131I美妥昔单抗注射液联合TACE治疗76例中晚期原发性肝癌的疗效及安全性研究

目的 评价131I美妥昔单抗注射液(利卡汀)联合TACE治疗中晚期原发性肝癌的疗效及安全性.方法 收集2010年11月至2013年5月期间收治的76例原发性肝癌患者,按治疗意愿分为单抗组(美妥昔单抗联合TACE治疗)及对照组(单纯TACE治疗)各38例.入组患者按要求行介入治疗,并定期随访,以评估疗效及不良反应.随访截止日期为2015年3月或肿瘤出现进展.结果 单抗组与对照组相比:1个月临床缓解率分别为23.7％和18.4％;疾病控制率分别为92.1％及97.4％;疾病中位无进展生存期(mPFS)为6个月及8个月,两组间差异无统计学意义(P＞0.05).两组间治疗相关的不良反应基本相仿,而在血液毒性及肝功能损害方面,试验组较对照组更为明显,但多为一过性,未发生与治疗药物相关的严重不良事件.结论 对于中晚期原发性肝癌,美妥昔单抗联合TACE治疗安全性高,但疗效尚需进一步验证.     

HAIC序贯TAE治疗不可切除肝细胞癌的安全性和有效性北大核心CSCD

目的 评估肝动脉灌注化疗(HAIC)序贯肝动脉栓塞术(TAE)治疗不可切除肝细胞癌的安全性及有效性。方法 收集2020年4月至2021年4月采用HAIC序贯TAE治疗的25例肝癌患者的临床资料,以ALBI评分评估患者肝功能变化情况,记录术后出现的不良反应。根据改良实体瘤疗效评价标准(mRECIST)评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),并随访患者的疾病进展时间(TTP)和生存时间(OS)。结果 患者首次治疗后3个月ALBI评分(-2.29±0.53)与术前(-2.32±0.44)相比,差异无统计学意义(t=-0.223,P=0.825)。主要不良反应包括肝功能损伤、骨髓抑制、腹痛、恶心呕吐、发热等,4例患者出现Ⅲ级不良反应(3例ALT升高,1例骨髓抑制),其余均为Ⅰ~Ⅱ级不良反应。术后6周ORR、DCR分别为68%、92%,术后12周ORR、DCR分别为72%、88%,中位TTP为271 d(95%CI:115.9~426.0),中位OS为510 d(95%CI:491.5~528.5)。结论 HAIC序贯TAE治疗不可切除肝癌临床疗效显著,具有良好的耐受性,是安全可行的。     

碳酸氢钠肝动脉灌注联合TACE治疗中晚期原发性肝癌的疗效观察

【摘要】 目的 观察碳酸氢钠肝动脉灌注联合TACE治疗中晚期原发性肝癌的临床效果和安全性。方法 选取2013年1月至2017年6月绍兴第二医院收治的57例不适合手术治疗的中晚期原发性肝癌患者,将其随机分为研究组（n=24）和对照组（n=33）,研究组采用碳酸氢钠肝动脉灌注联合TACE治疗,对照组采用传统TACE治疗,每6～8周为一个疗程,共治疗1～6个周期。评价两组介入治疗术后并发症发生率、肝功能和血清AFP改变情况、不同时段的的治疗有效率（ORR）、疾病控制率（DCR）和总生存时间（OS）。结果 两组患者介入治疗后均无严重并发症发生;术后1周肝肾功能变化和AFP下降水平等差异均无统计学意义（P＞0.05）;研究组和对照组在介入治疗后1、3、6和12个月的ORR和DCR差异均无统计学意义（P＞0.05）;两组的6、12、18、24、36个月生存率差异也均无统计学意义（P＞0.05）。结论 碳酸氢钠肝动脉灌注联合TACE治疗晚期原发性肝癌的临床效果与传统TACE（c-TACE）治疗相比无明显差异,但确切疗效还有待多中心、大样本、前瞻性随机对照研究评估。     

经肝动脉化疗栓塞治疗肝癌的疗效分析

目的 探讨经肝动脉化疗栓塞(TACE)、单纯灌注化疗(TAI)治疗原发性肝癌的疗效。材料与方法对32例原发性肝癌中25例行TACE治疗,7例行TAI治疗。结果通过TACE治疗的病例半年、1年、2年生存率分别为70％、56％、32．2％,TAI治疗的病例提高了生存质量。结论TACE治疗原发性肝癌能提高患的生存质量。延长生存时间。TAI治疗仅能提高生存质量。     

经导管肝动脉栓塞化疗联合华蟾素门静脉灌注治疗中期原发性肝癌疗效研究

目的探讨经导管肝动脉栓塞化疗(TACE)联合华蟾素门静脉灌注治疗中期原发性肝癌患者的临床疗效与预后。方法选取自2011年2月至2013年11月收治的中期原发性肝癌患者79例,其中,单独应用TACE的患者40例(单独组),联合应用TACE与华蟾素门静脉灌注的患者39例(联合组)。比较两组患者存活与门静脉侵犯情况,并分析其影响因素。结果单独组与联合组患者的1年存活率分别为62.5%(25/40)与82.1%(32/39),2年存活率分别为22.5%(9/40)与35.9%(14/39),3年存活率分别为7.5%(3/40)与17.9%(7/39);中位存活时间分别为15.0个月与18.0个月;门静脉癌栓发生率分别为82.5%(33/40)与61.5%(24/39)。两组比较,差异均有统计学意义(P<0.05)。华蟾素门静脉灌注、ChildPugh分级、甲胎蛋白水平及肿瘤大小是影响患者预后的独立危险因素。结论 TACE联合华蟾素门静脉灌注治疗可明显改善中期原发性肝癌患者的预后,值得临床推广。     

TACE联合瑞戈非尼序贯治疗中晚期肝细胞癌的疗效和安全性

【摘要】 目的 评估TACE联合瑞戈非尼二线序贯治疗中晚期肝细胞癌（HCC）的临床疗效和安全性。方法 纳入2018年6月至2019年12月中国科学院大学附属肿瘤医院收治的中晚期HCC患者60例。患者均接受TACE联合索拉非尼一线靶向治疗,因疾病进展或无法耐受索拉非尼,口服瑞戈非尼二线序贯治疗。按mRECIST标准评价疗效,并观察患者的疾病进展时间和总生存期（OS）,服药期间记录不良反应的发生。结果 随访至2021年6月,60例患者中,存活38例,死亡12例,失访10例,客观有效率（ORR）为3.3%,疾病控制率（DCR）为56.6％,中位疾病进展时间（mTTP）为3.5个月（95％CI:2.9～4.1个月）,中位总生存期（mOS）为11.3个月（95％CI:9.8～12.8个月）,1年生存率为76%。TACE联合瑞戈非尼的不良反应有手足皮肤反应35例（58.3％）,口腔黏膜炎18例（30％）,疲乏16例（26.7％）,腹泻22例（36.7％）,高血压7例（11.7％）,肝功能异常28例（46.7％）,蛋白尿4例（6.7％）,血小板减少27例（45％）,中性粒细胞减少16例（26.7％）,贫血32例（53.3％）等。结论 TACE联合瑞戈非尼二线序贯治疗中晚期HCC安全有效,对于索拉非尼治疗进展或无法耐受患者,联合序贯治疗可改善疾病进展时间和OS,且不良反应1～2级多见,绝大部分患者可耐受。     

三维适形放疗联合肝动脉化疗栓塞治疗原发性肝癌伴门静脉癌栓的疗效分析

目的 观察三维适形放疗联合TACE对不能手术的原发性肝癌伴门静脉癌栓的临床疗效.方法 33例原发性肝癌合并门静脉癌栓患者,TACE 1～2次后,行三维适形放射治疗,大体肿瘤靶区只包括癌栓,不包括肝内原发灶,采用4～6个共面或非共面照射野,使90%的等剂量曲线覆盖PTV.照射总量45～60Gy,单次照射剂量2～4 Gy/次.结果 有效率（CR＋PR）为54.6%（18/33）,1、2年的生存率分别为45.5%和21.2%.无严重并发症出现.结论 三维适形放射治疗联合TACE对肝癌合并门静脉癌栓有较好的疗效.     

经肝动脉栓塞化疗与激光消融术联合治疗原发性肝癌

目的研究原发性肝癌的综合性介入治疗方法和疗效。方法对A组38例原发性肝癌患者，采用经肝动脉灌注化疗栓塞术(TACE)，使用药物为吡柔比星(THP)50mg 丝裂霉素(MMC)10mg 卡铂(CBP)300mg 超化碘油。3～5次疗程后，全部病人在CT引导下行激光消融术。与B组38例原发性肝癌患者，仅行经肝动脉灌注化疗栓塞术。使用药物也为THP50mg MMC10mg CBP300mg 超化碘油，行3～8个疗程。治疗后复查二组患者的CT、甲胎蛋白(AFP)值及肝功能。结果A组治疗后肿瘤完全坏死率为85．4％。32例AFP值升高的患者，28例下降，3例不变，1例上升。治疗后第1、2年生存率分别为100％、81．5％。B组治疗后肿瘤完全坏死率为41．6％，28例AFP值升高患者中，下降12例，不变5例，上升11例。治疗后第1、2年生存率分别为68．4％、39．4％。两组肿瘤完全坏死率、AFP值的下降情况及第1、2年生存率的差异均有显著意义(其相应P值皆为0．001)。结论TACE联合激光消融术能有效地提高原发性肝癌的治疗效果，是1种值得推广的肝癌治疗的新模式。     

TACE联合中药治疗不可切除肝细胞癌的研究进展

肝细胞癌（HCC）是我国常见的恶性肿瘤之一,而对于中晚期的肝癌患者,大多数已丧失外科手术切除的机会,此时经皮肝动脉化疗栓塞术（TACE）是目前为止的首选治疗方案。虽然它有着较好的临床疗效,但其不良反应也是临床医生所必须面对的问题。传统中药由于药性温和,不良反应较少,可以减少化疗药物的用量,提高机体的免疫力,故采用TACE联合中药治疗原发性肝癌也逐渐被临床医生所推广。文章旨在综述康莱特、榄香烯、槐耳颗粒及肝复乐等中药与TACE联合治疗HCC的应用情况和优势。     

经肝动脉化疗、栓塞治疗原发性肝癌100例随访

自 1 990年 3月～ 1 997年 3月 ,我院共收治了42 0例不能手术切除的肝癌 ,作者分析了进行完整随访的 1 0 0例 ,探讨肝动脉化疗、栓塞治疗原发性肝癌的中远期生存率的影响因素。材料和方法一、一般资料1 0 0例中 ,男 75例 ,女 2 5例 ,年龄 2 0～ 70岁 ,平均 49岁 ,均经临床检查诊断为肝癌 ,所有病例初诊时 ,均因无手术指征而行肝动脉化疗加栓塞。二、方法采用Ｓｅｌｄｉｎｇｅｒ技术 ,先行腹腔动脉或肝总动脉造影 ,后将导管尽可能超选择性插入肿瘤供血动脉内 ,进行肝动脉化疗或栓塞 ,常用的药物有ＤＤＰ1 0ｍｇ ;ＭＭＣ 2 0ｍｇ ;5 Ｆｕ 1 .0…     

CalliSpheres载药微球经肝动脉化疗栓塞治疗大肝癌的近期疗效及安全性分析

目的探讨CalliSpheres载药微球经肝动脉化疗栓塞(DEB-TACE)治疗大肝癌的近期疗效及安全性。方法选取接受CalliSpheres DEB-TACE治疗的大肝癌患者作为观察组,并通过分层随机选取同期传统经肝动脉化疗栓塞(cTACE)治疗的大肝癌患者作为对照组,对比分析两组的近期疗效及安全性。结果共搜集60例大肝癌患者,观察组与对照组分别为30例。观察组1个月、3个月、6个月客观缓解率分别为73.3%、60%、46.7%,对照组1个月、3个月、6个月客观缓解率分别为40%、30%、16.7%;观察组1个月、3个月、6个月疾病控制率分别为90%、80%、70%,对照组1个月、3个月、6个月疾病控制率分别为63.3%、53.3%、43.3%。观察组不良反应发生率为90.0%,对照组不良反应发生率为96.7%。结论DEB-TACE治疗大肝癌的近期疗效优于cTACE,且安全可行,但结果仍需多中心、大样本的前瞻性随机对照研究加以验证。     

肝动脉化疗栓塞术联合甘露聚糖肽治疗中晚期肝癌的疗效观察

目的对比单纯肝动脉化疗栓塞术（TACE）与TACE联合甘露聚糖肽治疗中晚期肝癌的临床效果。方法96例中晚期肝癌患者分为两组,A组：48例行单纯TACE治疗;B组：48例行甘露聚糖肽＋TACE治疗,比较两组病人的疗效及毒副作用。结果总有效率：A组为39.6%,B组为55.4%;一年存活率A组为39.6%,B组为55.8%;A组主要副作用为轻至中度的白细胞下降、肝功能损害等,B组主要副作用为发热、轻度的白细胞下降和肝功能损害等。结论B组的疗效明显优于A组,甘露聚糖肽联合TACE是治疗中晚期肝癌的疗效显著的方法之一,副作用较少,改善了患者的肝功能,值得推广。     

氩氦刀冷冻消融治疗联合肝动脉化疗栓塞术对原发性肝癌生存的影响

目的：观察氩氦刀冷冻消融联合肝动脉化疗栓塞术对原发性肝癌生存的影响。方法：103例中晚期原发性肝癌患者入组;随机分入分入肝动脉化疗栓塞（TACE）组（31例）、氲氦刀冷冻消融组（32例）、TACE联合氩氦刀冷冻消融组（40例）。术后每月复查AFP、T细胞亚群、上腹部CT观察肿瘤坏死情况;随访26个月,观察患者6个月及1年生存率情况。结果：肝动脉化疗栓塞组、氩氦刀冷冻消融组、氩氦刀冷冻消融联合肝动脉化疗栓塞组完全坏死率分别为32．2％、50．0％、50．0％;经统计学检验,P〈0．05,各组之间差异具有统计学意义。1年生存率分别为54．8％、56．2％、75．0％,联合治疗组较单纯TACE组和氩氦刀冷冻消融组明显提高,差异具有统计学意义。结论：TACE联合氩氦刀冷冻消融更有利于改善患者长期生存,不良反应可耐受。     

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

Objective

To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) in patients with infiltrative hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with patient survival.

Materials and Methods

Fifty two patients who underwent TACE for infiltrative HCC were evaluated between 2007 and 2010. The maximum diameter of the tumors ranged from 7 cm to 22 cm (median 15 cm). Of 46 infiltrative HCC patients with portal vein tumor thrombosis, 32 patients received adjuvant radiation therapy for portal vein tumor thrombosis after TACE.

Results

The tumor response by European Association for the Study of the Liver criteria was partial in 18%, stable in 47%, and progressive in 35% of the patients. The median survival time was 5.7 months (Kaplan-Meier analysis). The survival rates were 48% at six months, 25% at one year, and 12% at two years. In the multivariable Cox regression analysis, Child-Pugh class (p = 0.02), adjuvant radiotherapy (p = 0.003) and tumor response after TACE (p = 0.004) were significant factors associated with patient survival. Major complications occurred in nine patients. The major complication rate was significantly higher in patients with Child-Pugh B than in patients with Child-Pugh A (p = 0.049, χ² test).

Conclusion

Transcatheter arterial chemoembolization can be a safe treatment option in infiltrative HCC patients with Child Pugh class A. Child Pugh class A, radiotherapy for portal vein tumor thrombosis after TACE and tumor response are good prognostic factors for an increased survival after TACE in patients with infiltrative HCCs.     

动脉内顺铂微球碘化油与抗癌药物碘化油栓塞化疗对肝癌疗效的比较

本文对42例原发性肝癌经顺铂微球碘化油化疗栓塞A组22例,和化疗药物碘化油栓塞B组20例,作疗效比较:1.肿瘤缩小率:A组占85％,B组占70％。2.生存率:A组6月、12月、18月及24月的生存率分别为72％、45％、23％及4.5％;B组分别为60％、25％、5％及0％。平均生存期A组10.6月、B组7.6月。顺铂微球加碘化油栓塞的效果明显高于化疗药物碘化油栓塞的效果。是治疗肝癌有效方法之一。并讨论了顺铂微球化疗栓塞的适应症,术后并发症及其处理原则。     

Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety

Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection (PEI) of hepatomas. This study retrospectively evaluates the safety and efficacy of PEI of unresectable medium-to-large (3.5–9 cm) hepatomas using a multipronged needle and with conscious sedation. Twelve patients, eight men and four women (age 51–77 years; mean: 69) received PEI for hepatomas, mostly subcapsular or exophytic in location with average tumor size of 5.6 cm (range: 3.5–9.0 cm). Patients were consciously sedated and an 18G retractable multipronged needle (Quadrafuse needle; Rex Medical, Philadelphia, PA) was used for injection under real-time ultrasound guidance. By varying the length of the prongs and rotating the needle, the alcohol was widely distributed within the tumor. The progress of ablation was monitored by contrast-enhanced ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) after each weekly injection and within a month after the final (third) injection and 3 months thereafter. An average total of 63 mL (range: 20–154 ml) of alcohol was injected per patient in an average of 2.3 sessions. Contrast-enhanced CT, ultrasound, or MRI was used to determine the degree of necrosis. Complete necrosis was noted in eight patients (67%), near-complete necrosis (90–99%) in two (16.7%), and partial success (50–89%) in two (16.7%). Follow-up in the first 9 months showed local recurrence in two patients and new lesions in another. There was no mortality. One patient developed renal failure, liver failure, and localized perforation of the stomach. He responded to medical treatment and surgery was not required for the perforation. One patient had severe postprocedural abdominal pain and fever, and another had transient hyperbilirubinemia; both recovered with conservative treatment. PEI with a multipronged needle is a new, safe, and efficacious method in treating medium-to-large-sized hepatocellular carcinoma under conscious sedation. Its survival benefits require further investigations.     

Prostate Artery Embolization for Giant Prostatic Enlargement: Short-Term Efficacy and Safety

Eight patients with giant prostatic enlargement > 200 mL and lower urinary tract symptoms who underwent bilateral prostatic artery embolization (PAE) were reviewed. Mean prostate volume decreased from 318.2 mL to 212.2 mL (P < .01). At 5-month mean follow-up, International Prostate Symptom Score decreased by 16.7 points (P < .05), and urinary quality of life improved by 3.0 points (P < .01). Three of 4 catheter-dependent patients no longer needed catheterization after the procedure. No major complications were encountered. Preliminary results suggest PAE is safe and effective in patients with giant prostatic enlargement > 200 mL.     

Correlation of Multislice CT and Histomorphology in HCC Following TACE: Predictors of Outcome

The purpose of this study was to correlate histopathological with CT findings in patients suffering from hepatocellular carcinoma (HCC) eligible for orthotopic liver transplantation (OLT), with a special focus on the antitumoral effect of transarterial chemoembolization (TACE) therapy. A total of 42 consecutive patients suffering from HCC had been treated prior to OLT by means of TACE. TACE was carried out with a mixture of Lipiodol (10-20 ml) and mitomycin C (max. dosage, 10 mg). TACE was performed at 6- to 8-week intervals. Follow-up investigation included contrast-enhanced multislice CT controls and laboratory control. Liver explants were evaluated macroscopically and microscopically to determine the number and size of the tumor lesions as well as the degree of tumor necrosis. Necrosis was investigated in H&E-stained sections. The degree of necrosis was classified as follows: 0-25%, 26-50%, 51-75%, 75-99%, and complete necrosis. Two hundred thirty-one TACE procedures (5.5 +/- 2.9; range, 1-14) were performed. Mean tumor size in CT before and after TACE was 4.1 +/- 2.4 (range, 1.0-12.0 cm) and 2.7 +/- 1.2 (range, 1.0-6.0 cm; p < 0.001). Mean tumor number before and after TACE in CT was 2.5 +/- 1.5 (n = 105; range, 1-8) and 2.4 +/- 2.0 (n = 103; range, 1-6; p = 0.99). In the surgical specimen tumor size and tumor number were 2.8 +/- 1.6 (range, 1.0-7.0 cm; p = 0.78) and 1.9 +/- 1.2 (range, 1-7; p = 0.003). Mean tumor necrosis was 67.8% +/- 28.1%. Tumor necrosis was subtotal or complete in 17 of 42 (40.5%) patients. Tumor necrosis correlated significantly with the degree of arterial devascularization in CT (p = 0.001), the amount of Lipiodol washout (p = 0.002), and the number of tumor lesions (i.e., unifocal vs. multifocal). Furthermore, elevated serum levels of bilirubin (p = 0.005) and decreased albumin (p = 0.004) affected the local antitumoral effect. A poor necrosis rate (< 25%) significantly correlated with the number of TACE procedures accomplished (p = 0.023). In conclusion, TACE provided an acceptable local antitumoral effect in patients scheduled for liver transplantation. Tumor necrosis depended significantly on the degree of arterial devascularization and the accumulation of Lipiodol within the HCC lesions. Unifocal tumors and preserved liver function were positive predictors for a more favorable local antitumoral effect. Poor necrosis rates were found in patients with significant Lipiodol washout and who received a limited number of TACE procedures.     

复方丹参注射液联合肝亚段动脉栓塞术治疗肝细胞癌临床疗效观察

目的:探讨肝动脉灌注复方丹参注射液联合肝亚段动脉栓塞术治疗肝细胞癌的临床疗效。方法:对53例经病理学确诊的肝细胞癌患者行经肝动脉灌注复方丹参注射液和肝亚段动脉化疗栓塞术治疗。检测栓塞治疗前后肝功能、甲胎球蛋白(AFP)血液含量;应用Karnofsky评分标准评价治疗前后生存质量的变化,以1~3年生存率评价其临床疗效。结果:技术成功率100%,术后30 d死亡率为1.89%。51例(96.23%)患者Karnofsky评分术后增加10分以上,生存质量提高。1~3年生存率分别为79.25%、66.04%、43.40%。肝功能改善,甲胎球蛋白(AFP)血液含量降低。结论:肝动脉灌注复方丹参注射液联合肝亚段动脉栓塞治疗提高了肝细胞癌患者的生存期,生活质量改善。