经肝段动脉栓塞治疗中晚期肝癌

目的：探讨105例不能手术切除的中晚期肝癌经肝段动脉栓塞治疗效果和治疗成功的关键步骤。方法：通过肝动脉造影,对105例不能手术切除的中晚期肝癌经肿瘤供血的肝段动脉进行化疗栓塞治疗。结果：肝段动脉栓塞术者的1,2,3,4和5年的生存率分别为90．0％、70．0％、50．0％、40．0％和30．0％;肝动脉栓塞术后联合肝段动脉栓塞术者其1,2,3,4和5年生存率分别为74．5％、49．1％、40．0％、29．1％和20．0％。结论：肝段动脉栓塞术是最佳的治疗方式,肝动脉栓塞术联合肝段动脉栓塞术可显著提高不能手术切除的中晚期肝癌的生存率。     

肝动脉或肝段支栓塞治疗中晚期肝癌

目的报告425例肝癌经肝动脉或肝段支柱塞治疗的临床价值。方法通过肝动脉造影,采用超液化碘油与抗癌药混悬剂和明胶海绵进行肝动脉或肝段文化疗栓塞术,随访分析其治疗效果。结果1,2,3,4,5年总的生存率分别为63．5％,38.1％,22．6％,14．7％和7.8％。肝段支柱塞者,1,2,3年生存率分别为90．0％,70．0％和50％。结论肝动脉或肝段支化疗栓塞术是治疗不能手术切除的中晚期肝癌的良好方法,肝段支栓塞术是最佳的治疗方式。     

肝动脉栓塞化疗治疗中晚期肝癌的临床研究

目的：研究肝动脉拴塞化疗治疗中晚期肝癌的疗效。方法：对118例经肝动脉栓塞化疗治疗的中晚期肝癌患者评价疗效并随访2a以上，观察其生存率。结果：完全缓解8例，部分缓解49例。轻微缓解44例，无变化17例。有效率达85．6％。1a生存率为66．9％，2a生存率为31．4％。结论：肝动脉栓塞化疗治疗中晚期肝癌疗效确切，副作用较少，易于在基层医院推广。     

肝、脾动脉双途径化疗栓塞治疗中晚期肝癌

肝动脉化疗栓塞（ＨＡＩ＋ＨＡＥ）是目前公认的治疗失去手术机会的中晚期肝癌的首选方法,单独 ＨＡＩ＋ＨＡＥ治疗往往力度不够,选择在此基础上的综合疗法一直是临床治疗的热点。我们经肝、脾动脉双途径化疗栓塞治疗中晚期肝癌３０例,报告如下。 １ 材料与方法１．１ 临床资料 经ＡＦＰ、肝组织活检病理及Ｂ超、ＣＴ证实的原发性肝癌３０例;男２３例,女７例;年龄３２～７４岁。肿瘤直径：＜ ５ｃｍ ４例,６～１０ｃｍ ２０例,＞１０ｃｍ ６例;结节型１８例,弥漫型１２例。伴有门静脉分支癌栓９例。预计生存期超过 ３个月。 所有…     

高龄中晚期肝癌经动脉药物灌注并栓塞治疗临床分析

目的经导管脉动脉灌注化疗药物及栓塞作为晚期肝癌首选的姑息疗法,其临床价值已得到肯定。本文为探讨老年性肝癌采用此法的效果及开发症。方法已确诊的72例70岁以上老年性肝癌,采用经定肝动脉插管,成功后灌注化疗药物,一般为三联,后以碘化油乳化剂及明胶海绵碎屑沿导管注入,进行肝动脉栓塞。结果72例病人共进行介入治疗224例次。其中进行检室51例次,最多13例次,最小2例次,平均4．8例次。生存期最长18个月,最短4个月,平均生存6.5个月。CR7例,PR43例,NC17例,PDS例,总有效率（CR＋PR）为69．4％（50／72）。经治疗后患者肝区疼痛减轻、腹水明显消退,食欲增加,免疫指标提高。结论高龄中晚期肝癌采用肝动脉化疗药物灌注并栓塞米不失为一种有效的姑息疗法。     

高龄中晚期肝癌经动脉药物灌注并栓塞治疗临床分析

目的：经导管肝动脉灌注化疗药物及栓塞作为晚期肝癌首先的姑息疗法,其临床价值已得到肯定。本为探讨老年性肝癌采用此法的效果及并发症。方法：已确诊的72例70岁以上老年性肝癌,采用经皮肝动脉插管,成功后灌注化疗药物,一般为三联,后以碘化油乳化剂及明胶海绵碎屑沿导管注入,进行肝动脉栓塞,结果：72例病人共进行介入治疗224例次,其中进行栓塞51例次,最后13例次,最小2例次,平均4．8例次,生存期最长18个月,最短4个月,平均生存6．5个月,CR7例,PR43例,NC17例,PD5例,总有效率（CR＋PR）为69．4％（50／72）。经治疗后患肝区疼痛减轻、腹水明显消退、食欲增加,免疫指标提高,结论：高龄中晚期肝癌采用肝动脉化疗药物灌注并栓塞术不失为一种有效的结息疗法。     

中药配合低剂量化疗药物经肝动脉化疗栓塞术治疗中晚期肝癌的临床观察

目的探讨中药配合低剂量化疗药物经肝动脉化疗栓塞术（TACE）治疗中晚期原发性肝癌的临床疗效和毒副反应。方法中晚期肝癌患者57例随机分为治疗组（29例）和对照组（28例）。治疗组给予中药联合低剂量化疗药物TACE,对照组仅给予常规剂量化疗药物TACE。比较观察2组的临床疗效和毒副反应。结果 2组瘤体有效率比较差异无统计学意义（P〉0.05）;2组患者中医证候改善的疗效比较差异有统计学意义（P〈0.05）;2组AFP控制有效率比较差异有统计学意义（P〈0.05）;2组在肝肾功能及白细胞变化方面比较差异有统计学意义（P〈0.05）;2组恶心呕吐、乏力、肝区疼痛发生率比较均有统计学意义（P均〈0.05）;2组患者整体生活质量比较差异有统计学意义（P〈0.05）。结论中药配合低剂量化疗药物TACE治疗中晚期肝癌能明显较单纯TACE提高患者生活质量及对治疗的耐受性。     

肝动脉栓塞及肝动脉-门静脉双重栓塞化疗治疗中晚期原发性肝癌的疗效比较

背景与目的:临床资料表明,肝的血液由肝动脉和门静脉双重供应,肝癌患者单纯应用肝动脉栓塞化疗(transcatheterarterialchemoembolization,TACE)难以控制肿瘤。本研究旨在探讨经肝动脉行动-门脉双重栓塞化疗(portalvenouschemoembolization,PVCE)治疗中、晚期原发性肝癌的临床价值。方法:回顾性分析1995年7月～1997年7月经肝动脉行动-门脉双重栓塞化疗对58例中、晚期原发性肝癌(TACE+PVCE组)的疗效,与同期行单纯肝动脉栓塞化疗的118例中、晚期原发性肝癌(TACE组)的疗效对比。结果:(1)TACE+PVCE组治疗有效率86.2%,显效率31.0%;TACE组治疗有效率69.5%,显效率13.6%(P<0.05)。(2)TACE+PVCE组半年生存率93.1%,TACE组72.0%;TACE+PVCE组1、4年的生存率分别为43.1%、6.9%;TACE组分别为51.7%、5.1%。寿命表法分析两组患者半年生存率间差异有显著性,1、2、3、4年生存率间差异无显著性。(3)两组患者栓塞后均有发热、腹痛、白细胞下降、肝功能受损发生,TACE+PVCE组肝功能受损较严.-重,甚至可出现黄疸、腹水,肝功能受损程度与碘油用量呈正相关。结论:经肝动脉行动-门脉双重栓塞化疗治疗中、晚期原发性肝癌的短期疗效明显优于单纯行肝动脉栓塞化疗,但中、长期疗效差异无显著性。     

中药配合肝动脉化疗栓塞治疗中晚期肝癌疗效观察

肝动脉灌注化疗药物(TAI)和栓塞(TAE)已成为治疗中晚期肝癌的最有效方法，它与中医中药结合有协同作用，可以提高疗效。我院自1994年3月—1998年n月对70例中晚期肝癌患者进行中药配合肝动脉化疗栓塞及单纯行肝动脉化疗栓塞治疗，对比观察其疗效及毒副作用，现报告如下。 1 资料与方法 1.1 临床资料 全组70例，其中10例为肝癌切除……     

Update on Embolization Therapies for Hepatocellular Carcinoma

Purpose of Review

The purpose of the review is to summarize the latest applications for embolotherapy in the management of patients with HCC according to BCLC stage.

Recent Findings

While traditionally reserved for patients with unresectable HCC and stage B disease, there is an important role for embolization therapies in earlier stage patients as an adjunct to ablation, bridging, or downstaging therapy, as a means to improve safety of resection, and potentially as an arterial ablative option in the case of radioembolization. Newer applications of radioembolization such as radiation segmentectomy have the potential to provide cure in localized unifocal disease, and transarterial chemoembolization–portal vein embolization and radiation lobectomy may provide a combination of treatment and future liver remnant hypertrophy for planned hepatic resection. There is also an increasing role for embolization in the treatment of stage C disease, and recent data suggest it can be used in combination with sorafenib with the potential for survival benefit over sorafenib alone, even in the case of portal vein tumor thrombus.

Summary

Embolization therapies play an increasingly important role in patients with BCLC stage A–C hepatocellular carcinoma. While different therapies may be offered on a patient-specific basis, there are limited prospective RCT data to support superiority of one technique over another.

     

Antiangiogenic Therapies for Advanced Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a significant cause of death worldwide. HCC is a highly vascular tumor, and proangiogenic cytokines such as vascular endothelial growth factor (VEGF), platelet‐derived growth factor (PDGF), and fibroblast growth factor may play crucial roles in this disease. Sorafenib, a multikinase inhibitor that blocks VEGF and PDGF signaling, was the first systemic therapy to demonstrate improved survival in patients with advanced HCC. Several other drugs targeting VEGF are in development. Because of the anticipation of eventual resistance to anti‐VEGF therapies, drugs that also target alternative proangiogenic pathways are being investigated. Recent clinical and preclinical data along with ongoing studies are reviewed.     

Revisiting Oxaliplatin-based Regimens for Advanced Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a global health problem, as it is the sixth most common cancer in the world and the third leading cause of cancer-related death. Many patients with HCC present with disease that is not suitable for any potentially curative therapy; such patients are candidates for palliative transarterial or systemic therapies. Sorafenib is the only systemic therapy to demonstrate modest survival benefit over supportive care in the context of randomised controlled trials. However, many cytotoxic chemotherapeutics have achieved a range of tumour responses, but so far without convincing survival benefits in smaller phase II studies. In this commentary, we will review the data regarding the recent interest for the use of oxaliplatin-based regimens for advanced HCC.     

晚期原发性肝癌内科治疗进展

摘 要：原发性肝癌是中国发病率和死亡率均较高的恶性肿瘤。目前临床上晚期原发性肝癌的治疗以全身系统性药物治疗为主,主要包括系统化疗、分子靶向治疗以及免疫治疗等。该文就近年来晚期原发性肝癌的内科治疗研究进展作一综述。     

肝动脉栓塞加部分脾栓塞治疗原发性肝癌伴脾亢的临床研究

对原发性肝癌伴肝硬化脾亢患者行肝动脉化疗栓塞加部分脾栓塞与单纯肝动脉化疗栓塞对照研究。结果显示，肝动脉化疗栓塞加部分脾栓塞疗效满意。动态观察血常规、肝功能及各项免疫指标，发现该组血细胞下降较单纯肝动脉化疗栓塞组明显减少，两组比较有显著差异（Ｐ＜０．０１），再次治疗的间隔时间缩短。长期观察发现，肝动脉化疗栓塞加部分脾栓塞组治疗前后肝功改善也较单纯肝动脉化疗栓塞组明显。提示肝动脉化疗栓塞加部分脾栓塞是治疗原发性肝癌伴肝硬化脾亢患者的有效方法之一     

Drug Treatment for Advanced Hepatocellular Carcinoma: First-Line and Beyond

Hepatocellular carcinoma (HCC) has high mortality. The option of systemic therapy has increased significantly over the past five years. Sorafenib was the first multikinase inhibitor, introduced in 2007, as a treatment option for HCC, and it was the only effective systemic treatment for more than ten years. It was not until 2017 that several breakthroughs were made in the development of systemic strategies. Lenvatinib, another multikinase inhibitor, stood out successfully after sorafenib, and has been applied to clinical use in the first-line setting. Other multikinase inhibitors such as regorafenib, ramucirumab and cabozantinib, were approved in quick succession as second-line therapies. Concurrently, immune checkpoint inhibitors (ICIs) have readily become established treatments for many solid tumors, including HCC. The most studied ICIs to date, target programmed cell death-1 (PD-1), its ligand PD-L1, and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). These ICIs have demonstrated efficacy in treating advanced HCC. More recently, combination of bevacizumab and atezolizumab (ICI targeting PD-L1) was approved as the gold-standard first-line therapy. Combination of ICIs with nivolumab and ipilimumab was also approved in the second-line setting for those who failed sorafenib. At the moment, numerous clinical trials in advanced HCC are underway, which will bring continuous change to the management, and increase the survival, for patients with advanced HCC. Our review article: (1) summarizes United States Food and Drug Administration (US FDA) approved systemic therapies in advanced HCC, (2) reports the evidence of currently approved treatments, (3) discusses potential drugs/drug combinations being currently tested in phase III clinical trials, and (4) proposes possible future directions in drug development for advanced HCC.     

卡培他滨联合肝动脉栓塞化疗治疗中晚期肝癌疗效

[目的]探讨卡培他滨联合肝动脉插管化疗栓塞（TACE）治疗中晚期肝癌的临床疗效及安全性。[方法]中晚期肝癌患者随机分为两组,研究组37例,对照组39例。研究组采用TACE4周后,口服卡培他滨每日2000mg/m^2,分2次服,服用14d,停药14d为1个周期：对照组采用单纯TACE治疗。每8周为1个疗程．2个疗程后评价近期疗效．并随访中位生存期．[结果]研究组和对照组中,有效率分别为48．6％,25．6％;疾病控制率为83．8％,61．5％;血清甲胎蛋白（AFP）下降率各为78.4％,56.4％;中位生存期各为12．2个月,7．6个月（P〈0．05）．服用卡培他滨主要毒副反应多为Ⅰ～Ⅱ级,可耐受。[结论]卡培他滨联合TACE治疗中晚期肝癌疗效优于单纯TACE,且具有较好安全性。     

Prognostic Nomogram for Advanced Hepatocellular Carcinoma Treated with FOLFOX 4

Background: The Oxaliplatin plus 5-Fluorouracil /Leucovorin (FOLFOX4) regimen have been approved by Chinese Food and Drug Administration (CFDA), and covered by health insurance for patients with advanced hepatocellular carcinoma (HCC) in China. However, the efficacy of FOLFOX4 for HCC patients is still under debate. In this study, we aimed to establish a nomogram to identify HCC patients who might benefit from FOLFOX4 chemotherapy base on individual profile. Methods: A total of 184 patients from the EACH study who were treated with FOLFOX4 were included in this analysis. Backward Cox proportional hazards regression combined with clinical experience was used to select variables for construction of the nomogram. The nomogram performance was assessed in terms of discrimination and calibration. The results were validated using bootstrap resampling. Results: Six variables were included in the prognostic models based on their clinical relevance: age, maximum tumor diameter, lymph node status, aspartate aminotransferase (AST), total bilirubin (TBIL) and alpha-fetoprotein (AFP). The calibration curve showed that the predicted survival probabilities closely matched the actual observations. The C-index of the model was 0.75 (95%CI: 0.71-0.80). This value was significantly superior to the one for the following staging systems: BCLC (0.67, P=0.004), CUPI (0.66, P<0.001), AJCC seventh edition (0.63, P=0.002), GRETCH (0.63, P<0.001). Conclusions: The proposed nomogram showed accurate prognostic prediction for 6-month overall survival of patients treated with FOLFOX4 and could be useful for clinicians counseling patients and making treatment decisions.     

索拉非尼治疗进展期肝细胞癌的疗效及预后因素分析

  目的  评价索拉非尼治疗进展期肝细胞癌（HCC）的疗效及分析其预后影响因素。  方法  前瞻性分析2007年8月至2009年7月间110例接受索拉非治疗的进展期HCC患者,评价其疗效、不良反应,以总生存期和无肿瘤进展生存期为预后指标进行单因素和Cox比例风险模型多因素分析。  结果  110例患者随访中位时间9（2~18）个月,服用索拉非尼中位时间6.5（2~18）个月。14例（12.7%）获得完全缓解（CR）,16例（14.5%）部分缓解（PR）,40例（36.4%）病情稳定（SD）,总有效率为70例（63.6%）。中位生存期和无肿瘤进展生存期分别为10.5个月（95%CI:8.7~12.3）和5.0个月（95%CI:3.7~6.3）。多因素分析显示:联合局部治疗（肝动脉化疗栓塞或氩氦刀）、美国东部肿瘤协作组活动状态评分（Eastern Cooperative Oncology Group performance status score,ECOG PS）和Child-Pugh分级是影响无肿瘤进展生存时间的独立预后因素,而联合局部治疗、ECOG PS评分和AFP（alfa-fetopro? tein）水平是影响总生存期的独立预后因素。亚组分析显示:在肝癌进展组患者中继续服用索拉非尼其总生存期明显长于终止索拉非尼治疗者（11个月vs. 7.5个月,P < 0.001）。  结论  索拉非尼治疗进展期HCC,ECOG PS评分是影响生存期的一个重要因素,联合局部治疗有益于改善生存期。