恩度联合经肝动脉化疗栓塞术治疗中晚期肝癌的疗效观察

目的探讨恩度联合经肝动脉化疗栓塞术治疗中晚期肝癌的临床效果。方法回顾性分析2011年10月至2013年4月间收治的50例中晚期肝癌患者的临床资料。其中,观察组25例,采用恩度联合经肝动脉化疗栓塞术治疗;对照组25例,采用单纯肝动脉化疗栓塞术治疗。结果观察组患者总有效率、1年生存率均明显高于对照组,术后1个月和6个月的肿瘤转移率明显低于对照组,差异有统计学意义(P<0.05);两组患者治疗后甲胎蛋白水平均明显低于治疗前,治疗前后差异有统计学意义(P<0.05)。结论恩度联合经肝动脉化疗栓塞术治疗中晚期肝癌的临床效果良好,值得推广。     

GF方案与FAM方案肝动脉化疗栓塞治疗肝癌的临床观察

目的比较吉西他滨+氟尿嘧啶(GF)方案与氟尿嘧啶+多柔比星+丝裂霉素(FAM)方案行肝动脉化疗栓塞治疗中晚期原发性肝癌的疗效与毒副反应。方法将63例中晚期原发性肝癌患者采用信封抽签法随机分为GF组和FAM组,进行肝动脉化疗栓塞。结果 GF组有效率为43.75%(14/32),治疗后AFP转阴率为81.48%,中位缓解期为6.5个月,中位生存期为14.6个月;FAM组有效率为25.81%(8/31),治疗后AFP转阴率为54.84%,中位缓解期为4个月,中位生存期为9.2个月。GF组有效率、治疗后AFP转阴率、中位缓解期及中位生存期均高于FAM组(P均<0.05)。GF组白细胞减少及血小板减少分别为46.88%(15/32)、34.38%(11/32),FAM组分别为25.81%(8/31)、16.13%(5/31),2组比较差异均有统计学意义(P均<0.05)。结论 GF方案肝动脉化疗栓塞是治疗中晚期肝癌的有效方案,且毒副反应可耐受。     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

目的探讨恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的疗效及安全性.方法选取30例中晚期肝癌患者入组研究,均给予恩度肝动脉灌注联合介入化疗栓塞治疗,同时选取30例中晚期肝癌患者作为对照组,仅行介入化疗栓塞治疗.于1～2个治疗周期后比较RECIST疗效,甲胎蛋白转阴率及生活质量评分,同时比较治疗副作用.结果实验组30例患者中29例可评价疗效.实验组治疗后K氏评分显著升高(80.39±8.37Vs73.93±9.22,P=0.002);恩度治疗组的治疗有效率及甲胎蛋白转阴率显著高于对照组(P=0.021,P=0.046).治疗副作用轻微.结论采用恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌,患者生活质量及近期疗效提升明显,甲胎蛋白转阴率亦有明显改善,而治疗相关副作用不大,值得临床推广及进一步研究.     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

新辅助化疗在老年中晚期口腔鳞状细胞癌治疗中的临床意义

目的：探讨分析新辅助化疗在治疗老年中晚期口腔鳞状细胞癌中的临床效果。方法收集46例老年中晚期口腔鳞状细胞癌行新辅助化疗患者作为研究组,选取同期收治的60例未行新辅助化疗老年中晚期口腔鳞状细胞癌患者作为对照组,统计入组患者新辅助化疗后临床有效率、病理有效率,对比新辅助化疗前后细胞凋亡及增殖指数,肿瘤组织Ki-67、EGFR、p53及RARβ的表达变化,并分析新辅助化疗后手术及生存情况,比较两组生存率差异。结果研究组化疗后临床有效率和病理有效率分别为80.43%和69.57%。化疗后细胞凋亡指数明显高于化疗前,细胞增殖指数低于化疗前,差异均具有统计学意义（P=0.007、0.015）。化疗后Ki-67、EGFR、p53均低于化疗前,RARβ高于化疗前,差异均具有统计学意义（P=0.004、0.027、0.021、0.013）。研究组患者的中位生存期为28个月,新辅助化疗3、4个疗程患者远期生存率高于2个疗程患者,差异有统计学意义（P=0.021、0.017）。3个疗程和4个疗程化疗患者远期生存率比较差异无统计学意义（P=0.117）。对照组患者中位生存期为17个月,两组患者生存率差异具有统计学意义（P=0.015）。结论新辅助化疗可从多方面改善老年中晚期口腔鳞状细胞癌的临床效果,应成为其综合治疗的重要组成部分。     

含雷替曲塞方案经TACE治疗45例中晚期肝癌的临床疗效

摘 要：［目的］ 探讨基于雷替曲塞化疗方案联合肝动脉化疗栓塞术（trans-arterial chemo-embolization,TACE）治疗中晚期原发性肝癌的临床疗效。［方法］ 选择2013年7月至2016年7月介入治疗科治疗的中晚期原发性肝癌患者80例,根据不同的治疗方案,随机分为观察组（45例）和对照组（35例）。对照组予以氟尿嘧啶和奥沙利铂化疗方案加TACE治疗,观察组在上述治疗方案基础上联合雷替曲塞治疗,比较两组患者术后疗效。［结果］ 治疗后6个月,观察组患者术后肿瘤缓解率高于对照组（χ2=7.467,P=0.006）,观察组患者AFP和AST水平均低于对照组（t=6.622、2.338,P＜0.001、0.022）,两组患者其余化验指标无统计学差异。两组患者术后不良反应及并发症发生率无统计学差异。随访3年后,观察组患者中位生存时间为20个月,1年、2年、3年生存率分别为60.00％、42.22％、33.33％,对照组患者中位生存时间为12个月,1年、2年、3年生存率分别为42.86％、20.00％、14.29％。观察组患者术后生存时间显著性高于对照组（χ2=4.981,P=0.026）。［结论］ 基于雷替曲塞方案联合TACE治疗中晚期肝癌可降低患者AFP水平,提高治疗效果,远期疗效方面可延长肝癌患者生存时间,具有一定的临床应用价值。     

高强度聚焦超声联合肝动脉热化疗栓塞治疗原发性肝癌

 目的　观察高强度聚焦超声（HIFU）联合肝动脉热化疗栓塞治疗中晚期肝癌的疗效,并行临床分析。方法　2006年5月至2009年2月49例原发性肝癌患者接受HIFU治疗,其中30例患者行HIFU治疗前曾行肝动脉热化疗栓塞治疗（A组）,19例行单纯的HIFU治疗（B组）。治疗后定期复查甲胎蛋白（AFP）,1个月后复查超声或CT、MRI确定肿瘤是否完全坏死,以后每3个月复查。结果　HIFU联合肝动脉热化疗栓塞后血清AFP呈不同程度的下降,治疗前后差异有统计学意义。HIFU治疗后肿物回声有不同程度增强、CT／MRI呈典型的凝固性坏死表现。其中A组有效率86.6 %,B组有效率23.3 %,差异有统计学意义（P＜0.05）。A组中位生存11.3个月,B组生存4个月;A组6个月、1年生存率分别为80.4 %、42.9 %,B组为13.2 %、0,两组差异有统计学意义（P＜0.01）。结论　HIFU联合肝动脉热化疗栓塞能改善不能手术中晚期肝癌患者的生存,有望成为不能手术切除肝癌的一种有效手段。     

单纯肝动脉化疗栓塞对中晚期肝癌患者疼痛的疗效分析

目的 观察单纯肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）对中晚期肝癌患者疼痛的治疗效果。方法 回顾性分析1 542例符合巴塞罗那肝癌分期系统的中晚期肝癌伴明显上腹部疼痛并随访半年以上患者的临床资料,根据是否采取TACE治疗,将患者分为TACE组（n=935）和对照组（n=607）,分析两组患者一般资料、治疗后6个月的疼痛缓解情况和不良反应发生率。结果 治疗前具有重度和中度疼痛的TACE组患者治疗6个月后疼痛显效率较对照组高（P<0.05）,而治疗前具有轻度疼痛的患者治疗6个月后疼痛显效率两组差异无统计学意义（P>0.05）。TACE组患者治疗后恶心呕吐发生率较对照组低（P<0.05）,但TACE相关性腹痛和骨髓抑制发生率明显增高（P<0.05）。结论 TACE可有效缓解治疗前有中重度疼痛的中晚期肝癌患者治疗后6个月的上腹部疼痛,但急性疼痛和骨髓抑制发生率较高。     

经肝动脉栓塞化疗联合微波刀治疗中晚期肝癌的临床疗效分析

探讨联合应用经肝动脉化疗栓塞联合微波刀治疗中晚期肝癌的临床应用价值。方法:收集经病理、AFP和（或）影像学证实的不能手术切除的中晚期肝癌患者63例,按治疗方法随机分为经肝动脉化疗栓塞治疗组和经肝动脉化疗栓塞联合微波刀治疗组,经肝动脉化疗栓塞治疗组31例,联合治疗组32例。结果:经肝动脉化疗栓塞治疗组与联合治疗组治疗后患者AFP定量平均下降率分别为52.2%（12/23）和80.0%（20/25）,两组间差异有统计学意义（P<0.05）;经肝动脉化疗栓塞治疗组的完全坏死率为12.9%（4/31）;而联合治疗组的完全坏死率为34.4%（11/32）,经统计学分析两组有明显统计学意义。经肝动脉化疗栓塞治疗组在1个疗程治疗结束6个月后复查影像学发现肝癌复发率为32.3%（10/31）;联合治疗组肝癌复发率为9.4%（3/32）,两者间差异有显著意义（P<0.05）。经肝动脉化疗栓塞治疗后患者1年的生存率为64.5%（18/31）,而经联合治疗后患者1年生存率为87.5%（28/32）,两组间差异有统计学意义（P<0.05）。结论:经肝动脉化疗栓塞联合微波消融治疗可显著提高中晚期肝癌患者的生存率,延长患者生存期。      

TACE联合PMCT治疗中晚期肝癌的临床观察

目的:观察TACE联合PMCT治疗中晚期肝癌的治疗效果.方法:61例原发性中晚期肝癌患者随机分为两组,单纯TACE组30例,TACE联合PMCT组31例,所有患者先行肝动脉化疗栓塞术(TACE),TACE联合PMCT组于二周后再施行PMCT手术,治疗三周期后,对疗效进行评价.结果:TACE组的完全坏死率、1年生存率分别为43.3%、63.3%;而联合治疗组分别为83.9%、80.6%.两组间完全坏死率、1年生存率差异均有统计学意义(P＜0.05).结论:原发性中晚期肝癌患者采用TACE+PMCT疗效优于单纯TACE治疗.     

拉米夫定在肝癌合并乙型肝炎术后治疗中的应用

目的 探讨拉米夫定在原发性肝癌合并乙型肝炎治疗中的作用。方法 选取2002年1月至2006年5月我院58例原发性肝癌合并乙型肝炎患者,随机分为两组：对照组27例,行单纯肿瘤切除术;治疗组31例：肿瘤切除术联合拉米夫定治疗。观察比较两组间术后肝功能、乙型肝炎病毒复制相关指标、肝癌术后复发率和生存率。结果 6月后对照组血清天门冬胺酸转胺酶水平明显高于治疗组。术后2、3年,肝功能Child pugh积分治疗组明显小于对照组(7.4±1.7 vs. 8.9±1.8,7. 8±1.5 vs. 10.2±2.2,P<0.05)。治疗组术后6、12月HBV DNA转阴率分别为90.3%、100%,明显高于对照组0%和3.7%(P<0.01),且乙肝e抗原转阴率亦好于对照组。两组术后1、2年复发率和生存率间差异均无统计学意义,但术后3年复发率治疗组明显低于对照组(45.2% vs. 59.3%,P<0.05),而术后3年生存率高于对照组(77.4% vs. 54.8%,P<0.05)。结论 拉米夫定可有效控制原发性肝癌合并乙型肝炎术后体内病毒复制,保护术后肝功能,降低术后复发,改善肝癌患者愈后。     

The impact of hepatitis B virus (HBV) infection on clinical outcomes of patients with diffuse large B‐cell lymphoma

We performed a retrospective study to analyse the characteristics and clinical outcomes of diffuse large B‐cell lymphoma (DLBCL) patients with hepatitis B virus (HBV) infection and compare with those without HBV infection. The occurrence of hepatitis after withdrawal of prophylactic antiviral treatment on completion of chemotherapy was also assessed. The HBsAg‐positive patients were given prophylactic antiviral treatment until 6 months after finishing chemotherapy. A total of 81 patients were recruited with 16 in the HBsAg‐positive group and 65 in the HBsAg‐negative group. The clinical characteristics were similar in both groups of patients. There was no significant difference in complete remission rate between the two groups (63% in HBsAg‐positive group vs. 54% in HBsAg‐negative group, P = 0.59). There was also no statistically significant difference in overall survival between the two groups (P = 0.23). Four of the 16 HBsAg‐positive patients (25%) had hepatitis after cessation of chemotherapy and prophylactic lamivudine. The mean time of onset of hepatitis was 3 months after stopping lamivudine. In conclusion, HBV infection did not appear to affect the prognosis of DLBCL patients given antiviral prophylaxis. It is reasonable to consider prophylactic antiviral therapy to extend to at least one year on completion of chemotherapy.     

Association of HBV DNA replication with antiviral treatment outcomes in the patients with early-stage HBV-related hepatocellular carcinoma undergoing curative resection

Background: It remains unclear what the antiviral therapy affects disease?free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)?related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels. In this study, we analyzed the association of antiviral treatment with DFS and OS based on the stratifi?cation of baseline HBV DNA load in early?stage (stages I and II) HCC patients. Methods: We included 445 patients with early?stage HBV?related HCC who underwent curative resection, and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification. The Kaplan–Meier and Cox regression analyses were performed to determine the association of clinical characteristics with survival. Results: The median follow?up period was 74 months. For all patients, cumulative OS rates in the antiviral group were significantly higher than those in the non?antiviral group (log?rank test, P = 0.023), whereas no significant differencesin DFS rates were observed. High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients. In patients with baseline HBV DNA levels ≥2000 IU/mL, antiviral treatment was significantly associated withprolonged DFS and OS (log?rank test, P or undetectable, antiviral treatment did not show a significant benefit in prolonging DFS and OS. Conclusions: High baseline HBV DNA levels are associated with poor prognosis in the patients with early?stage HCC, and the antiviral treatment could generate survival benefits for the patients. Therefore, antiviral treatment should be given for these patients. However, the effect of antiviral treatment on the patients with low viral load remains unclear, and further investigation is warranted.     

抗病毒治疗对乙型肝炎病毒相关性肝细胞癌患者根治性术后的影响

  目的  评价抗病毒治疗对乙型肝炎病毒(hepatitis B virus,HBV)相关性肝细胞癌(hepatocellular carcinoma,HCC)患者根治性手术预后的影响。  方法  回顾性分析478例HBV-HCC根治性术后患者,分为拉米夫定抗病毒治疗组141例和空白对照组337例,比较两组无瘤生存率、总生存率、复发时再治疗措施选择和死亡原因。经倾向性评分匹配法(propensity score matching,PSM)平衡组间协变量,再次分析以上指标。  结果  经平均28个月随访,治疗组和对照组术后1、3、5年无瘤生存率分别为73.1%、54.7%、44.5%和70.8%、58.2%、52.0%(P=0.778);总生存率分别为92.1%、84.4%、79.1%和86.9%、66.1%、54.5%(P=0.002);PSM后观察到相似结果;匹配后亚组分析显示抗病毒治疗明显提高巴塞罗那肝癌分期(Barcelona Clinical Liver Cancer staging system,BCLC)A/B期患者总生存率(P=0.035),但未能显著提高BCLC-C期患者总生存率(P=0.775);治疗组复发时获得再次根治性、姑息性治疗的例数分别为28例和24例,对照组19例和38例(P=0.031);治疗组死于肿瘤复发进展、肝功能衰竭的例数分别为18例和11例,对照组23例和36例(P=0.041)。  结论  HBV-HCC根治性术后抗病毒治疗虽未能有效提高患者无瘤生存率,但使患者在复发时获得更多根治性治疗的机会并减少肝衰竭发生,明显延长了术后生存时间,尤其对于早、中期患者。      

肝癌射频消融术后联合替吉奥节拍化疗的疗效评价

目的 探讨肝癌患者射频消融术后口服低剂量替吉奥的节拍化疗临床疗效。方法 选择接受射频消融术的肝癌患者,按照术后是否口服替吉奥进行节拍化疗分为RFA+替吉奥组和RFA对照组,回顾性分析两组患者术后18个月内的临床疗效,评价其原发肿瘤控制率和无疾病进展时间。结果 随访观察显示,术后9个月RFA+替吉奥组的肿瘤控制率为93.3%,RFA对照组肿瘤控制率为73.4%,差异有统计学意义(P=0.038);随访18个月内,RFA+替吉奥组无疾病进展时间中位数为16.25个月,RFA对照组无疾病进展时间中位数降低为12.25个月(P＜0.001);1年无疾病进展率在RFA对照组为53.3%,显著低于RFA+替吉奥组83.3%(P=0.012)。两组均无治疗相关性死亡,主要并发症发生率为13.3%。结论 射频消融术后进行替吉奥节拍化疗治疗肝癌可以减缓肿瘤进展,延长肝癌患者的无疾病进展时间。     

长、短疗程口服抗病毒药预防急性髓系白血病患者乙型肝炎病毒再激活的观察研究

背景与目的：乙型肝炎病毒(hepatitis B virus,HBV)再激活是急性髓系白血病(acute myeloid leukemia,AML)合并HBV感染的患者接受诱导和巩固化疗期间严重并发症之一,核苷类抗HBV药物(包括拉米夫定和恩替卡韦等)已成为预防和抢先治疗HBV再激活主要抗病毒药物。该研究观察并探究AML合并HBV感染患者化疗前后长疗程和短疗程口服核苷类抗HBV药物预防病毒再激活的临床疗效和安全性。方法：回顾性分析29例AML合并HBV感染并接受至少4个疗程化疗患者的临床资料。根据患者口服核苷类抗HBV药物预防治疗前HBV表面抗原(hepatitis B surface antigen,HBsAg)含量以及抗HBV药物持续服用时间分为4个亚组,系统分析和比较不同亚组患者HBV再激活情况和药物不良反应。结果：长疗程预防(long course prophylaxis group,LCP)组,即口服抗HBV药物持续至化疗结束后6个月以上,该组患者的HBV再激活率和HBV相关性肝炎发生率分别为5.56%(1/18)和0%(0/18),明显低于短疗程预防(short course prophylaxis group,SCP)组患者(即口服抗HBV药物持续至化疗结束后1个月以内)的45.45%(5/11)和36.36%(4/11),差异有统计学意义(P=0.018和P=0.014),而LCP和SCP组患者的HBV原发耐药率分别为11.11%(2/18)和9.09%(1/11),差异无统计学意义(P>0.05)。进一步亚组分析显示,预防治疗前HBsAg阳性患者(HBsAg大于等于0.05 IU/mL)经长疗程预防,其HBV再激活率和HBV相关性肝炎发生率分别为8.33%(1/12)和0%(0/12),明显低于SCP组,66.67%(4/6)和66.67%(4/6),差异有统计学意义(P=0.022和P=0.005);同时,LCP和SCP组中HBsAg(+)患者的HBV原发耐药率分别为8.33%(1/12)和16.67%(1/6),差异无统计学意义(P>0.05)。此外,LCP组中HBsAg阴性患者(HBsAg小于0.05 IU/mL)的HBV再激活率、肝炎发生率和原发耐药率与SCP组中HBsAg(-)患者比较,差异无统计学意义(P>0.05)。LCP和SCP组患者均未发生3级以上药物毒性反应。结论：长疗程口服核苷类抗HBV药物是降低AML合并HBsAg(+)感染患者化疗后病毒再激活以及病毒相关事件发生率有效而且安全性良好的预防治疗方案。     

Hospital- and community-based screenings for hepatocellular carcinoma in Taiwan

In Taiwan, hepatocellular carcinoma (HCC) has been the leading cause of cancer incidence and mortality in recent decades. The majority of patients have hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The HBV carrier rate and incidence of HCC in children have declined with the implementation of a hepatitis B vaccination program for newborns since 1984. A combination of α-fetoprotein and ultrasonography (US) has been used for surveillance in patients with chronic HBV and HCV infection in intervals of 3-6 and 6-12 months for cirrhosis and chronic liver disease, respectively. A secular survival improvement in HCC patients has been demonstrated. A reasonable screening protocol should include two stages. The first stage is identification of high-risk subjects and the second stage is US screening of high-risk subjects. Community-based HCC screening programs have been conducted for more than two decades in Taiwan. The commonly used first-stage markers are HBsAg and anti-HCV, while the platelet count should be a useful marker in HCV-endemic communities. The benefit of HCC screening was shown by a prolonged overall survival. However, this was limited to the early curable stage in elderly subjects. Prevention and control of HCC have multiple modalities. Identification of a high-risk group for active surveillance, effective antiviral treatment for chronic HBV and HCV infection, and early detection and prompt treatment of HCC should decrease the sequelae of HCC in Taiwan.     

Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma

PURPOSE: To investigate whether three-dimensional conformal radiotherapy (3D-CRT) influences hepatitis B virus (HBV) reactivation and chronic hepatitis B (CHB) exacerbation in patients with HBV-related hepatocellular carcinoma (HCC). METHODS AND MATERIALS: Of the 48 HCC patients with HBV who underwent 3D-CRT to the liver, 16 underwent lamivudine therapy before and during 3D-CRT (Group 1) and 32 did not receive antiviral therapy before 3D-CRT (Group 2). To analyze spontaneous HBV reactivation, we included a control group of 43 HCC patients who did not receive any specific treatment for HCC or CHB. RESULTS: The cumulative rate of radiation-induced liver disease for Groups 1 and 2 was 12.5% (2 of 16) and 21.8% (7 of 32), respectively (p > 0.05). The cumulative rate of HBV reactivation was significantly greater in Group 2 (21.8%, 7 of 32) than in Group 1 (0%, 0/16) or the control group (2.3%, 1 of 43; p < 0.05 each). The cumulative rate of CHB exacerbation, however, did not differ significantly between Groups 2 (12.5%, 4 of 32) and 1 (0%, 0 of 16) or the control group (2.3%, 1 of 43; p > 0.05 each). The CHB exacerbations in the 4 Group 2 patients had radiation-induced liver disease features but were differentiated by serum HBV DNA changes. Two of these patients required antiviral therapy and effectively recovered with lamivudine therapy. CONCLUSIONS: In patients with HBV-related HCC undergoing 3D-CRT, HBV reactivation and consequent CHB exacerbation should be considered in the differential diagnosis of radiation-induced liver disease, and antiviral therapy might be considered for the prevention of liver function deterioration after RT.     

Hepatitis B virus reactivation after radiofrequency ablation or hepatic resection for HBV-related small hepatocellular carcinoma: A retrospective study

Background and purpose

Reactivation of hepatitis B virus (HBV) happens after systemic chemotherapy, transarterial chemoembolization (TACE) or hepatic resection for HBV-related hepatocellular carcinoma (HCC) patients. The incidence and risk factors of HBV reactivation after radiofrequency ablation (RFA) are unclear.

Patients and methods

From August 2006 to August 2011, 218 consecutive patients with HBV-related small HCC treated with RFA (n = 125) or hepatic resection (n = 93) were retrospectively studied. The incidence of HBV reactivation and risk factors were analyzed.

Results

HBV reactivation developed in 20 (9.2%) patients after treatment. The incidence of HBV reactivation was significantly lower in the RFA group (5.6%, 7/125) than the hepatic resection group (14.0%, 13/93, P = 0.034). On univariate and multivariate analyses, no antiviral therapy (OR 11.7; 95% CI 1.52–90.8, P = 0.018) and treatment with RFA/hepatic resection (OR3.36; 95% CI 1.26–8.97, P = 0.016) were significant risk factors of HBV reactivation. On subgroup analysis, the incidence of HBV reactivation was lower in patients who received antiviral therapy than those who did not receive antiviral therapy in both the hepatic resection group (2.9% vs. 20.7%, P = 0.027) and the RFA group (0% vs. 7.6%, P = 0.188), although the difference was not significant in the latter group.

Conclusion

The incidence of HBV reactivation after RFA was relatively low when compared with hepatic resection. Prophylactic antiviral therapy is recommended, especially for patients who are going to receive hepatic resection for HBV-related HCC to decrease the incidence of post-treatment HBV reactivation.     

金龙胶囊对肝癌切除后复发转移影响的初步临床观察

目的:观察金龙胶囊对肝切除术后肝癌肝内转移复发、机体细胞免疫的影响并评估其临床疗效。方法:将肝细胞癌122例随机分成治疗组与常规化疗对照组,观察血清中NK细胞和T细胞亚群的变化;检测血清中的MMP-9和AFP水平;术后1年内,每个月行B超检查1次,每3个月行增强CT1次,观察肿瘤有无复发及临床疗效并对生活质量进行评分。结果:术后肝癌切除联合金龙胶囊治疗组CD4 /CD8 和NK细胞水平高于对照组,P<0.05;治疗组血清AFP与对照组比较差异无统计学意义,但MMP-9水平明显低于对照组,P<0.05;治疗组术后半年影像学检查肿瘤复发率为37.7%(23/61),与对照组60.6%(37/61),比较差异有统计学意义,P<0.05。治疗组平均生存期、中位生存期较对照组明显延长,P=0.001;生活质量评分治疗组明显优于对照组,P<0.05。结论:肝癌切除术后联合金龙胶囊治疗能明显降低MMP-9的水平,有效抑制残肝术后肝内转移的发生;对患者的细胞免疫功能影响小,有利于患者术后免疫功能的及时恢复;同时可提高临床疗效及患者术后生活质量及生存期,对于肝细胞肝癌的预后具有重要的临床价值。