全身化疗联合肝动脉栓塞化疗治疗乳腺癌术后肝转移的临床疗效观察

目的:探讨全身化疗联合肝动脉栓塞化疗治疗乳腺癌术后肝转移的临床疗效及毒副反应。方法:对62例乳腺癌患者分别采用全身化疗或全身化疗联合肝动脉栓塞化疗,比较其疗效。结果:62例患者中总有效率(OR)为51.6%,其中,全身化疗组的客观有效率(RR)为37.0%,全身化疗加肝动脉栓塞化疗的患者客观有效率(RR)为62.9%,联合治疗组的疗效明显好于单纯化疗组(P<0.05)。总中位生存期为17个月,其中,全身化疗组中位生存期为15个月,全身化疗加TACE组中位生存期为22个月,两者的生存期有显著差异(P<0.05)。主要毒副反应为骨髓抑制和胃肠道反应。结论:全身化疗联合肝动脉栓塞化疗治疗乳腺癌肝转移疗效显著,毒副作用小,可以作为乳腺癌肝转移综合治疗中的主要治疗手段。     

鸦胆子油乳肝动脉灌注治疗转移性肝癌

[目的]探讨鸦胆子油乳联合化疗药物经药盒植入系统(PCS)肝动脉灌注对消化道肿瘤肝转移的临床疗效.[方法]经锁骨下动脉穿刺植入PCS至肝脏供血动脉,16例患者经PCS灌注或栓塞治疗,同时联合鸦胆子油乳肝脏供血动脉内灌注治疗(A组);14例患者单纯化疗灌注或栓塞(B组).每4周为1个疗程,连用6个疗程.[结果]A组16例患者生存期9～24个月,中位生存期17个月,有效率68.8%,1年生存率为81.3%,2年生存率为43.8%;B组14例患者生存期4～18个月,中位生存期14月,有效率57.1%,1年生存率42.9%,2年生存率28.6%.且A组较B组骨髓毒性轻,体力状况明显改善.[结论]鸦胆子油乳联合化疗药物肝动脉内灌注治疗能提高消化系统肿瘤肝转移的疗效;并可改善患者的体力状况及降低骨髓毒性.     

肝动脉泵生物化疗治疗进展期黑色素瘤肝转移Ⅱ期临床研究

背景与目的:黑色素瘤肝转移全身治疗效果不佳,国外研究发现肝动脉灌注化疗可显著改善疗效,本研究进一步探讨肝动脉泵为基础的生物化疗治疗肝转移的疗效及对生存期的影响。方法:选择进展期黑色素瘤肝转移患者21例,予肝动脉泵置入,行淋巴细胞删除性化疗(福莫司汀 达卡巴嗪),化疗后立刻进行自体细胞因子诱导的杀伤细胞回输,并同时应用白介素-2、粒细胞巨噬细胞集落刺激因子治疗,28d为一周期。疗效评定采用实体瘤疗效评价标准。对21例患者的疾病控制率、不良反应发生率、无进展生存期、总生存期进行分析。结果:可评价疗效患者共17例,完全缓解1例,部分缓解1例,稳定6例,进展9例,疾病控制率47.06%(8/17)。中位无进展生存期3个月。中位生存期6个月。Ⅲ～Ⅳ级的不良反应占38.1%(8/21)。结论:对于进展期黑色素瘤肝转移患者,以肝动脉泵为基础的生物化疗可明显改善患者的疾病控制率,无进展生存期、总生存期有延长趋势,毒副作用可耐受,是一种有良好前景的治疗模式。     

肝动脉插管栓塞化疗联合腹腔灌注化疗治疗结直肠癌肝转移48例疗效观察

目的 探讨肝动脉插管栓塞化疗联合腹腔灌注化疗治疗结直肠癌肝转移的疗效.方法 48例结直肠癌分别行左半结肠、右半结肠或经腹直肠癌根治术后行肝动脉置泵,经药泵给药栓塞化疗及腹腔灌注化疗.结果 本组48例,完全缓解(CR)5例(10.42%),部分缓解(PR)23例(47.92%),总有效率(CR+PR)58.34%.生存期最短3个月,最长3年以上.结论 肝动脉插管栓塞化疗联合腹腔灌注化疗治疗结直肠癌肝转移,毒副反应小,疗效确切,是治疗结直肠癌肝转移的有效方法.     

62例消化道肿瘤的肝转移瘤的介入治疗

目的探讨采用介入化疗并栓塞方法治疗消化道肿瘤肝转移的疗效、并发症及生存期.方法治疗组38例采用介入法行肝动脉栓塞化疗(TAE),对照组24例,采用行肝动脉灌注化疗(TAI).结果介入栓塞化疗(TAE)组CR+PR为84.2%(32/38),介入灌注化疗(TAI)组CR+PR为37.5%(9/24)两组比较P＜0.01.介入栓塞化疗组38例中6,12,24个月生存期分别为94.7%、64.5%和41.7%而介入化疗灌注化疗组24例中6,12,24个月,生存率分别为58.3%、31.8%和15.0%.结论采用肝动脉栓塞化疗是消化道肿瘤肝转移的一种有效方法,无论在疗效及生存期上栓塞肿瘤(TAE)明显优于灌注化疗(TAI).     

氟脲苷肝动脉持续灌注联合草酸铂静脉化疗治疗肝转移癌

目的观察经肝动脉灌注氟脲苷(FUDR)同时联合草酸铂(OXA)静脉化疗治疗肝转移癌的疗效及毒副反应.方法 28例结直肠癌或胃癌肝转移患者,经肝动脉灌注FUDR,静脉输入OXA治疗2～6个周期.所有病例均行术前术后CT扫描评价治疗效果.随访44个月,评价疗效、生存期及毒副反应.结果总有效率为42.8%,中位生存时间(MST)为25个月,出现肝转移后的MST为15.5个月,1,2,3年生存率分别为89.3%、67.8%和25.0%.结论采用新的化疗方案FUDR加OXA局部联合全身同时化疗安全有效,患者生存期得以延长.     

结肠癌肝转移肝动脉介入治疗的局限性

目的 分析结肠癌肝转移行肝动脉介入治疗后的疗效,探讨介入治疗的局限性。方法 对75例结肠癌肝转移行肝动脉介入治疗后患者进行分析,分别就肿瘤结节单发或多发、合并其它脏器转移与否、肿瘤积压供多寡、单纯灌注或灌注加栓塞、单纯介入治疗或结合全身化疗等方面对患者的中位生存期进行比较。化疗药物选用表阿霉素（E-ADM）或顺铂（PDD）、丝裂霉素（MMC）、甲酰四氢叶酸钙（CF）、氟尿嘧啶（5-FU）联合方案,或加超液化碘油（LUF）栓塞。结果 近期疗效以CT作为评价手段,有效率（CR PR）为45.3%,中位生存期20.0个月。有效者（CR PR）中位生存期为27.5个月,1年生存率为100%;无效者（无变化 进展：NC PD）平均生存期为16.0个月,1年生存率为65.0%。全组1、2、3、4、5年生存率分别为87.0%、48.1%、27.4%、22.4%、16.8%。肝单发转移、未合并其它脏器转移、肿瘤多血供加栓塞治疗、结合全身化疗者中位生存期较长。结论 经肝动脉介入治疗结肠癌肝转移是目前较为有效的治疗方法之一,但须根据病情制订治疗方案并结合全身化疗进一步提高疗效。     

经门静脉和肝动脉灌注化疗治疗不可切除的结直肠癌肝转移的临床研究

[目的]探讨不可切除的结直肠癌肝转移患者的治疗方法.[方法] 97例不可切除的结直肠癌肝转移患者分为治疗组47例和对照组50例.对照组结直肠癌切除术后2周开始FOLFOX方案全身化疗.治疗组在结直肠癌切除术中及术后经门静脉和肝动脉化疗泵行5-Fu肝脏局部灌注化疗,全身化疗和其余治疗同对照组.[结果]两组治疗后病灶数目和大小均减小,CEA、CA199均降低,两组差异显著(P＜0.05).治疗组中位生存时间33.7个月,1、3、5年生存率分别为81.2％、42.8％和10.6％,对照组中位生存时间21.8个月,1、3、5年生存率分别为64.0％、19.7％和0,两组差异显著(P＜0.05);两组术后并发症及不良反应发生率无明显差异(P＞0.05).[结论]经门静脉和肝动脉灌注化疗对于不可切除的结直肠癌肝转移瘤是安全有效的,可以延长患者的生存期,改善患者预后.     

乳腺癌肝转移的治疗(附48例病例报告)

目的比较乳腺癌肝转移肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)和全身化疗的疗效.方法对48例经检查证实的乳腺癌肝转移患者28例行TACE治疗,20例行单纯全身化疗进行分析.结果 TACE组有效率为35.7%,显著高于全身化疗组(P<0.05),1、2、3年生存率TACE组分别为62.24%、31.12%、10.37%,单纯化疗组分别为31.58%、10.69%、0%,结果发现两者的生存期存在明显差异(P<0.05).结论 TACE治疗和全身治疗疗效有明显差异,TACE治疗在乳腺癌肝转移治疗中更值得提倡.     

198例结直肠癌肝转移患者外科治疗的疗效分析

背景与目的:肝脏是结直肠癌常见的转移部位,35%的患者在确诊时已发生肝转移,肝转移患者的预后较差。尽管手术切除、化疗、射频消融术、介入治疗等手段应用于临床,但治疗效果不同。本研究探讨结直肠癌肝转移外科治疗的临床疗效。方法:对我院5年间经病理检查证实的198例结直肠癌肝转移患者的临床资料进行回顾性分析。根据治疗方法的不同进行分组:根治性切除组46例(23.2%)、姑息性切除组43例(21.7%)、手术探查组或最佳支持治疗组29例(14.6%)、肝动脉置泵化疗组41例(20.7%),全身化疗组39例(19.7%);对其生存期进行比较和统计学分析。结果:根治性切除组中位生存期37.1个月,5年生存率为31.2%;姑息性切除组的中位生存期14.3个月,5年生存率为0;肝动脉置泵化疗组的中位生存期21.3个月,5年生存期为7.5%;全身性化疗和探查组或最佳支持治疗组的中位生存期分别为18.7个月、6.3个月,均无5年生存者。根治性切除组与其他组比较,中位生存期有统计学意义(P<0.01)。结论:根治性切除是提高结直肠癌肝转移患者生存率的重要手段;姑息性切除治疗效果并不优于辅助性治疗,对于不能根治性切除的病例可采用肝动脉置泵化疗。     

白蛋白结合型紫杉醇联合吉西他滨动脉灌注治疗进展期胰腺癌的安全性和有效性回顾性研究

背景与目的：白蛋白结合型紫杉醇联合吉西他滨（nab-paclitaxel combined with gemcitabine,AG）方案静脉化疗是进展期胰腺癌有效治疗方案之一,动脉灌注化疗（transcatheter arterial chemotherapy,TAC）具有增强疗效并降低不良反应的优势,观察AG方案经TAC治疗进展期胰腺癌患者的有效性和安全性。方法：回顾性分析2016年1月—2019年6月复旦大学附属肿瘤医院收治的63例接受治疗的进展期胰腺癌患者,患者均经病理学检查确诊为胰腺导管腺癌,其中Ⅲ期15例,Ⅳ期48例,所有患者接受经动脉灌注化疗和（或）栓塞治疗,动脉灌注化疗用药方案为盐酸吉西他滨1 000 mg/m ² 联合白蛋白结合型紫杉醇125 mg/m ² ,灌注时间≥10 min,伴有肝转移者同时行供血动脉栓塞。结果：63例患者中,术中行数字减影血管造影（digital subtraction angiography,DSA）可见胰腺肿瘤和肝转移灶动脉供血比例分别为66.67%和35.29%;接受治疗1次4例,2次6例,3次6例,4次及以上47例,治疗次数最多为9次,间隔时间为21～45 d。1年生存率为36.51%,中位生存期（median overall survival,mOS）为9.2个月,6个月无进展生存（progression-free survival,PFS）率为44.44%,中位PFS（median PFS,mPFS）为4.7个月。多因素分析显示KPS≥80、Ⅲ期与较长的生存期相关,接受多次动脉灌注化疗和（或）栓塞是良好的生存预后相关因素。发生治疗相关的Ⅲ度及以上血液学不良反应包括中性粒细胞减少（3.17%）和血小板下降（4.76%）,非血液学不良反应包括乏力（6.35%）、恶心呕吐（9.52%）、腹泻（4.76%）和转氨酶升高（4.76%）;17.46%和22.22%的患者出现发热及肝区疼痛栓塞综合征,所有不良反应经治疗后均好转,无治疗相关性死亡病例。结论：白蛋白结合型紫杉醇联合吉西他滨经动脉灌注治疗进展期胰腺癌具有较好的安全性,不良反应与静脉给药相比有所减少,可有效地控制病情,使患者生存获益。     

乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。     

CalliSpheres载药微球经肝动脉化疗栓塞治疗全身化疗失败的不可切除结直肠癌肝转移的疗效及预后因素分析

目的 观察CalliSpheres载药微球经肝动脉化疗栓塞术(drug?eluting bead transarterial chemoembolization,DEB?TACE)治疗全身化疗失败的不可切除结直肠癌肝转移的疗效与安全性.方法 回顾性分析2018年6月—2020年6月山东省临沂市肿瘤医院收治的42例至少接...     

影响乳腺癌肝转移患者预后的多因素分析

目的:分析影响乳腺癌肝转移患者的预后因素。方法:回顾分析我院1991年3月-2004年2月收治的26例乳腺癌肝转移患者的临床资料,采用t检验比较多因素对乳腺癌肝转移患者TTP影响的差异。结果:乳腺癌肝转移患者化疗的有效率为53．84％。肝内单一转移灶7人,中位TTP为9．86个月,多个转移灶19人,中位 TTP为6．10个月,P>0．05;不伴有其它远处转移灶10人,中位TTP为5．00个月,伴有其它远处转移灶16人,中位 TTP为9．86个月,P>0．05;肝转移后化疗17人,中位TTP为9．65个月,不化疗9人,中位TTP为2．33个月,P< 0．05。结论:化疗对乳腺癌肝转移患者的预后有明显的影响,肝内转移灶数目和是否伴有其它转移灶对预后影响不明显。     

结直肠癌肝转移患者经微波消融联合肝动脉栓塞化疗的效果和肝功能变化情况

目的探讨微波消融术(MWA)联合肝动脉化疗栓塞术(TACE)治疗结直肠癌肝转移中的临床疗效及其患者肝功能变化、生存情况以及生活质量评价。方法回顾性分析80例结直肠癌肝转移患者的临床相关资料,其中有38例单独行肝动脉化疗栓塞术治疗,为TACE组;其他42例行微波消融联合肝动脉栓塞化疗进行治疗,为MWA+TACE组。对2组的临床疗效、患者肝功能变化、生存情况以及生活质量评价数据进行整理分析。结果 TACE组和MWA+TACE组的临床有效率分别是39.5%和76.2%,MWA+TACE组患者的临床疗效显著优于TACE组患者(χ~2=11.098,P≈0.001)。2组患者的血清白蛋白、谷丙转氨酶、总胆红素含量等肝功能各项指标不存在统计学差异(P>0.05)。MWA+TACE组患者的2年、3年生存率显著高于TACE组(P<0.05)。在治疗6个月后,MWA+TACE组患者的生理状况、功能状况、情感状况、家庭/社会状况均显著高于TACE组患者(P<0.05);在总体评分上,MWA+TACE组患者显著优于TACE组(P<0.05)。结论微波消融联合肝动脉栓塞化疗治疗结肠癌肝转移有非常显著的效果,相对于单独化疗,能够延长患者的生存时间以及提高其生活质量,且对肝功能不会造成损害。     

术后首发肺转移的三阴性乳腺癌临床病理特点及预后因素分析

目的:分析和探讨术后首发肺转移的三阴性乳腺癌患者的临床病理特点,以及可能影响生存的预后因素。方法:对71例术后首发肺转移三阴性乳腺癌患者的临床资料进行回顾性分析,通过COX分析影响总生存的预后因素。结果:71例术后首发肺转移三阴性乳腺癌患者中以浸润性导管癌为主（97.2%）,术后中位无病间期为14.4个月,发生肺转移后的1、2、3年生存率分别为81.7%、45.1%、16.7%。单因素分析显示,新辅助治疗、原发肿瘤大小、淋巴结转移状态、临床分期、一线化疗最佳疗效、肺转移灶数目与预后相关（P＜0.05）。多因素分析显示,是否行新辅助治疗和肺转移灶数目是术后首发肺转移患者的独立预后因素（P＜0.05）。结论:术后首发肺转移三阴性乳腺癌患者术后无病间期短,远期生存率较低,是否行新辅助治疗和肺转移灶数目是影响术后首发肺转移患者转移后总生存期的独立预后因素。     

Clinical characteristics and prognosis of triple-negative breast cancer patients with postoperative initial visceral metastasis北大核心CSCD

Objective: To analyze and discuss the clinicopathologic characteristics of triple-negative breast cancer with initial visceral metastasis after surgery, as well as the efficacy of first-line chemotherapy and the prognostic factors. Methods: A retrospective analysis was performed using the clinical data of 107 triple-negative breast cancer patients with postoperative initial visceral metastasis, who were treated in Department of Medical Oncology, Fudan University Shanghai Cancer Center from January 1, 2011 to June 30, 2013. The analysis also included their first-line chemotherapy efficacy, survival situation and prognostic factors. Results: Among 107 patients, there were 101 patients (94.4%) with invasive ductal carcinoma and 6 patients (5.6%) with other pathological types or mixed patterns. The postoperative median disease-free interval was 14.4 months; the 1-, 2- and 3-year survival rates after visceral metastasis were 75.7%, 41.1% and 22.4%, respectively. The objective response rate of first-line platinum-based chemotherapy was 60.0%, and the median progressionfree survival time was 8.6 months; which were significantly higher or longer than that in the non-platinum chemotherapy group (36.2%, P = 0.014; 5.1 months, P = 0.023). However, there was no significant difference in the median survival time between the two groups (19.9 vs 20.9 months, P = 0.423). Univariate analysis showed that neoadjuvant chemotherapy, postoperative radiotherapy, lymph node metastasis status, clinical stage, disease-free interval, best curative effect of first-line chemotherapy, plurivisceral metastasis, and progression-free survival after first-line chemotherapy had significant effects on the overall survival (all P < 0.05). Additionally, multivariate analysis showed that neoadjuvant chemotherapy and disease-free interval had significant effects on overall survival (both P < 0.05). Conclusion: The triple-negative breast cancer patients with initial visceral metastasis have short disease-free interval time and low long-term survival rate. The first-line platinumbased chemotherapy is a good choice for these patients. The neoadjuvant chemotherapy and disease-free interval within one year may be the independent prognostic factors for their overall survival. Copyright © 2017 by TUMOR All rights reserved.     

Breast cancer brain metastases: differences in survival depending on biological subtype,RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT)

Background: Patients with breast cancer brain metastasis are a heterogeneous group in relation to tumor biology and outcome.Materials and methods: The group of 222 breast cancer patients with brain metastasis was divided into three biological subgroups. The propensity of biological subtypes for metastases to the brain and survivals depending on biological subtype, recursive partitioning analysis of Radiation Therapy Oncology Group (RPA RTOG) prognostic class and the use of systemic treatment after whole-brain radiotherapy were assessed.Results: The rate of patients with triple-negative, human epidermal growth factor receptor 2 (HER2)-positive and luminal breast cancer with brain metastases was 28%, 53% and 19%, respectively. Median survival from brain metastases in triple-negative, HER2-positive and luminal subtype was 3.7, 9 and 15 months, respectively. Median survival from brain metastases in RPA RTOG prognostic class I, II and III was 15, 11 and 3 months, respectively. In the luminal and in the triple-negative subtype, systemic therapy prolonged survival from 3 to 14 months and from 3 to 4 months, respectively. In HER2-positive subtype, median survival without further treatment, after chemotherapy and after chemotherapy with targeted therapy were 3, 8 and 11 months, respectively.Conclusions: HER2-positive and triple-negative breast cancers have special predilection for metastases to the brain. Survival from brain metastases depended on performance status and the use of systemic treatment.     

Clinical characteristics and prognosis of triple-negative breast cancer patients with postoperative initial visceral metastasis北大核心CSCD

Objective: To analyze and discuss the clinicopathologic characteristics of triple-negative breast cancer with initial visceral metastasis after surgery, as well as the efficacy of first-line chemotherapy and the prognostic factors. Methods: A retrospective analysis was performed using the clinical data of 107 triple-negative breast cancer patients with postoperative initial visceral metastasis, who were treated in Department of Medical Oncology, Fudan University Shanghai Cancer Center from January 1, 2011 to June 30, 2013. The analysis also included their first-line chemotherapy efficacy, survival situation and prognostic factors. Results: Among 107 patients, there were 101 patients (94.4%) with invasive ductal carcinoma and 6 patients (5.6%) with other pathological types or mixed patterns. The postoperative median disease-free interval was 14.4 months; the 1-, 2- and 3-year survival rates after visceral metastasis were 75.7%, 41.1% and 22.4%, respectively. The objective response rate of first-line platinum-based chemotherapy was 60.0%, and the median progressionfree survival time was 8.6 months; which were significantly higher or longer than that in the non-platinum chemotherapy group (36.2%, P = 0.014; 5.1 months, P = 0.023). However, there was no significant difference in the median survival time between the two groups (19.9 vs 20.9 months, P = 0.423). Univariate analysis showed that neoadjuvant chemotherapy, postoperative radiotherapy, lymph node metastasis status, clinical stage, disease-free interval, best curative effect of first-line chemotherapy, plurivisceral metastasis, and progression-free survival after first-line chemotherapy had significant effects on the overall survival (all P < 0.05). Additionally, multivariate analysis showed that neoadjuvant chemotherapy and disease-free interval had significant effects on overall survival (both P < 0.05). Conclusion: The triple-negative breast cancer patients with initial visceral metastasis have short disease-free interval time and low long-term survival rate. The first-line platinumbased chemotherapy is a good choice for these patients. The neoadjuvant chemotherapy and disease-free interval within one year may be the independent prognostic factors for their overall survival. Copyright © 2017 by TUMOR All rights reserved.