肝门部胆管癌外科治疗的疗效及预后影响因素分析

目的 探讨肝门部胆管癌(HCC)外科治疗的临床效果及预后影响因素。方法 回顾性分析行外科手术治疗的114例HCC患者临床资料,分析HCC外科治疗的临床效果及预后影响因素。结果 114例HCC患者中行根治性切除61例(53.51%),其中姑息性切除53例(46.49%),根治性切除术后出现肝功能衰竭3例,胆瘘5例,胆道感染4例,切口感染11例,姑息性切除术后出现胆道感染5例,胆漏4例;随访术后3年总体生存率为24.56%(28/114),根治性切除术后3年生存率为36.07%(22/61),高于姑息性切除术的11.32%(6/53),差异有统计学意义(P<0.05);单因素分析显示：手术方式、肿瘤分化程度、TNM分期、淋巴结转移、门静脉侵犯、合并高胆红素血症与HCC外科治疗预后有关,差异有统计学意义(P<0.05);年龄、性别、肿瘤大小、手术时间、辅助化疗、术中出血量与HCC外科治疗预后无关,差异无统计学意义(P>0.05);多因素分析显示：姑息性切除、肿瘤低分化、TNM分期T3-T4期、淋巴结转移、门静脉侵犯、合并高胆红素血症是影响HCC外科治疗预后的高危因素(P&l...     

67例肝门部胆管癌的外科治疗及预后分析

目的：探讨肝门部胆管癌（HCC）的外科治疗特点及预后因素,以期进一步提高HCC外科疗效。方法：回顾性分析67例病理诊断为HCC患者的临床资料。结果：不同手术方法术后累计生存率差异显著（P〈0.001）。根治切除组1、3年生存率显著高于姑息切除组和单纯引流组,手术切除组较非手术切除组生存时间显著提高（P〈0.001）。术前T分期和Bithmuth分型能指导手术切除率及术式选择。不同的T分期的手术切除率及切缘阴性率差异显著（P〈0.001）。分别对16个可能影响预后的因素进行单因素预后分析表明肿瘤大小、门静脉侵犯、局部浸润及转移、手术方法、UICC分期、改良T分期、淋巴结转移对预后有影响,统计学上有显著性差异（P〈0.05）。COX模型多因素预后分析表明手术方法、UICC分期是两个独立预后因素。结论：根治性切除是最重要预后因素,扩大手术范围能获得较好切缘无癌率,术前的T分期和Bismuth分型综合评估将有助于进一步在安全的范围内提高手术切除率及根治性切除率。     

原发性肝癌的三级根治切除标准

目的阐述原发性肝癌三级根治切除标准的内容并评价其临床意义.方法根据根治标准的完善程度将肝癌根治切除标准分为3级.Ⅰ级标准完整切除肉眼所见肿瘤,切缘无残癌.Ⅱ级标准在Ⅰ级标准基础上增加4项条件(1)肿瘤数目不超过2个;(2)无门脉主干及一级分支、总肝管及一级分支、肝静脉主干及下腔静脉癌栓;(3)无肝门淋巴结转移;(4)无肝外转移.Ⅲ级标准在Ⅱ级标准基础上增加术后随访结果阴性条件,即术后2个月内AFP降至正常(术前AFP阳性者)和影像学检查未见肿瘤残存.回顾性分析354例肝癌患者行肝切除治疗的临床资料,按3级标准的根治与否分为6组Ⅰ级标准根治组,Ⅰ级标准姑息组;Ⅱ级标准根治组,Ⅱ级标准姑息组;Ⅲ级标准根治组,Ⅲ级标准姑息组.寿命表法计算各组生存率,并加以比较.结果原发性肝癌各根治切除组生存率均高于相应姑息组(P<0.01).随着采用根治标准级别的升高,其切除后生存率也逐级提高,Ⅰ级、Ⅱ级和Ⅲ级标准根治组5年生存率分别为43.2%、51.2%和64.4%,各组生存率差异有显著性(P<0.01).结论原发性肝癌手术切除可以采用分级根治标准判定手术根治性.所应用的根治标准越严格,其获得的疗效越好.按较高级别肝癌根治切除标准选择病例、实施手术和加强随访,将提高肝癌切除手术疗效.     

肝外胆管癌161例的外科治疗和预后分析

目的：探讨肝外胆管癌（extrahepatic cholangiocarcinoma，EHCC）的临床特征和治疗方法对患者远期生存率的影响及EHCC切除术后的预后因素。方法：对1995年4月至2006年7月收治的161例EHCC患者的临床特点、诊断、手术方式和随访结果进行回顾分析。选择对EHCC切除术后的预后可能产生影响的临床因素，通过COX比例风险模型进行多因素预后分析。结果：161例手术治疗的EHCC，根治性切除110例，姑息性切除32例，引流或探查19例。161例患者总体1、2、3、5年生存率分别为74．9％、45．3％、36．5％和11．1％。COX分析结果表明肝脏浸润、门脉或肝动脉侵犯和淋巴结转移是EHCC根治切除影响预后的独立因素（P〈0．05）。结论：根治性切除是提高EHCC患者远期生存率及改善生活质量的关键，肝叶切除和（或）胰十二指肠切除联合骨骼化切除是提高根治切除率及远期疗效的重点。     

原发性肝癌肝切除术肝动脉与门静脉灌注化疗的比较

目的评价原发性肝癌根治性切除术后肝动脉灌注化疗与门静脉灌注化疗的疗效，探讨原发性肝癌根治性切除术后复发及转移的预防途径。方法经病理确诊的原发性肝癌７５例，其中４２例行根治性切除及术后选择性肝动脉插管化疗，３３例行根治性切除及术后门静脉灌注化疗。每隔１～３个月重复，定期复查。结果原发性肝癌切除术后肝动脉灌注化疗组的术后复发率（２１．４３％）低于门静脉灌注化疗组（３６．３６％），且生存时间（１１．４个月）明显较门静脉灌注化疗组（７．６个月）长，而门静脉灌注化疗组的转移率（９．０９％）明显低于肝动脉灌注化疗组（３２．１４％）。结论原发性肝癌根治性切除术后行肝动脉灌注化疗较门静脉灌注化疗疗效好，而原发性肝癌切除术后同时结合肝动脉、门静脉灌注化疗对术后预防肿瘤的复发与转移可能更为理想     

残胃癌的治疗和预后

残胃癌(GSC)的主要治疗方式为手术切除,应当整块切除肿瘤并行根治性淋巴结切除术.晚期GSC若无法行根治术,应争取行姑息性切除术,以改善患者的生活质量,延长生存期.GSC的预后与肿瘤浸润深度、病理分期、胃周淋巴结转移情况、是否可行根治性切除等密切相关.     

纵隔淋巴结转移非小细胞肺癌的外科治疗

目的：总结纵隔淋巴结转移（N2）肺癌的外科治疗效果,探讨其临床病理特点与预后关系。方法：用SPSS软件对我院外科治疗1083例非小细胞肺癌建立数据库,对其中147例N2肺癌进行统计分析。结果：N2组中鳞癌发生率最低,肺鳞癌淋巴结转移度明显低于其他类型肺癌（P＜0．01）,其预后明显优于肺腺癌（P＜0．05）。根治性切除者淋巴结转移度明显低于姑息性切除者,预后明显优于姑息性切除者（P＜0．05）。淋巴结转移数与预后有关,＞4枚者预后差（P＜0．05）。手术方式及术后综合治疗与预后无明显关系。结论：肺癌外科治疗常规进行纵隔淋巴结清扫对达到根治效果和准确分期十分必要。     

手术切除治疗巨大原发性肝癌的预后因素分析

目的 研究巨大原发性肝癌患者手术切除治疗后的预后影响因素,寻找改善巨大原发性肝癌患者预后的方法。方法 回顾性分析69例手术切除治疗的巨大原发性肝癌患者的临床资料,采用Cox回归模型对16个可能与患者预后有关的因素进行统计学分析。结果 58例患者获得随访,随访患者的l、3、5年生存率分别为58.2％、31.4％和12.3％。单因素分析的结果显示,有无肝内转移、有无血管侵犯、肝硬化程度和是否行根治性切除与巨大原发性肝癌手术切除治疗后患者的预后有关（均P＜0.05）。Cox多因素回归分析的结果显示,肝硬化程度、有无肝内转移和是否行根治性切除是影响巨大原发性肝癌患者手术切除治疗后预后的独立因素（均P＜0.05）。结论 积极行手术切除是治疗巨大原发性肝癌的主要措施,其预后取决于是否伴有肝内转移、肝硬化程度和是否行根治性切除。     

肝癌根治性切除术后复发率及危险因素

原发性肝癌的发病率近年来呈增高的趋势，肝癌的死亡率，根据中国肿瘤防治研究办公室进行的中国恶性肿瘤死亡抽样调查结果显示，已由原来的第三位升至第二位。目前原发性肝癌是有效的治疗方法仍然是手术切除。虽然近年来肝癌的手术切除率明显提高，但肝癌切除术后的复发严重影响肝癌生存期的提高。因此肝癌术后复发的预防和治疗是当前一个重要研究领域。一、肝癌的根治性切除目前根治性切除的标准尚不一致。欧美学者多认为肉眼所见肿瘤完全切除即为根治。有些亚洲学者则认为肝切缘应距肿瘤1cm～2cm方局根治。一般认为根治性切除的标准为：（…     

不同手术方法治疗肝内胆管癌的临床效果评价及预后危险因素分析

目的探讨不同手术方法治疗肝内胆管癌的临床效果及影响预后的危险因素分析。方法选取肝内胆管癌患者106例,所有患者行术前诊断评估,并根据不同的手术治疗方法分为手术根治切除治疗(根治组)、姑息性切除与辅助治疗(姑息治疗组)、对症治疗(经皮途径也能完成胆道引流)(对症治疗组),并对不同手术切缘的生存率及影响预后的因素进行分析。结果根治组患者的预后优于姑息治疗组,姑息治疗组患者的预后优于对症治疗组,生存率及中位生存时间由高到低为手术根治组>姑息治疗组>对症治疗组。单因素分析发现术前CA19-9、ALT以及淋巴结转移与预后相关(P<0.05),患者的性别、年龄、肝硬化、白蛋白以及合并结石与预后无关(P>0.05);行Cox回归分析发现,淋巴结转移、CA19-9、AJCC分期、肿瘤多发以及谷丙转氨酶为肝内胆管癌患者长期生存预后因素。手术方式及手术切缘对预后均有影响。结论肝内胆管癌患者术前完善各项相关检查,对疾病的准确诊断评估具参考价值,根治性手术治疗可明显改善患者预后。     

Prediction of the risk of hepatic failure in patients with portal vein invasion hepatoma after hepatic resection.

AIM: Hepatic failure can develop after curative hepatectomy in patients with a hepatocellular carcinoma (HCC) invading the portal vein, because of cirrhosis and excessive tissue loss. This study aimed to identify the risk factors for hepatic failure in such patients. METHOD: Forty patients with an HCC invading the portal vein underwent curative hepatectomy from January 1995 to June 2003. Eight patients developed hepatic failure and died within 3 months. Possible risk factors for this were analysed using univariate and multivariate regression. These included the liver function index, surgical blood loss, tumour pattern, portal hypertension, estimated residual liver volume measured by computed tomography (ERLV(CT)) and estimated residual liver volume using the indocyanine green (ICG) retention rate at 15 min (ERLV(ICG15)). RESULTS: The ERLV(CT) smaller than the ERLV(ICG15) and presence of portal hypertension were independent risk factors for post-hepatectomy hepatic failure. CONCLUSION: Having portal vein invasion HCC with portal hypertension or an ERLV(CT) less than an ERLV(ICG15) are significant predictors of post-hepatectomy hepatic failure. These factors are important considerations for patients with portal vein invasion HCC who could undergo curative hepatic resection.     

术前FIB-4评分与肝细胞癌术后患者预后的关系研究

  目的   探讨FIB（Fibrosis）-4评分系统与肝细胞癌（HCC）患者临床病理特征及预后的关系。  方法   收集2009年1月至2012年12月间245例接受根治性肝切除手术的HCC患者的临床及随访资料进行分析,利用Kaplan-Meier进行单因素生存分析,Cox比例风险回归模型进行多因素生存分析。  结果   根据患者术前FIB-4评分,将患者分为FIB-4Ⅰ（≤3.25）和FIB-4Ⅱ（ > 3.25）。FIB-4能够预测肝硬化程度（Ishak分级:1~5级 vs. 6级,r=0.681,P < 0.001）,其主要与患者的肝功能指标如谷草转氨酶（P < 0.001）、胆红素（P=0.009）、白蛋白（P=0.001）及血小板计数（P < 0.001）相关,与其他病理特征无关。单因素及多因素分析均表明FIB-4能够预测HCC患者的预后（总生存时间:P=0.037,0.011;无瘤生存时间:P=0.027,0.043）。  结论  FIB-4有可能作为HCC根治性切除术后的预后参考指标之一。      

HLA class I antigens are possible prognostic factors in hepatocellular carcinoma

Thirty patients who underwent hepatectomy for the treatment of hepatocellular carcinoma (HCC) were examined for expression of HLA class I antigens on HCC cells by flow cytometry. The expression was found significantly lower in cases of stage IV compared with those of stage I or stage II (p<0.05), and in cases of intrahepatic metastases compared with those without metastases (p<0.001). In cases of non-curative hepatectomy, the expression of HLA class I antigens was lower compared with those treated by curative resection. Postoperative cumulative disease-free survival rates were well correlated with the expression rate of HLA class I antigens (p<0.05). Expression of HLA class I antigens on HCC may indicate low malignancy and better prognosis.     

Systemic therapy for hepatocellular carcinoma (HCC): from bench to bedside

Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of cancer mortality. For patients with early resectable disease, surgical resection or transplantation is considered a potentially curative modality for hepatocellular carcinoma (HCC); on the other hand, for patients with unresectable or metastatic disease, treatment is essentially palliative and prior to the approval of sorafenib, there was no globally approved systemic treatment for patients presenting with unresectable or metastatic HCC. Sorafenib is the only systemic treatment to demonstrate a statistically significant but modest overall survival benefit in a large phase III trial. Thus, novel systemic approaches represent a high unmet medical need in advanced HCC. In this review article, we will try to take a journey through the history of systemic therapeutic options for HCC passing through the current standard options and exploring the potential new systemic options for this disease.     

Comment on “Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”

The present letter to the editor is in response to the research “Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis” by Elshaarawy et al in World J Gastroenterol 2021; 13(5): 424–439. The preoperative assessment of the liver reserve function in hepatocellular carcinoma (HCC) patients with cirrhosis is crucial, and there is no universal consensus on how to assess it. Based on a retrospective study, Elshaarawy et al investigated the impact of various classical clinical indicators on liver failure and the prognosis after hepatectomy in HCC patients with cirrhosis. We recommend that we should strive to explore new appraisal indicators, such as the indocyanine green retention rate at 15 min.     

原发性肝癌伴胆管癌栓的外科治疗方式

目的 探讨伴胆管癌栓的原发性肝癌(HCC)外科治疗方式的选择。 方法 回顾性分析1994～2001年15例HCC伴胆管癌栓的外科治疗情况。 结果 肝癌切除加胆管癌栓清除术7例,肝癌切除加肝外胆管切除术4例,单纯胆总管切开取栓术3例,背驮式肝移植1例。术后1年生存率为73.3％,3年生存率为40％,其中有2例生存已超过5年。 结论 原发性肝癌伴胆管癌栓行外科治疗是一种积极有效的治疗方法。复发后的再次手术可取得较好疗效。肝移植作为一种崭新的手术方式值得探讨。     

Treatment of recurrent hepatocellular carcinoma after liver transplantation

Aim: Liver transplantation (LT) is a curative treatment for localized hepatocellular carcinoma (HCC), but the recurrence rate after LT is about 10–20%, with a dismal prognosis. Little data exist as to the natural history, treatment outcome and optimal treatment of recurrent HCC after LT. We reviewed various treatment modalities given to patients with recurrent HCC after LT. Methods: Among 132 patients who underwent LT for localized HCC, we retrospectively reviewed medical records of 39 of the 132 patients who developed recurrent HCC after LT. We analyzed the clinical outcome of various treatment modalities and treatment‐related adverse events. Results: A total of 39 (29%) of the original 132 patients had recurrent HCC, most recurrences (82%) having occurred within 1 year after LT and involved extrahepatic lesions. Only seven patients had recurrent disease limited to the liver. The median overall survival from the initial treatment of all relapsed patients was 6.9 months. There were various initial treatment modalities, namely palliative systemic chemotherapy, trans‐catheter arterial chemo‐embolization/infusion (TACE/I), radiation therapy (RT), surgical resection and no treatment. The median overall survival was 9.5 months for first‐line chemotherapy, including those who had prior local therapy, 6.3 months TACE/I and 6.9 months for RT. Conclusion: Various clinical approaches have been used to treat patients with recurrent HCC after LT in a clinical setting. More effective strategies and clinical guidelines for recurrent HCC following LT must be established.     

Expression and prognostic significance of osteopontin and caspase‐3 in hepatocellular carcinoma patients after curative resection

Osteopontin (OPN) plays an important role in the development, invasion, and metastasis of malignancies. Recently, several studies have reported that OPN enhances chemoresistance in small‐cell lung cancer and breast cancer by blocking caspase‐9 and caspase‐3‐dependent cell apoptosis. The aim of this study was to assess the value of OPN and caspase‐3 for predicting tumor recurrence after curative resection in hepatocellular carcinoma (HCC) patients. We found that OPN expression increased concordantly with increasing metastatic potential in human HCC cell lines, whereas caspase‐3 expression declined. In a tumor tissue microarray immunohistochemical analysis, we found that patients with higher levels of OPN and lower levels of caspase‐3 had a significantly poorer prognosis than patients with lower OPN and higher caspase‐3 levels. The combination of OPN and caspase‐3 expression thus served as an effective prognosticator. These findings suggest that OPN alone or in combination with caspase‐3 may act as an independent indicator for HCC patients after curative resection. (Cancer Sci 2010; 101: 1314–1319)