肝动脉化疗栓塞联合索拉菲尼治疗中晚期肝细胞癌

目的 探讨肝动脉化疗栓塞（TACE）联合索拉菲尼治疗中晚期肝细胞癌（HCC）的临床价值。方法 前瞻性分析我院2011年1月至2012年1月接受TACE联合索拉菲尼（n=27）和TACE单独治疗（n=25）的中晚期HCC患者的临床资料,比较两组患者肿瘤中位进展时间、肿瘤无进展生存率和总生存率。结果 随访期间,联合治疗组共发生肿瘤进展18例,死亡10例,疾病控制率为74.1%;TACE单独治疗组共发生肿瘤进展19例,死亡15例,疾病控制率为68.0%。联合治疗组和TACE单独治疗组肿瘤中位进展时间分别为6.5个月和3.3个月（P＜0.05）,两组6和12个月的肿瘤无进展生存率分别为51.9%、33.3%和27.6%、16.5%（P＜0.05）,总生存率分别为81.0%、60.8%和63.3%、34.8%（P＜0.05）。联合治疗组的手足皮肤反应、口腔黏膜炎发生率较TACE单独治疗组高（P＜0.05）,药物减量辅以对症治疗后控制良好。结论 TACE联合索拉菲尼治疗中晚期HCC是安全有效的,优于TACE单独治疗,值得临床进一步验证推广。     

Obesity conveys poor outcome in patients with hepatocellular carcinoma treated by transarterial chemoembolization

Purpose

The purpose of this retrospective study was to evaluate the impact of obesity on radiologic outcomes in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE).

Comparison of transarterial chemoembolization in patients with unresectable,diffuse vs focal hepatocellular carcinoma

HYPOTHESIS: Transarterial chemoembolization (TACE) is beneficial for selected patients with unresectable hepatocellular carcinoma (HCC). DESIGN AND SETTING: A prospective comparison study in a tertiary hospital. STUDY PERIOD: November 21, 1995, to May 2, 2001, with a mean follow-up of 939 days. PATIENTS: A total of 157 TACE treatments were performed in 88 patients with unresectable HCC: 132 treatments in 69 patients with focal HCC (F-HCC) and 25 treatments in 19 patients with diffuse HCC (D-HCC). INTERVENTIONS: Transarterial chemoembolization consisted of selective catheterization and intra-arterial infusion of a mixture of doxorubicin hydrochloride, cisplatin, and mitomycin followed by embolization. Sequential treatments were performed for bilobar HCC. MAIN OUTCOME MEASURES: Child-Pugh classification and clinical outcomes, including alpha-fetoprotein (AFP) response, length of hospital stay, readmission rate, and survival, were compared between patients with F-HCC and D-HCC following TACE using the chi(2) test, Fisher exact test, or t test (2-tailed, unpaired). RESULTS: Fifty-eight patients (84%) in the F-HCC group and 18 patients (95%) in the D-HCC group had cirrhosis. For those patients with cirrhosis, 58 (100%) in the F-HCC group and 14 (78%) in the D-HCC group had a Child-Pugh score of A or B (P =.002). The mean baseline AFP was higher in the D-HCC group: 55 577 vs 7815 ng/mL in the F-HCC group (P =.001). Of the patients secreting AFP, 4 (29%) of 14 in the D-HCC group and 30 (68%) of 44 in the F-HCC group had a significant decrease in AFP 1 month following TACE (P =.01). The mean hospital stay was longer (3 vs 1.9 days; P =.001), and readmissions occurred more frequently (44% vs 9%; P<.001) in the D-HCC group. The mean survival rate was significantly higher in the F-HCC group: 425 vs 103 days (P<.001). CONCLUSIONS: In patients with F-HCC, TACE is well tolerated and provides a survival benefit. However, there is no apparent benefit for patients with D-HCC. Importantly, tumor characteristics and hepatic reserve are essential criteria for successful TACE.     

经皮射频消融治疗复发性肝癌的预后分析

目的 探讨影响经皮射频消融(PRFA)治疗复发性肝癌预后的影响因素.方法 1999年1月至2008年12月共有82例复发性肝癌患者(单个肿瘤最大径≤7 cm;多个肿瘤者最大径≤5 cm且肿瘤数目≤3个)接受PRFA治疗,收集其临床及病理学特征等12项可能影响预后的因素作回顾性单因素与多因素分析.结果 全组患者1、3、5年生存率分别是75.8%、43.9%、34.5%(从PRFA术后算起)和95.1%、63.2%、46.6%(从初次手术算起);单因素分析显示初次肿瘤大小、复发期限长短、复发肿瘤数目、复发肿瘤大小、血清谷氨酰转肽酶(GGT)和白蛋白(ALB)水平与复发性肝癌行PRFA的预后有相关性(P<0.05);进一步行Cox模型多因素分析得出与预后相关因素为复发期限长短、复发肿瘤大小、血清GGT与ALB水平(P<0.05).结论 PRFA治疗复发性肝癌疗效确切,复发期限、复发肿瘤大小、血清GGT与ALB水平为其显著性预后影响因子.     

肝动脉化疗栓塞联合射频消融术治疗中晚期肝癌的疗效

目的评价TACE联合射频消融(RFA)治疗中晚期肝癌的疗效。方法回顾性分析72例中晚期肝癌患者,其中35例行TACE联合RFA治疗(联合组),37例行单纯TACE治疗(对照组)。术后随访,比较两组短期疗效、治疗后肝功能、血清甲胎蛋白、并发症以及远期生存率。结果联合组术后总有效率(29/35,82.86%)明显高于对照组(20/37,54.05%;P=0.009)。联合组和对照组术后血清甲胎蛋白降至(102.19±32.13)μg/L、(218.46±49.87)μg/L(P0.001)。联合组1、2、3年生存率分别82.86%、54.29%、34.29%,中位生存期25个月;对照组分别为54.05%、32.43%、13.51%,中位生存期16个月;两组生存率差异有统计学意义(P=0.009)。联合组及对照组治疗后肝功能均有一过性改变,术后2周基本恢复,两组比较差异无统计学意义(P均0.05)。结论 TACE联合RFA治疗中晚期肝癌是有效的综合介入治疗方法。     

Local recurrence following complete radiologic response in patients treated with transarterial chemoembolization for hepatocellular carcinoma

PurposeThe purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsOne-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4–86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression.ResultsA total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51–2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P <0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57–2.67]; P<0.001), INR (HR: 0.13 [95% CI: 0.03–0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016).ConclusionA significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.     

经皮肝穿刺射频热凝与肝动脉化疗栓塞联合治疗肝细胞癌

目的：探讨对于无手术指征或考虑手术疗效欠佳的较大肝癌（3－7cm）和位于肝门区的小肝癌先行肝动脉化疗栓塞（TACE）,再行B超引导经皮肝穿刺射频热凝（PRFA）治疗肝癌的意义。方法2000年1月至2001年7月对符合条件的15例肝癌患者先行TACE,而后进行B超引导PRFA治疗,另15例肝癌患者直接给予B超引导PRFA治疗。治疗后定期复查甲胎蛋白（AFP）。1个月后复查MRI或CT确定肿瘤是否完全坏死,以后每2－3个月复查。Kaplan-Meier法计算无瘤生存率和累积生存率。结果：TACE加PRFA组肿瘤完全坏死率86．7％（13／15）,单纯PRFA组为26．7％（4／15）,差异有显著意义。前组AFP转阴率66．7％（6／9）,后组20％（2／10）。前组6个月无瘤生存率100％（13／13）,后组75．0％（3／4）。前组1、1．5、2年的生存率分别为100％、100％和66．7％,后组1和1．5年的生存率分别为80．0％和40．0％,差异有显著意义。结论：对于较大的（＞3cm）、位于肝门区的、边界不清的或较多个瘤灶的肝癌先行TACE,再适时给予PRFA,可以扩大肿瘤坏死范围,增加肿瘤完全坏死率、减少复发、提高生存率。     

动脉化疗栓塞术联合射频消融治疗无法手术的原发性肝癌

目的比较动脉化疗栓塞术(TACE)联合射频消融(RFA)、TACE联合放疗对无法手术的原发性肝癌(PHC)的疗效。方法选取2011年10月至2012年10月期间无法进行或不愿进行手术的PHC患者120例,分成两组:TACE+RFA组(A组,n=60)和TACE+放疗组(B组,n=60),治疗结束后3个月对比观察两组疗效和毒副反应,随访观察生存时间。结果 A组和B组近期有效率分别为46.7%和51.7%,两组差异无统计学意义(P0.05)。A组和B组中位生存时间分别为27个月和16个月,两组差异有统计学意义(P0.05)。毒副作用方面,两组在上消化道出血上差异有统计学意义(P0.05)。结论与TACE+放疗相比,TACE+RFA治疗无法手术的PHC远期效果更为显著。     

Recurrent hepatocellular carcinoma successfully treated with radiofrequency thermal ablation

We report a patient with hepatocellular carcinoma (HCC) who was successfully treated with radiofrequency thermal ablation (RFA). A 71-year-old man was admitted to our hospital in August 1996 with recurrence of HCC. Partial hepatic resection had been performed in January 1993 for HCC that had measured 1.3 cm in segment VIII, and subsequently he had received six sessions of percutaneous ethanol injection (PEI) for treatment of recurrence. Dynamic computed tomography (CT) performed in August 1996 showed two recurrent tumors, one measuring 3.8 cm in segment VIII adjacent to the right hepatic vein, and one measuring 2.0 cm in segment V. Three sessions of percutaneous RFA were performed. After this treatment, most of the tumor in segment VIII and all the tumor in segment V showed low density on dynamic CT, and the right hepatic vein was preserved. However, a remnant of the mass appeared near the right hepatic vein 2 months after the treatment. An additional two sessions of RFA were performed. After the end of treatment, serum alpha-fetoprotein level dropped to the normal range, and no sign of recurrence has been observed until September 1998. Received for publication on Aug. 17, 1998; accepted on Dec. 10, 1998     

Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma involving microvascular invasion

Background

Microvascular invasion (MVI) has recently been reported to be an independent prognostic factor in patients with hepatocellular carcinoma (HCC). This study compared the outcomes of adjuvant transarterial chemoembolization (A-TACE) after hepatic resection (HR) in patients with HCC involving MVI.

Hepatitis status, child-pugh classification, and serum AFP levels predict survival in patients treated with transarterial embolization for unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents one of the most prevalent cancers worldwide. Most patients are not surgical candidates, and transarterial embolization (TAE) has been used to treat patients with unresectable HCC. The purpose of this study was to identify factors that predict survival in patients treated with TAE at a Western medical center. Review of a prospective database identi.ed 345 patients treated for HCC at University Hospital (Newark, NJ) between July 1998 and July 2004. Of these patients, 109 patients underwent TAE. Eleven of these patients were subsequently treated surgically and excluded from this study. Of the remaining 98 patients, demographic data and laboratory values were analyzed to predict survival by univariate and multivariate analysis. Several factors, including hepatitis status, Child-Pugh classification, serum alpha fetoprotein levels <500 ng/ml, bilirubin <2.0 mg/dl, prothrombin time <16 seconds, platelet count <200 × 10 9/l, albumin >3.5 gm/dl, and multiple treatments, predicted survival by univariate analysis. Serum alpha fetoprotein levels, Child-Pugh classification, and hepatitis status were found by multivariate analysis to independently predict survival. These factors may help to select patients with unresectable HCC who might benefit from TAE.     

经动脉化疗栓塞同步微波消融与序贯联合微波消融治疗肝细胞癌的预后对比

目的 比较经动脉化疗栓塞（TACE）同步联合微波消融（MWA）与TACE序贯联合MWA治疗肝细胞癌（HCC）的有效性与安全性。方法 回顾性分析苏州大学附属第一医院单中心2016年2月至2021年3月间行TACE同步或序贯联合MWA治疗的HCC患者临床资料。主要观察指标为无进展生存（PFS）时间和3、6及12个月总体生存（OS）率,次要观察指标为消融针次、消融时间、肿瘤反应及并发症发生率。结果共63例患者纳入本研究,同步组29例,序贯联合组34例。两组患者的PFS时间[同步组（7.4±2.4）个月 vs序贯组（6.2±3.6）个月],3、6、12个月OS率（同步组100%、100%、96.6% vs 序贯组100%、97.1%、91.2%）,差异均无统计学意义（P＞0.05）。同步组平均消融针次[（1.5±0.5）次]及消融时间[（9.9±3.9）min]均低于序贯组（[ 2.1±0.7）次、（14.6±4.5）min],均存在统计学差异（P＜0.05）。两组患者肿瘤客观反应率（同步组79.4% vs 序贯组73.5%）和肿瘤控制率（同步组89.7% vs 序贯组88.2%）无统计学差异（P＞0.05）。两组患者不良反应及并发症发生率无统计学差异（P＞0.05）。结论 本研究初步结果显示TACE同步联合或序贯联合MWA两种方式均能有效控制HCC肿瘤进展,在近期疗效方面无差异。与序贯联合相比,TACE同步联合MWA治疗能减少消融针次及消融时间,且未增加并发症发生率。     

Tolerance of radiofrequency ablation by patients of hepatocellular carcinoma

Background  

Radiofrequency ablation (RFA) is currently an effective method for ablation of hepatocellular carcinoma (HCC). Early reports have indicated that RFA is safe and virtually free from major complications. Unlike partial hepatectomy for HCC on patients with cirrhosis, there are no data on the safety limit of RFA. However, information is vital for selection of appropriate patients for the procedure. In this study, we analyzed results from use of RFA on HCC patients and determined the lower limit of liver function with which HCC patients can tolerate RFA.     

Treatment of hepatocellular carcinomas by thermal ablation and hepatic transarterial chemoembolization

Local tumor recurrence after thermal ablation of hepatocellular carcinoma (HCC) can impact on overall survival and are very closely linked to partial treatment of the primary lesion or to potential microvascular invasion or satellite micronodules located close to the main lesion. The diagnosis of these liver metastases close to the primary lesion on CT and MRI is difficult and their incidence, number and spread throughout the liver correlates with diameter of primary tumor. Tumor diameter is currently the key factor to predict whether or not thermal ablation of HCC will be complete or not. It has now been shown for monopolar radiofrequency ablation that this therapy alone is sufficient to effectively treat single HCCs < 3 cm in diameter provided that liver micrometastases are not present. If the HCC is >3 cm in size, multifocal or in the case of tumor recurrence, overall survival and recurrence-free survival results are better if monopolar radiofrequency ablation is combined with hepatic trans-arterial chemoembolization. The timing of this combination of treatments probably influences its effectiveness on tumor and tolerability and remains to be assessed.     

ART and science in using transarterial chemoembolization for retreating patients with hepatocellular carcinoma

Intermediate stage hepatocellular carcinoma (HCC) comprises of a highly heterogeneous patient population, both in terms of liver function and tumour burden. Transarterial chemoembolization (TACE) is the treatment of choice for this subgroup of patients, provided that liver function is relatively preserved. Not all patients respond to an initial session of TACE, and further session might impair liver function. The ART score consists of an increase of AST >25%, increase of Child-Pugh of one or two points and absence of radiological tumour response and helps identify patients that would not benefit from further TACE sessions. We critically appraise the use of this score, particularly in terms of patient selection and timing of calculation of its variables. Once sufficiently validated, it can become a safe, objective and accurate clinical tool in everyday practice.     

射频消融联合肝动脉栓塞化疗治疗难以手术切除的结肠癌肝转移

AFP含量为(32.77±4.66)μg/L,与全身化疗组术后血清AFP含量(256.33±17.85)μg/L比较差异有统计学意义(P＜0.01).RFA联合TACE组术后平均生存时间明显长于全身化疗组(P＜0.01).结论 对于难以手术切除的结肠癌肝转移,经皮射频消融联合肝动脉栓塞化疗可明显改善患者免疫功能,提高临床疗效.     

肝癌射频消融后常规行经导管肝动脉化疗栓塞的临床分析

目的:探讨肝癌射频消融（RFA）联合经导管肝动脉化疗栓塞（TACE）的疗效及必要性。方法:对65例肝癌患者RFA后进行1次以上的TACE治疗。其中男54例，女11例。肿瘤最大长径1.5～10.0 cm，其中≤3 cm者14例， 3.1～5.0 cm者17例，＞5.0 cm者34例。按肝功能Child pugh分级，A级51例，B级14例。病理诊断肝细胞癌58例，胆管细胞性肝癌7例。采用RFA肿瘤治疗系统行RFA，并随后常规行CT以评价RFA的疗效，然后行TACE,术后1月行CT检查，以评价肿瘤消融情况，并观察生存率，以评价治疗效果。结果:RFA后完全消融24例，基本消融15例，部分消融26例。RFA+TACE的近期效果为根治性22例、亚根治性13例和姑息性30例。肿瘤消融程度与近期疗效密切相关(r=0.877，P＜0.001)。肝癌RFA+TACE治疗后总体1，2，3年生存率为78.2%，65.3%，44.0%。Cox回归模型分析显示消融程度，是最终与生存时间有关的因素，获得完全消融、基本消融或部分消融者3年生存率分别为73.5%，45.0%和0.0%。肿瘤较小的肝癌容易获得完全消融、近期及远期疗效较好；反之预后较差。结论:TACE对RFA后残余的癌灶或微小转移病灶可起治疗作用；中大肝癌RFA后联合TACE是必要的。     

Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma

BACKGROUND: Transarterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC), but the long-term survival benefit remains unclear. METHODS: Pretreatment variables were analysed for factors predictive of actual 5-year survival from a prospective database of patients with inoperable HCC treated by TACE between 1989 and 1996. RESULTS: Complete 5-year follow-up (median 91 months) was obtained for 320 patients who underwent a median of 4 (range 1-41) TACEs. Median tumour size was 9 (range 1-28) cm. There were 25 5-year survivors (8 per cent), including eight with tumours larger than 10 cm in diameter and three with portal vein branch involvement. On univariate analysis, female gender (P = 0.037), absence of ascites (P = 0.028), platelet count below 150 x10(9) per litre (P = 0.011), albumin concentration greater than 35 g/l (P = 0.04), alpha-fetoprotein level below 1000 ng/ml (P = 0.007), unilobar tumour (P = 0.027), fewer than three tumours (P = 0.015), absence of venous invasion (P = 0.011), and tumour diameter less than 8 cm (P = 0.021) were significant predictors of 5-year survival. Albumin concentration greater than 35 g/l (P = 0.011), unilobar tumour (P = 0.012) and alpha-fetoprotein level below 1000 ng/ml (P = 0.014) were independent prognostic factors on multivariate analysis. CONCLUSION: Five-year survival is possible with TACE for inoperable HCC, even in some patients with advanced tumours. Unilobar tumours, alpha-fetoprotein level below 1000 ng/ml and albumin concentration greater than 35 g/l were factors predictive of 5-year survival.     

肝动脉栓塞化疗联合经皮射频消融治疗肝癌

目的: 探讨肝动脉栓塞化疗联合经皮射频消融治疗不能手术切除的肝癌的价值.方法: 对2000年2月至2003年2月间103例不能手术切除的肝癌分别行肝动脉栓塞化疗(51例)或肝动脉栓塞化疗联合经皮射频消融(52例).结果: 两组治疗后6个月生存率差异无显著性意义(P>0.05),1年及2年生存率差异有显著性意义(P<0.01).肿瘤缩小率差异有显著性意义(P<0.01).结论: 对不能手术切除的肝癌,肝动脉栓塞化疗联合经皮射频消融能明显提高肿瘤缩小率及生存率.