liver. The aim of this study was to determine the prognostic factors in the management of hepatic metastases of gastrointestinal carcinoid tumors. METHODS: We reviewed our prospective database of 1084 hepato-pancreatico-biliary patients for patients with the diagnosis of metastatic carcinoid to the liver from 6/1998 to 9/2006. RESULTS: We identified 54 patients, 21 men, 33 women, median age 59 years (range 37-86), median number of tumors 3 (range 1-27), and median size of hepatic metastasis of 4 cm (range 1-13). Hepatic resection was performed in 23 (43%) with 16 (70%) receiving additional hepatic directed therapy. Hepatic resection was found to have a statistically significant improved overall survival (P < 0.05) when compared to nonhepatic resection patients with an actuarial 5 years survival for surgical (75%) compared to nonsurgical (62%). Multivariate analysis demonstrated that the use of tobacco was a significant factor in poor overall outcome (P = 0.005). CONCLUSION: Multimodality therapy in the management of hepatic carcinoid metastasis can be done safely and effectively. We recommend the use of hepatic resection when feasible as this treatment most likely offers the best long-term outcome.     

Transpleurodiaphragmatic cryosurgical ablation for recurrent unresectable colorectal liver metastases

BACKGROUND AND OBJECTIVES: Cryosurgical ablation (CSA) allows the focal destruction of unresectable liver metastases after previous liver resection. The abdominal approach may be difficult for recurrent colorectal cancer metastases located in the upper part of the remaining liver, close to the inferior vena cava (IVC), the hepatic veins, and the diaphragm. A transpleurodiaphragmatic access was assessed for safety and efficacy. METHODS: Between September 1999 and July 2004, 13 patients with recurrent unresectable colorectal liver metastases underwent transpleurodiaphragmatic CSA via limited right thoracotomy. Seventeen lesions were treated; median diameter was 31 mm (range 13-40 mm). One to three cryoprobes were used, depending on the size and location of metastases. RESULTS: There was no operative death; three patients developed minor complications (23%). Median hospital stay was 10 days (8-14 days). After a median follow-up of 26 months (range 8-69 months), 9 patients were alive, and 5 were disease-free. Six patients had liver recurrences outside the cryolesion. Median disease free survival was 12 months with 60% 3-year survival after CSA and 58% 5-year survival after first liver surgery. CONCLUSIONS: Transpleurodiaphragmatic CSA is safe and effective in selected patients with unresectable recurrent liver metastases from colorectal cancer.     

肝脏部分切除术在复发性上皮性卵巢癌肝实质转移治疗中的价值

目的 探讨复发性上皮性卵巢癌肝实质转移患者行肝脏部分切除术的临床价值.方法 回顾性分析39例复发性上皮性卵巢癌肝实质转移患者的临床病理资料.结果 39例患者中,10例进行了肝脏部分切除术,29例仅行挽救性化疗.手术组患者的病变均为单叶,且病灶＜3个,与化疗组比较,差异有统计学意义(P＜0.05),在年龄、初次手术病理类型及病理分级、初次减瘤手术结果、初次治疗后的无瘤生存时间、肝转移瘤大小及肝转移时CA125水平等方面,差异均无统计学意义(P＞0.05).10例手术患者中,单纯行肝脏手术6例,同时行其他部位肿瘤细胞减灭术4例,其中7例减瘤手术满意.3例发生手术并发症,无手术死亡病例.8例肝脏病理切缘为阴性的患者中,局部复发6例,中位复发时间为术后12个月.减瘤手术满意的患者与行挽救性化疗的患者,肝转移后的中位总生存时间分别为26个月和9个月,肝转移后3年累积生存率分别为60.0%和16.8%,两组比较,差异有统计学意义(P＜0.05).结论 对存在肝实质转移的复发性上皮性卵巢癌患者施行包括肝脏部分切除术在内的满意肿瘤细胞减灭术,术后辅以化疗,有可能改善患者的预后.

Abstract：

Objective To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer. Methods A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008was conducted. Results Ten patients underwent partial hepatic resection for metastatic ovarian cancer.All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3 (P ＜0.05).No significant difference existed in patient age,the primary pathology type and tumor grade,the rate of optimal primary cytoreductive surgery,the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy(P ＞0.05).There were 7 patients who achieved optional surgery.The operation complication was 3/10 andthere was no perioperative mortality.There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins.The median recurrence time was 12(5-24) months after the hepatic resection.The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients,respectively(P ＜0.05).Conclusion Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.     

The impact of hepatic resection on metastatic colorectal cancer

Although liver resection is the accepted treatment for patients with metastatic colorectal cancer to the liver, there remains some controversy as to the criteria for patient selection and its impact on the recurrent disease following the operation. One hundred and sixteen patients underwent liver resection for metastaic colorectal carcinoma over the last 23 years at our institution. The actual survival was 50.5% at 5 years, and 38.6% at 10 years, excluding the 30-day operative mortality rate of 1.7%. Positive hepatic lymph nodes, extrahepatic disease, number of tumors (4 or more), and bilobar distribution of the diseases were strongly associated with poor outcome. These prognostic factors were also documented as the major prognostic determinants by 21 consecutive articles we reviewed. Among 52 (45.6%) patients with hepatic recurrence, patients who were acceptable surgical risks and had no extrahepatic diseases or a limited number (one or two) of lung metastasis were candidates for the repeat resection. Consequently, 31 patients underwent repeated hepatic resection. Their survival rate was 53.9% at 3 years and 32.3% at 5 years, with no mortality. This outcome is markedly better than that of untreated patients with an estimated survival of 3 to 24 months. Thus, an aggressive approach to surgical treatment is feasible with low risk and the potentially curative strategy even for recurrent hepatic metastases, providing the opportunity to achieve 5 year survival.     

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

Radiotherapeutic management of brain metastases from breast cancer

We have reviewed the medical records of 28 breast cancer patients with brain metastases who were treated with radiotherapy at our clinic from 1980 through 1994 (4 patients, postoperatively; 24 patients, radiotherapy alone). Radiotherapy was delivered as whole brain irradiation using lateral opposed 10 MV X-rays. Ten patients received an additional boost to a reduced field. One patient was treated with localized stereotactic irradiation alone. The radiation dose for tumors ranged from 32 Gy to 60 Gy (mean, 49 Gy) in 2 or 3 Gy daily fractionated doses. The brain was the first site of metastatic involvement in only two patients. In the 26 evaluable patients, neurologic functional improvement was achieved in 24 patients (92%) with complete response (CR) in 1 2 patients (46%) and partial response (PR) in 1 2 patients (46%). The survival rates from the initial treatment were 39% at 5 years and 16% at 10 years (median survival time, 50 months), and those after treatment of brain metastases were 29% at one year and 18% at 2 years (median survival time, 6 months). Performance status tended to be associated with survival (p=0.10), and the presence of liver metastasis was the most important risk factor concerning survival (p=0.056). Two patients suffered severe chronic complications. One patient developed severe dementia after whole brain irradiation with a total dose of 45 Gy in 3 Gy daily fractionated dose, and another patient developed widespread brain necrosis after combined radiotherapy with intrathecal local infusion of methotrexate. Radiotherapeutic management is useful for breast cancer patients with brain metastasis, and long-term survival may also be possible even if patients have preexisting extracranial metastases, except for hepatic involvement. Radiation-related complications should therefore be avoided in these patients.     

Hepatic resection for synchronous liver metastases of gastric cancer]

Since 1970, we have treated 125 patients with synchronous liver metastases from gastric cancer. We analyzed 4 of these 125 patients who underwent hepatic resection, and studied the indications for hepatic resection. There were 3 H1 patients and 1 H2 patient. Lateral segmentectomy was performed for 2 patients and partial segmentectomy was performed for 2 patients. Hepatic arterial infusion (HAI) chemotherapy followed by surgery was performed for patients, one of whom died of recurrence in the residual liver at 49 months. The other patient has survived without recurrence for 30 months. Two patients without HAI died after 11.3 months and 1.9 months, respectively. The survival time of 3 H1 patients who underwent hepatectomy was 30.2 months, while that of the other H1 patients without hepatectomy was 8.3 months. In conclusion, when local control is obtained during surgery and the liver metastasis is H1 in a patient with synchronous liver metastasis of gastric cancer, aggressive hepatectomy supported by HAI should be performed to improve the prognosis.     

Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma: how many are too many?

BACKGROUND: The number of hepatic metastases for which resection or ablation is appropriate remains controversial. METHODS: A retrospective analysis was performed of prospectively collected data from patients with liver metastases from colorectal carcinoma who underwent hepatic cryotherapy and hepatic arterial chemotherapy (HAC) with or without undergoing resection. Patients routinely had preoperative bone scans, chest computed tomography (CT) scans, and abdominal angio-CT scans. Positron emission tomography scans were unavailable. All patients were followed until June 2002 or until death occurred. Kaplan-Meier and Cox regression methods were used to evaluate the impact of 17 potentially prognostic factors on survival. RESULTS: One hundred seventy-two patients who underwent hepatic cryotherapy and HAC with or without undergoing liver resection for in situ eradication of metastases formed the basis of this report. One patient (0.6%) died postoperatively from myocardial infarction. The morbidity rate was 27.9%. The median survival was 28 months (range, 0-98 months). The factors age < or = 50 years, well-differentiated or moderately differentiated primary tumor, small cryolesions (<3.5 cm), complete eradication of extrahepatic metastases at cryotherapy, and low preoperative carcinoembryonic antigen (CEA) levels were associated independently with a favorable outcome. In addition, a univariate analysis showed that the absence of untreated extrahepatic disease at laparotomy, postoperative CEA normalization, and a large decline in CEA levels were significant statistically. The number of lesions was not prognostic. One hundred forty-six patients (84.9%) who underwent a complete operation had 1-year, 2-year, 3-year, 4-year, and 5-year survival rates of 89%, 65%, 41%, 24%, and 19%, respectively. The median survival of patients with 1 metastasis, 2 metastases, 3 metastases, 4 metastases, 5 metastases, 6 or 7 metastases, and 8-12 metastases were 32 months, 29 months, 30 months, 31 months, 27 months, 37 months, and 21 months, respectively (P=0.7859). Twenty-five patients had 6 or 7 lesions, and their 5-year survival rate was 25%. CONCLUSIONS: When all colorectal hepatic lesions were eradicated, the numbers of hepatic metastases were not prognostic of survival in patients with liver metastases from colorectal carcinoma.     

肝细胞肝癌脑转移临床特性和预后分析

目的：分析肝细胞肝癌（hepatocellular carcinoma,HCC）脑转移的临床特点和预后相关因素。方法：回顾性研究2004—0430—2011-12-01我院在放疗科诊治的32例HCC脑转移患者,其中27例接受脑部肿瘤的放射治疗,随访患者的生存情况。结果：32例患者中,27例患者出现中枢神经系统症状,5例无症状即发现颅脑转移。脑转移到死亡的中位生存期为（4．53±2．12）个月,颅脑HCC后到脑转移的中位时间为14．5个月,1年生存率为15．6％。单因素分析显示,颅脑症状（P=0．008）、RPA（P=0．002）、Child-Pugh肝功能分级（P〈0．01）及肝内病灶控制情况（P=0．040）与生存时间相关;多因素分析则显示,颅脑症状、颅内转移灶数目（P=0．027）和是否接受过脑转移灶放疗（P=0．001）是影响患者预后的主要因素。20例脑转移患者已经出现肺转移,21例患者死于肝内病灶未控,5例患者因脑转移灶未能控制而死亡。结论：HCC脑转移患者生存时间短,大部分患者以伴有颅外转移灶,颅内症状、肝功能分级、颅内病灶个数和是否放疗是预后主要因素。     

复发性肝癌再次肝切除的效果

在392例次肝癌切除中,19例为复发性肝癌作再次肝切除.第1次至第2次肝切除的间隔时间平均为35月.作第2次肝切除的肿瘤平均5cm.切除术的类型有剔出术4例,1肝段切除8例,2肝段切除7例.复发性肝癌再次术后生存5年以上4例,最长14年健在.已知死亡6例,其生存平均11个月,表明再次肝切除可提高复发性肝癌的生存期.     

What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma?

PURPOSE: This study aimed to analyze the effect of each therapeutic modality to clarify the treatment strategy for adrenal metastases from hepatocellular carcinoma (HCC). METHODS: Adrenal metastasis from HCC was observed in 45 patients. Fifteen patients who were determined to have multi-organ metastasis including the adrenal glands were excluded, and the remaining 30 patients were reviewed. RESULTS: The location of adrenal metastasis was right side, left side, and both in 17, 9, and 4 patients, respectively. Treatment for adrenal metastasis consisted of adrenalectomy in 5 patients, non-surgical treatment such as TACE, or chemotherapy and radiotherapy in 19 patients, while 6 patients received no treatment. The median survival duration was 11.05 months in the 30 patients with adrenal metastasis. In the 25 patients with well-controlled intrahepatic lesions, the median survival time of those patients who received adrenalectomy, non-surgical treatment, and no treatment was 21.41, 11.05, and 5.64 months, respectively. The difference in cumulative survival according to mode of treatment of adrenal metastasis in the well-controlled intrahepatic lesion group was statistically significant. CONCLUSION: We envisage increased benefit after adrenalectomy in terms of survival in patients with well controlled intrahepatic lesions at the time of adrenal metastasis and good general medical condition.