原发性肝细胞癌病灶形态学的CT研究

我们对２３２例原发性肝细胞癌病灶的术前ＣＴ表现进行分析。以病灶的形态、轮廓光整度、边缘整齐度作为指标，将肝癌病灶术前ＣＴ表现分为３种类型：类圆膨胀生长型（Ⅰ型）、不规则膨胀生长型（Ⅱ型）、不规则浸润型（Ⅲ型）。对不同ＣＴ分型与手术病理结果对照观察发现：从Ⅰ型～Ⅲ型，肿瘤的肝内播散率分别为１８．６％、３７．７％、４７．８％，肝外淋巴结转移率分别为０、７．８％、２３．２％，门静脉瘤栓形成率分别为２．３     

肝细胞癌肝移植患者外周血甲胎蛋白mRNA的表达

背景与目的探讨肝细胞癌(HCC)肝移植患者术前外周血甲胎蛋白(AFP)mRNA的表达。方法采用TaqMan实时荧光定量RT-PCR法定量检测28例     

复发性肝细胞癌来源及治疗对策的探讨

肝细胞癌(HCC)恶性程度高,而且术后容易复发,本文通过长期随访,对352例复发的HCC的来源及再次手术的20例HCC的疗效进行了分析研究,探讨复发性HCC的治疗对策,以求有效提高复发者的远期生存率。     

HBx基因及其产物与原发性肝细胞癌

 原发性肝细胞癌(以下简称原发性肝癌)为世界第八大恶性肿瘤,在非洲和东南亚发病率很高,在中国列男性恶性肿瘤的第三位。在过去的几十年中,人们对其进行了一系列流行病学和实验室研究,确定了原发性肝癌与乙型肝炎病毒(HBV)、黄曲霉毒素、饮酒等很多因素有关。     

索拉非尼治疗肝细胞癌肝移植术后复发的疗效

目的 探讨索拉非尼治疗肝细胞癌肝移植术后肿瘤复发或转移晚期患者的疗效及不良反应.方法 回顾性分析我院2008年1月至2020年10月收治的40例肝细胞癌肝移植术后发生复发或转移患者的临床资料,观察患者口服索拉非尼(400 mg,2次/日)治疗的近期疗效、远期生存及安全性.近期疗效采用RECIST1.1标准进行评估;生存...     

肝细胞癌肝移植术后复发转移治疗策略的探讨

目的 探讨肝细胞癌(HCC)肝移植术后复发转移患者的治疗策略.方法 收集2007年1月至2018年12月我院31例HCC患者接受肝移植术后出现复发转移的临床资料,分析采用不同治疗手段的近期和远期疗效情况.近期疗效采用RECIST1.1标准进行评估;生存分析采用Kaplan-Meier法并进行Log-rank检验.结果 ...     

小肝细胞癌CT研究的新进展

小肝细胞癌(Small HepatocellularCarcinoma,SHCC)的手术切除率高,术后生存期长,据上海医科大学肝癌研究所报告,5年生存率高达70％以上。因此,SHCC的早期发现和诊断是目前临床工作中面临的重大课题。本文所指SHCC是以病灶最大径≤3cm为标准。     

肝细胞癌伴门静脉癌栓不同治疗方法的比较

目的 比较肝细胞癌合并门静脉癌栓(ｔｕｍｏｒ ｔｈｒｏｍｂｉ ｉｎ ｐｏｒｔａｌ ｖｅｉｎ,ＰＶＴＴ）不同治疗方法的疗效及其意义。方法 １４７例肝细胞癌伴门静脉主干或第１分支癌栓的住院患者,按不同治疗方法分成４组：保守治疗组（Ａ组,１８例）;肝动脉结扎和（或）肝动脉插管化疗组（Ｂ组,１８例）,术后定期栓塞化疗;肝癌联同ＰＶＴＴ切除组（Ｃ组,７９例）;手术切除＋肝动脉化疗栓塞和（或）肝动脉置管或门静脉     

小肝细胞癌的CT研究及影像学评价

鉴于目前的设备和检测手段，大部分原发性肝癌病例发现时已属晚期，手术切除率低，预后不良；而小肝癌（≤3cm）手术切除率高，术后五年生存率可达60％－70％。因此肝癌的早期发现和诊断具有重要的临床意义。一、小肝癌的CT检查和各种影像学方法比较从1989年－1992年，我们对200例小肝癌进行了前瞻性研究，其中118例共187个病灶经手术病理证实，统计结果表明，病灶愈小．各种影像学方法和检出率愈低。3cm以上病灶均易位出；2cm－3cm病灶，虽有一定的假阴性（漏检），但阳性事甚高，各种方法差异不大；2cm以内特别是≤1cm的病灶，阳性举（检…     

Evolution of Proinflammatory Cytokines in Hepatocellular Carcinoma Patients Undergoing Orthotopic Liver Transplantation

OBJECTIVE To analyze the expression and levels of serum proinflammatory cytokines including tumor necrosis factor alpha (TNF-α), and interleukin (IL)-6 in patients with hepatocellular carcinoma (HCC), who received orthotopic liver transplantation (OLT).METHODS The blood samples of 20 consecutive HCC patients who underwent liver transplantation were detected and analyzed for the clinical serum biochemical parameters, TNF-α and IL-6.Blood samples were drawn from the radial artery at planned time points: preoperatively, intraoperatively, and postoperatively.Levels of serum TNF-α and IL-6 were detected with enzymelinked immunosorbent assay (ELISA).RESULTS The levels of serum TNF-αand IL-6 increased significantly at reperfusion phase compared with those detected preoperatively (P < 0.01), and the level of serum IL-6 remained significantly higher until the third day after the liver transplantation. There was a significant correlation between TNF-αand IL-6 (P<0.001).CONCLUSION This research into the effects of the proinflammatory cytokines on liver transplantation has provided new insights into the mechanisms of ischemia and reperfusion injury to OLT.     

Hepatocellular Carcinoma,Alpha Fetoprotein,and Liver Allocation for Transplantation: Past,Present and Future

Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.     

Percutaneous Radiofrequency Ablation Guided by Contrastenhanced Ultrasound in Treatment of Metastatic Hepatocellular Carcinoma after Liver Transplantation

This study evaluated the advantages and applications of contrast-enhanced ultrasound (CEUS)-supportedpercutaneous radiofrequency ablation (RFA) in the treatment of metastatic hepatocellular carcinoma after livertransplantation, based on clinical details. CEUS-supported percutaneous RFA was adopted to treat 12 patientswith hepatic metastatic carcinomas after liver transplantation. The diameters of the metastatic carcinomas variedfrom 1 cm to 5 cm, and the foci were discovered after 3 months to 12 months. Each focus was diagnosed andlocalised by CEUS for RFA once or twice. Curative effects were evaluated by CEUS or contrast-enhanced CTafter the treatment. The re-examination results at 2 weeks post-treatment showed that the foci of 11 patients wereablated completely, whereas one patient with the largest focus required retreatment by RFA because of a partialresidue. No local recurrence was found one month later in the re-examination. CEUS-supported percutaneousRFA in the treatment of hepatic metastatic carcinoma after liver transplantation has the advantages of accuratelocalisation, good efficacy, easy operation, and minimal invasion without any complications. Therefore, it canbe recommended as the preferred therapy for hepatic metastatic carcinoma after liver transplantation.     

Multicenter Italian Experience in Liver Transplantation for Hepatocellular Carcinoma in HIV‐Infected Patients

Background.

The aim of our work is to assess the clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV-coinfected patients. This is a multicenter study involving three Italian transplant centers in northern Italy: University of Modena, University of Bologna, and University of Udine.

Patients and Methods.

We compared 30 HIV-positive patients affected by HCC who underwent LT with 125 HIV-uninfected patients who received the same treatment from September 2004 to June 2009. At listing, there were no differences between HIV-infected and -uninfected patients regarding HCC features. Patients outside the University of California, San Francisco criteria (UCSF) were considered eligible for LT if a down-staging program permitted a reduction of tumor burden.

Results.

HIV-infected patients were younger, they were more frequently anti-HCV positive, and a higher number of HIV-infected patients presented a coinfection HBV-HCV. Pre-LT treatments (liver resection and or locoregional treatments) were similar between the two groups. Histological characteristics of the tumor were similar in patients with and without HIV infection. No differences were observed in terms of overall survival and HCC recurrence rates.

Conclusion.

LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post-LT outcome.     

Living-Donor Liver Transplantation for Hepatocellular Carcinoma: Impact of the MELD Score and Predictive Value of NLR on Survival

Background: Patients with hepatocellular carcinoma (HCC) tend to be referred for liver transplantation (LT) at an early stage of cirrhosis, with lower pre-LT Model of End-Stage Liver Disease (MELD) scores. We investigated the impact of high MELD scores on post-LT outcomes in patients with HCC and validated the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR). Patients and Method: This retrospective single-center cohort study enrolled 230 patients with HCC who underwent LDLT from 2004–2019 in our institute. We defined a high MELD score as ≥20. Results: The MELD < 20 and MELD ≥ 20 groups comprised 205 and 25 cases, respectively. Although there was no significant difference in disease-free survival between the two groups (p = 0.629), the incidence of septic shock (p = 0.019) was significantly higher in the high MELD group. The one-, three-, and five-year overall survival rates were not significantly different between the two groups (p = 0.056). In univariate analysis, a high pre-LT NLR was associated with poorer survival in the high MELD group (p = 0.029, hazard ratio [HR]: 1.07, 90% confidence interval [CI]: 1.02–1.13). NLR cut-off values of ≥10.7 and <10.7 were predictive of mortality, with an AUC of 0.705 (90% CI: 0.532–0.879). The one-, three-, and five-year post-LT survival rates were significantly higher among the recipients with an NLR < 10.7 than those with an NLR ≥ 10.7 (p = 0.005). Conclusions: Pre-LT MELD score ≥ 20 was associated with a higher risk of developing post-LT septic shock and mortality. The pre-LT serum NLR is a useful predictive factor for clinical outcomes in patients with HCC with high MELD scores.     

Clinical,Epidemiological and Histopathological Aspects in Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation

Background: Hepatocellular Carcinoma (HCC) is the primary liver cancer with high incidence and mortality rates.Currently one of the major etiologies for liver disease, HCC and liver transplantation is nonalcoholic fatty liver disease(NAFLD). The aim of the present study was to evaluate the epidemiological, histopathological and clinical aspects ofHCC transplant patients, with emphasis on NAFLD etiology. Methods: This study included all HCC patients submittedto liver transplantation from 2010 to 2016 of the University Reference Center. The analyzed variables were age, gender,ethnicity, causes that led to liver transplantation, alpha-fetoprotein (AFP) dosage, histological aspects, recurrence,survival and NAFLD. Results: A total of 60 patients were included in the study being 80% men with a mean age of58.3 ± 10.6 years. All patients were cirrhotic. The causes that led to the transplantation were the presence of the hepatitisC virus (HCV) (56.6% of the patients), an association of the virus with alcohol (20%), the presence of the hepatitis Bvirus (HBV) (20%), alcoholic liver disease (ALD) (50.9%) and NAFLD (25%). Of the latter, eight were diagnosedpre-transplantation and seven were NAFLD carriers without a previous diagnosis. Regarding the Edmondson-Steinerhistological classification, 58.5% of the patients were classified as grade ≤ II. Conclusions: There is predominance ofmale patients with a mean age of 58.3 years. Degree ≤ II is the most frequent to the Edmondson-Steiner histologicalclassification in the evaluated casuistic. HCV, ALD and NAFLD is the most common etiological agents found in thestudy. The (high) underestimated prevalence of NAFLD in the pre-transplanted patients is due to the fact that all patientspresented cirrhosis, masking NAFLD signals.     

影响肝癌肝移植术后肿瘤复发转移的临床病理因素

目的: 探讨肝细胞癌患者肝移植术后肿瘤复发转移的临床和病理因素。 方法: 回顾性分析2002年1月～2006年6月期间施行的781例以肝细胞癌行首次肝移植患者术后的无瘤生存情况,应用单因素分析和Cox回归多因素分析各项临床及病理指标对肿瘤复发转移的影响。 结果: 移植术后6个月、1、2、3年的无瘤生存率分别为86.85%、74.87%、63.36%和56.67%。术后肝癌复发或转移后1年生存率为26.27%。Cox回归多因素分析发现,影响术后肝癌复发转移的独立危险因素包括肿瘤最大直径、数目、双叶分布、血管侵犯和术前甲胎蛋白。研究发现,存在肉眼癌栓的患者术后HCC复发转移的风险是无癌栓患者的9倍,存在镜下微血管侵犯的患者复发转移风险可达5倍。 结论: 严格筛选肝癌肝移植的适应证可以有效降低肿瘤复发转移的风险。     

小肝癌合并严重肝硬化的治疗选择

[目的]探讨合并严重肝硬化的小肝癌的治疗方法.[方法]分析1998年至2003年98例合并严重肝硬化的小肝癌患者采取不同治疗方式后的疗效.[结果]手术切除88例,切除率89.8%,无围手术期死亡.全组1、3、5年复发率分别为16.3%、29.0%、35.3%;1、3、5、10年生存率分别为87.8%、72.5%、60.8%和41.7%.无水酒精注射术组复发率明显高于切除组(P＜0.01),而两组生存率比较差异无显著性(P＞0.05).[结论]对合并严重肝硬化的小肝癌,应根据病情,选择合理的、个体化的治疗方案,以求得最好的疗效.     

原发性肝癌患者肝储备功能的研究

目的 :探讨原发性肝癌患者的肝储备功能。方法 :将 2 37例原发性肝癌患者的ICGR15分别与患者的腹水、血浆白蛋白、胆红素、Child’s分级及术后肝功能损害率进行统计分析。结果 :1)ICGR15与腹水、胆红素、Child分级及术后肝功能损害呈正相关 ,P =0 0 0 ;与血浆白蛋白呈负相关 ,P =0 0 0。 2 )ICGR15 >2 0 %时 ,患者出现腹水、低蛋白血症、黄疸、Child’s分级升高和术后肝功能损害的机率明显增高 ,P =0 0 0。结论 :ICGR15是评估原发性肝癌患者的肝储备功能和肝功能较好的指标。     

肝癌介入治疗模式的探讨

目的探讨肝癌介入治疗的合理模式。方法回顾性总结1000例以不同方式进行介入治疗的肝癌病例资料,通过分析其病理、生化、影像及生存率等临床因素,比较各种治疗方式的价值及优缺点结果经导管节段性肝动脉栓塞化疗(S-TOCE)与常规肝动脉注射碘油抗癌药混悬剂栓塞化疗(C-TOCE)比较,前者对肿瘤的杀伤作用大,对非癌肝组织的损害较C-TOCE轻,生存率优于C-TOCE;经皮无水酒精注射术(PEI)联合栓塞治疗可起到杀死残余癌灶的作用,对非癌肝组织未造成明显损害,生存率较单纯栓塞明显提高。对肝癌的各种并发症采取不同方式的介入治疗,能不同程度地改善患者生存质量或提高生存率。结论肝癌的介入治疗应根据肿瘤大小和类型选择/不同的介入治疗方式;对肝癌的各种并发症采取积极的介入治疗是有效和必要的。