INFLUENCE FACTORS TO RECURRENCE OF HEPATOCELLULAR CARCINOMA AFTER SURGICAL RESECTION

Duetomanyreasons,therecurrenceofhepatocellularcarcinoma(HCC)aftersurgicalresectioniseasilytakenplace.Thefocusofrecurrencecannotbere-resectedforthegreatpartofthepateints.Thetreatmentoftranscatheterarterialchemoembolization(TAE)wasperformedforthesepatients.Howtodecreasetherecurrencerateandincreasesurvivalrateofthesepatientsisoneofimportantproblems.Thecurrentstudywasestablishedtofindtherelationshipwithprimaryhepatocellularcarcinomaandrecurrencetumors,bysurgicalresectionfindings,pathologicalexa…     

肝癌术后复发

Objective:To analyze pest-surgical recurrence of hepatocellular carcinoma (HHC) according to pathologic findings, primary tumor and angiographic features of the recurrent tumor. Methods:In this series, 100 cases of recurrent HCC were analyzed in following aspects: (1) size, tumor nodular numbers, gross and histologic findings of the primary tumor; (2) post-surgical recurrent time; (3) size, tumor nodular numbers, blood supply, staining property, and accumulation of lipiodol oil in the recurrent tumor. Following angiography, arterial chemoembolization was performed. Results:In the primary tumor, single nodules were seen in 80 cases, multiple nodules in 16 cases and multiple fused nodules in 4 cases. All tumors were classified as: trabecular type, 65 eases; compact type, 12; sclerotic type, 2 cases; mixed type, 15 cases and cholangiocareinoma type, 6 cases. 38 cases had incomplete or no capsule. Satellite tumor nodules were grossly identified during operation in 33 cases, but were proven microscopically in 66 cases. Tumor thrombi of portal vein was noted in 18 cases during oeration, but 85 cases in histopathological sections. The recurrent tumors were diagnosed post surgically within 6 months in 67 cases, 6-12 months in 15 cases and after 12 months in 18 cases respectively. On angiography, 67% recurrent tumors was rich in blood supply and with abundant accumulation of lipiodol after embolization. Conclusion:The post-surgical recurrence rate of the HCC patients with massive size, incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus was high. The patients shoud receive angiography in 1-2 months after surgery in order to detect early recurrence and, if confirmed, the patients may be treated by transcatheter arterial chemoembolization     

肝癌术后预防性肝动脉化疗栓塞对延缓复发的意义

[目的]了解预防性肝动脉化疗栓塞术(TACE)在延缓肝癌手术后复发方面的作用.[方法]对823例行根治性切除并经病理证实为肝细胞癌患者进行随访分析.其中126例患者手术后行预防性TACE,将可能影响原发性肝癌术后复发的观察指标包括性别、年龄、术前AFP、有无癌栓、手术切缘、手术前肿瘤是否破裂、肿瘤大小、肿瘤有无子灶、肿瘤包膜情况、手术后有无行预防性TACE等,用Cox模型分析各因素与复发时间之间的关系.所有数据经SAS6.12和SPSS统计软件处理分析.[结果]年龄小、有癌栓、手术前肿瘤有破裂、肿瘤体积大和肿瘤周围有子灶等因素使肝癌手术后复发时间提前,保证较大手术切缘距离和手术后行预防性TACE可延缓肝癌手术后复发.预防性TACE可明显降低肝癌患者术后2年的复发率.[结论]对有早期复发病理学征象的肝癌患者行预防性TACE治疗可能延缓术后肿瘤复发.     

原发性肝癌根治切除后介入治疗对复发防治的疗效评价

目的 探讨原发性肝癌根治切除术后肝动脉介入综合治疗对肝昨发的防治效果。方法 根治术后定期复查肝功能、甲胎蛋白（ＡＦＰ）、Ｂ超、胸片等,于术后２个月按Ｓｅｌｄｉｎｇｅｒ法行肝动脉造影或碘化油ＣＴ检查,根据有无残癌分为两组;无残癌者为预防组,有残癌者为治疗组。预防组术后２个月和５个月分别行预防量的肝动脉化疗栓塞治疗,以观察复发率和生存期,治疗组按常规量行肝动脉化疗栓塞治疗,每２个月得１次以观察生存期。     

肝癌原位肝移植术后肿瘤复发的多层螺旋CT和MRI影像学诊断

目的 探讨肝癌原位肝移植术后肿瘤复发的CT和MRI影像学表现及其诊断价值.方法 回顾性分析161例肝癌肝移植术患者的术后肿瘤复发情况,重点分析肿瘤复发患者的CT和MRI表现、复发部位及复发时间.结果 161例肝癌肝移植术患者术后复发29例,复发率为18.0%.复发者的原发肿瘤分期为Ⅱ期4例,Ⅲ期7例,Ⅳa期8例,Ⅳb期10例.肺部复发21例,呈2～3 cm左右结节状病灶,4例伴有胸膜复发.移植肝复发9例,呈多发结节型4例,弥漫型及巨块型各2例,单发结节型1例,其中2例伴有门静脉、下腔静脉栓形成.淋巴结复发9例,见于肝门区、小网膜区、胰头周围、腹膜后及后纵隔,其中1例伴有淋巴结融合、坏死.骨骼复发4例,呈溶骨性骨质破坏,CT呈不均匀低密度影,MRI呈不均匀长T1、长T2信号影,2例周围伴有软组织肿块.与移植肝、淋巴结、骨骼及其他部位相比,肺部肿瘤复发率最高(P=0.001).Ⅳb期肝癌肝移植术后肿瘤复发的发生率明显高于Ⅱ期～Ⅳa期患者(P=0.001).4例Ⅱ期肝癌肝移植后均在1年后复发,25例Ⅲ～Ⅳb期肝癌均在1年内复发.结论 肝癌肝移植肿瘤复发以肺部及胸膜最多见,移植肝、淋巴结次之.Ⅱ期肝癌肿瘤复发晚于Ⅲ～Ⅳb期肿瘤,Ⅳb期为肝癌肝移植手术的禁忌证.CT和MRI检查在肝癌肝移植诊断中具有重要意义.     

Percutaneous microwave coagulation therapy for hepatocellular carcinoma

We performed percutaneous microwave coagulation therapy (PMCT) for 34 hepatocellular carcinoma (HCC) patients, including 18 primary and 16 recurrent HCC ones. Cumulative 1, 2-, 3- and 4-year survival rates of primary HCC patients were 94, 78, 78% and 62%, respectively, while those of recurrent HCC patients were 100, 79, 62% and 41%, respectively. There were no differences between groups. In both groups, local recurrence was found in about 50% of patients. The mean tumor size (diameter 2.6 +/- 0.6 cm) of patients with local recurrence was relatively larger than that (2.2 +/- 0.6 cm) of patients without local recurrence (p = 0.081). Seventeen of 27 patients with moderately or poorly differentiated HCC had local recurrence, while none of patients with well-differentiated HCC did (p = 0.005). Subsequently, local control failure led some patients to have progressive diseases such as multiple intrahepatic metastasis, tumor thrombi in the portal vein, and distant metastasis. From these findings, PMCT should be performed only for well-differentiated HCC less than 2 cm in diameter. If the patients with moderately or poorly differentiated HCC larger than 2 cm in diameter cannot tolerate hepatic resection because of their poor hepatic functional reserve, PMCT should be performed in combination with other non-surgical treatment modalities.     

肝细胞癌病理学微侵袭的影响因素对放疗靶区确定的潜在价值

目的 通过病理切片观察肝细胞癌镜下外侵特点,提供准确的病灶浸润范围,以指导临床医生确定放疗靶区范围.方法 搜集4年间149例肝细胞癌手术切除的病理标本及其相关临床资料,包括肿瘤最大直径、包膜情况、边界情况、门脉癌栓、TNM临床分期、Edmondson-Steiner分级、血清中AFP值、未梢血血小板计数、肝硬化程度.肿瘤切缘必须>1cm,术前影像学检查及术中探查均未发现原发肿瘤周边子灶.通过常规病理切片在显微镜下确定肝癌微侵袭灶距离.结果 肿瘤微侵袭灶距原发灶距离最远为4mm,范嗣O.5～4.0 mm,平均(1.64±0.09)mm.有微侵袭灶者较无侵袭灶者易出现复发,其复发率分别为44%(35/79)和29%(20/70)(P=0.047).肿瘤最大直径、包膜情况、边界情况、门脉癌栓、TNM临床分期、Edmondson-Steiner分级、血清中AFP值、末梢血血小板计数、肝硬化程度与微侵袭灶有关(P值均<0.05).通过对肿瘤最大直径、肿瘤包膜、门脉癌栓、血清中AFP值、末梢血血小板计数5项简单临床指标评分,O～2分者自包膜外扩2mm即能达到97%的准确性,>2分者准确性仅83%.结论 肝细胞癌的微侵袭灶外侵距离与肿瘤最大直径、肿瘤包膜、门脉癌栓、血清中AFP值、末梢血血小板计数有关,通过5项简单临床指标评分可初步判断外侵范围.     

根据大肝癌的血供特点确定介入治疗的碘油剂量

目的　探讨介入治疗时根据CT显示大肝癌血供的情况 ,确定个体较准确的碘油剂量的可行性。方法　对 10 0例大肝癌 (最大直径 >8cm)行多排螺旋CT 3期薄层扫描 ,根据血供特点分为 4型 :多血供、少血供、混合性血供和明显动静脉瘘。根据肿瘤大小和血供特点确定相应超液化碘油的剂量。经肝动脉行化疗栓塞 (TACE)时随机分为两组 ,第 1组按照术前制定剂量并根据实际情况以充满为止 ;第 2组仅以肿瘤最大直径为标准。观察两组肿瘤内碘油充填情况 ,比较两组符合率及有效率。结果第 1组和第 2组符合率分别为 82 .0 %和 36 .0 % ,有效率分别为 84 .0 %和 4 6 .0 % ,第 1组显著高于第 2组 ,差异具有非常显著性 (P <0 .0 1)。结论　根据CT图像对大肝癌肿瘤血供进行分类 ,确定灌注碘油的剂量 ,并在治疗中进行适当调整 ,可取得较好疗效。     

乳腺叶状肿瘤复发的治疗及预后分析

目的 探讨乳腺叶状肿瘤复发的治疗方法以及预后.方法 回顾分析1972年3月至2006年6月收治的26例乳腺叶状肿瘤复发患者的临床资料.结果 26例患者的中位生存时间为96个月.原发肿瘤≥5 cm者10例,其中6例出现局部复发,4例死亡;<5 cm者16例,其中5例出现局部复发,3例死亡.复发肿瘤≥5 cm者14例,其中5例出现局部复发,3例死亡;<5 cm者12例,其中6例出现局部复发,4例死亡.原发肿瘤和复发肿瘤的大小对肿瘤再次复发(P=0.094,P=0.383)和预后(P=0.142,P=0.486)影响不显著.良性肿瘤组12例患者中,3例出现局部复发,2例死亡;恶性肿瘤组14例患者中,8例小现局部复发,5例死亡.乳腺叶状肿瘤的良恶性与肿瘤再次复发(P=0.046)和预后(P=0.028)存存相关性.结论 乳腺叶状肿瘤的恶性程度对肿瘤再次局部复发和患者预后有显著影响,而肿瘤大小与再次局部复发和预后无关.乳腺叶状肿瘤复发后的补救手术十分重要,手术必须保证一定的安全范围;多次局部复发患者的于术治疗效果较好.     

肝细胞癌端粒酶活性及hTERT mRNA表达与术后早期复发的关系

目的：研究肝细胞癌端粒酶活性及人端粒酶逆转录酶（hTERT）mRNA表达与肝细胞癌术后早期复发的关系。方法：采用ELISA—TRAP法检测60例肝癌组织及其癌旁组织端粒酶活性，RT—PCR法检测hTERT mRNA表达，5例正常肝脏组织作为对照。分析端粒酶活性及hTERT mRNA表达与临床病理之间的关系。结果：肝癌组织端粒酶活性及hTERT mRNA表达阳性率分别为86．7％（52／60）及90％（54／60），癌旁组织端粒酶活性及hTERT mRNA表达阳性率分别为40％（24／60）及43．3％（26／60）。正常肝脏组织均未检测到端粒酶活性及hTERT mRNA表达。癌旁组织端粒酶活性及hTERT mRNA表达与术后早期复发及包膜浸润、门静脉侵犯、肝内转移等恶性肿瘤的恶性生物学行为有关。结论：癌旁组织端粒酶活性及hTERT mRNA表达可能是肝细胞癌术后早期复发的预后指标。