CT引导下微波消融对肝癌术后复发应用价值及术后复发危险因素分析

目的:探讨CT引导下微波消融对肝癌术后复发应用价值以及术后复发危险因素分析。方法:选取2015年1月至2017年1月在我院接受肝癌切除术术后复发患者30例（复发组）,同时选取肝癌切除术术后未复发患者30例作为对照组,复发组患者给予CT引导下微波消融,观察治疗效果。同时比较复发组和对照组患者临床病理资料差异。结果:30例患者经消融治疗后1个月复查,CR患者25例;总不良反应发生率为26.67%,主要为疼痛伴低热、乏力等;中位总体生存时间为15个月,1年、2年总体生存率分别为70.00%和22.70%;治疗后CD4+水平为（40.03±6.22）%,明显高于治疗前（P<0.05）;治疗后CD8+和α-L-岩藻糖苷酶分别为（25.59±4.12）%和（25.20±5.11） U/L,明显低于治疗前（P<0.05）;复发组首次手术肿瘤数量＞1个、邻近大血管比例,明显高于对照组（P<0.05）;Logistic回归分析显示首次手术肿瘤数量＞1个、邻近大血管是肝癌切除术术后复发的危险因素（OR=2.330和3.357,P<0.05）。结论:CT引导下微波消融治疗肝癌术后复发有较好的效果;肝癌切除术术后复发的危险因素包括肿瘤数量,是否邻近大血管。     

术前肾功能正常患者肝癌切除术后急性肾损伤的危险因素分析及预测模型的建立

目的探讨术前肾功能正常接受肝癌切除术的患者术后急性肾损伤（AKI）的危险因素,为临床相关预防方案的选择及改善患者的预后提供参考。方法 选取2015年1月至2021年12月在中山大学附属第一医院术前肾功能正常接受肝癌切除术的患者1951例,参照2012年改善全球肾脏病预后组织（KDIGO）制订的标准诊断肝癌切除术后AKI的发生情况,入选对象分为AKI组（n=145）和非AKI组（n=1806）。比较AKI组与非AKI组患者的临床特征、术前实验室资料、术中情况、术后实验室资料及临床演变,分析肝癌切除术后继发AKI的危险因素及预后情况。结果 1951例术前肾功能正常接受肝癌切除术的患者术后AKI发生率为7.43%(145/1951)。将单因素分析中P<0.05的自变量行多因素Logistic回归分析,结果显示体重指数、术前合并高血压病、高脂血症、肝硬化、术中低中心静脉压时间延长、术中使用去甲肾上腺素是影响术后AKI发生的独立危险因素。将上述危险因素绘制ROC曲线,并制作术前肾功能正常行肝癌切除术的患者术后发生AKI的Nomogram预测模型。与非AKI组相比,AKI组术后转入重症监护室...     

多发性骨髓瘤肾功能不全的临床特征及危险因素分析

目的分析多发性骨髓瘤(Multiplemyeloma,MM)伴肾功能不全(renalfailure,RF)患者的临床特征,探索发生RF的危险因素。方法对MM伴发RF的91例患者进行回顾性分析,并与同期住院的165例肾功能正常MM对照研究,统计学方法采用卡方检验和logistic回归分析。结果91例中48(52．7％)例以肾损害为首发症状,其中30(62．5％)例延误诊治。与对照组比较,高血钙、高血尿酸、贫血、血M蛋白增高、溶骨性损害发生率均明显增加(P<0．05)。预后较对照组有明显差别：3月内病死率为26／91对14／165(P<0．0001)．3月～1年病死率为14／91对12／165(P<0．05),生存期超过1年的为18／91对95／165(P<0．0001)。回归分析显示发生RF的危险因素包括肾毒性药物的应用史、中重度贫血、血M蛋白增高、男性、高钙血症。结论肾功能不全是MM的早期并发症,容易引起误诊,这类患者确诊MM时病情往往较重,并发症多,预后差。对贫血重、伴有高血钙、曾用肾毒性药物的MM患者,应警惕RF的发生。     

微波固化治疗对肝癌患者免疫功能的影响

目的：观察微波固化治疗对肝癌患者免疫功能的影响。方法：对行微波固化治疗的肝癌患者,分别于治疗前3天,治疗后3天、5天、7天、14天、21天、28天测定血IgA、IgG、IgM、淋巴细胞数、T淋巴细胞亚群分类。结果：较治疗前相比,治疗后免疫功能指标一周内均无明显变化,2周后,细胞免疫功能有明显增强（P〈0．05）,体液免疫功能亦有所增强,但无统计学意义（P〉0．05）。结论：微波固化治疗能增强肝癌患者机体的免疫功能,尤其对细胞免疫功能影响明显,有利于提高机体抗肿瘤能力。     

微波固化治疗对肝癌患者免疫功能的影响

目的:观察微波固化治疗对肝癌患者免疫功能的影响.方法: 对行微波固化治疗的肝癌患者,分别于治疗前3天,治疗后3天、5天、7天、14天、21天、28天测定血IgA、IgG、IgM、淋巴细胞数、 T淋巴细胞亚群分类.结果: 较治疗前相比,治疗后免疫功能指标一周内均无明显变化,2周后,细胞免疫功能有明显增强(P<0.05),体液免疫功能亦有所增强,但无统计学意义(P>0.05).结论: 微波固化治疗能增强肝癌患者机体的免疫功能,尤其对细胞免疫功能影响明显,有利于提高机体抗肿瘤能力.     

肝癌微波治疗术中出现血红蛋白尿的影响因素

目的:探讨肝癌患者进行微波固化治疗过程中出现血红蛋白尿的影响因素及其临床意义.方法:回顾性研究2007年内36例行微波固化治疗肝癌患者的临床资料,比较出现血红蛋白尿组和未出现组在肿瘤大小及与肝内主要血管及其分支的距离、微波治疗持续时间以及术后甲胎蛋白降低程度等方面之间的差异.结果:超声提示下,术中出现血红蛋白尿组,肿瘤与周围肝内主要血管距离小于未出现组(P=0.000);微波治疗持续时间为27.9min±7.5min,长于未出现组(P=0.040).术中出现血红蛋白尿组AFP水平降低程度为99.8ng/ml±68.0ng/ml,低于未出现组(P=0.008).而肿瘤大小和微波治疗强度对术中是否出现血红蛋白尿无影响(P>0.05).结论:肝癌微波固化治疗过程中出现血红蛋白尿的影响因素主要为肿瘤与肝内主要血管的距离以及微波治疗持续时间.由于术中出现血红蛋白尿组AFP水平降低程度显著低于未出现组,因此我们推测肝癌患者微波治疗术中出现血红蛋白尿可能提示术后必须联合肝动脉栓塞介入治疗等综合疗法以提高疗效指标之一.     

肝癌无水酒精注射术的疗效及影响因素

原发性肝癌（ＨＣＣ）目前的治疗效果尚不尽人意。手术切除是ＨＣＣ首选的治疗方法 ,但我国大多数ＨＣＣ病例均伴有肝硬化或（和）慢性肝炎 ,由于肝功能不佳而不能接受手术切除。对于不能手术切除的ＨＣＣ病人 ,Ｂ超引导下的经皮无水酒精注射术（Ｐｅｒｃｕｔａｎｅｏｕｓｅｔｈａｎｏｌｉｎｊｅｃｔｉｏｎ，ＰＥＩ）是目前疗效较为肯定的疗法之一。本文重点概述ＰＥＩ的指征、疗效及影响疗效的因素。１ＰＥＩ治疗ＨＣＣ的指征ＰＥＩ在应用的早期主要用于治疗直径＜３ｃｍ的小肝癌 ,因为较大的肿瘤无水酒精无法完全弥漫浸润而易于局部复发。…     

经皮微波热凝固治疗肝癌的初步研究

超声引导经皮肝穿刺微波热凝固疗法 ( percutaneousmi crowavecoagulationtherapy ,PMCT )是近年应用于临床的新技术 ,2 0 0 1年 3月至 2 0 0 3年 2月我们应用该疗法治疗了 2 1例肝癌患者 ,共 2 3个瘤体 ,现报告如下。1　资料与方法1.1　临床资料男性患者 16例 ,女性 5例 ,年龄     

Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with renal insufficiency

BackgroundPatients with metastatic renal cell carcinoma (mRCC) with renal insufficiency are generally excluded from clinical trials, despite their increasing numbers. Thus, we evaluated the efficacy and toxicity of sunitinib in such patients.Patients and methodsKorean patients with mRCC with renal insufficiency who had received sunitinib as first-line treatment between January 2008 and May 2012 were included. Patient characteristics, clinical outcomes and toxicities were evaluated. Overall survival (OS) and progression-free survival (PFS) were determined according to the degree of renal impairment.ResultsThe median age of the 34 patients evaluated was 66 years, 90% had an Eastern Cooperative Oncology Group performance status of 0 or 1 and the median glomerular filtration rate was 46.5 mL min⁻¹·1.73 m⁻² (range, 21.1–59.5). The starting sunitinib dose was 37.5 and 50 mg for 12 and 22 patients, respectively. A 4-weeks-on–2-weeks-off regimen was followed for 31 patients; a 2-weeks-on–2-weeks-off regimen, for one patient; and a daily regimen, for two patients. The best response was partial response in eight patients and stable disease in 12. Median OS and PFS times were 26.3 months (95% confidence interval [CI]: 17.1–35.3) and 12.2 months (95% CI: 10.2–13.2), respectively. Common non-haematologic adverse events (AEs) were stomatitis, rash, general oedema and fatigue. The most common AEs of ⩾grade 3 severity were fatigue, neutropenia and thrombocytopenia.ConclusionsIn patients with mRCC with renal insufficiency, sunitinib was efficacious and did not cause increased toxicity. Thus, clinicians should not hesitate to treat patients with mRCC with renal insufficiency with sunitinib.     

Efficacy of sunitinib in patients with metastatic or unresectable renal cell carcinoma and renal insufficiency

AimThe aim of this retrospective, registry-based study was to analyse treatment outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib and renal insufficiency (RI).MethodsThe cohort included 790 patients treated with sunitinib between 2006 and 2013. At the start of sunitinib therapy 22, 234, and 534 patients had severe (glomerular filtration rate [GFR] <30 ml/min/1.73 m²), moderate (GFR 30–60 ml/min/1.73 m²) or mild RI/normal renal function (GFR >60 ml/min/1.73 m²), respectively.ResultsFor the three groups defined above, median progression-free survival (PFS) (95% confidence interval [CI]) was 5.3 months (0.1–18.5), 8.1 months (6.2–9.9) and 11.3 months (9.4–13.2) (p = 0.244), and median overall survival (OS) was 26.3 months (1.2–51.4), 21.2 months (13.2–29.1) and 26.3 months (22.6–29.9) (p = 0.443), respectively. The disease control rates were 45.5%, 56.4% and 59.2%, respectively (p = 0.374). No unexpected toxicity was reported in the patients with RI, but the treatment was more frequently discontinued because of adverse events and the duration of therapy was significantly shorter in these patients (p = 0.007).ConclusionsDuration of first-line targeted treatment for mRCC was significantly shorter for patients with RI, and may have translated into a trend to shorter PFS. These results highlight the need for optimal management of side-effects in patients with mRCC and RI.     

超声引导经皮微波治疗原发性肝癌远期疗效评价

目的　评价经皮穿刺微波凝固治疗 (PMCT)原发性肝癌 (HCC)的远期疗效。方法　在超声引导下对 177例HCC患者共 2 6 5个肿瘤灶进行PMCT ,病灶最大直径 1.5～ 8.7cm ,平均4.12± 1.89cm。随访 5～ 74个月 ,定期复查影像 (彩超、CT、MRI)及血清AFP ,184个结节再次穿刺活检。结果　治疗后超声检查显示 ,92 .0 % (2 0 7/ 2 2 5 )的病灶血流消失 ,88.5 % (138/ 15 6 )的病灶增强CT无强化 ,88.9% (32 / 36 )的病灶增强MRI无强化。 184个结节治疗后再活检 ,92 .4% (170 / 184)完全坏死。 6例患者PMCT后外科切除病灶 ,病理显示肿瘤完全坏死 5例 ,大部分坏死 1例。全组 1～ 5年累计生存率分别为 90 .1%、76 .9%、6 8.3%、6 4.2 %和 5 7.8% ,高分化及中分化者的生存曲线均明显好于低分化者 (P <0 .0 5 ) ,中分化与高分化者之间无统计学差异。全组 1～ 5年累计新生病灶率分别为2 6 .1%、37.8%、43.5 %、48.6 %和 5 8.9%。全组无严重并发症。结论　PMCT治疗HCC安全有效 ,可使直径 <5cm的肿块一次原位灭活 ,患者的 5年生存率较高。     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

目的 探讨肝细胞癌(HCC)射频消融(RFA)治疗后肿瘤残留的危险因素及预后.方法 回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料,分析可能与RFA后肿瘤残留有关的临床因素以及残留HCC的预后.结果 114例HCC患者经RFA治疗一次后,完全消融90例,肿瘤残留24例.90例肿瘤完全消融患者的中位生存期为40个月,24例肿瘤残留患者的中位生存期为29个月,二者差异无统计学意义(P=0.242).在24例肿瘤残留患者中,经再次治疗后达到无肿瘤残留者11例,其中位生存期为53个月;经再次治疗后仍有残留者13例,其中位生存期为28个月.RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较,差异无统计学意义(P=0.658);与再次治疗后仍有肿瘤残留患者的中位生存期比较,差异有统计学意义(P=0.012).多因素分析表明,肿瘤＞3 cm(P=0.007)和靠近大血管(P=0.042)是HCC经RFA治疗后肿瘤残留的独立危险因素.结论 肿瘤＞3 cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素.对未能达到完全消融的HCC患者,应积极采取进一步治疗措施,争取达到完全根治肿瘤,以改善预后.     

Risk factors and prognosis of patients with recurrent hepatocellular carcinoma who undergo liver re-resections

BackgroundManagement of recurrent hepatocellular cancer (HCC) after liver resection is challenging, with unsatisfactory long-term patient outcomes. Liver re-resection, in theory, is a good treatment option. We therefore studied prognosis and risk factors of patients who undergo re-hepatectomy.MethodsWe retrospectively analyzed 103 patients who underwent re-hepatectomy.ResultsThe re-resection postoperative complication rate was 31.1% (32/103). Patients with gross vascular invasion (GVI), cirrhosis, or hepatitis B (HBV) infections not treated with antiviral therapy had higher morbidity than patients without these diseases (per chi-square tests). In bivariate regression analysis, cirrhosis (odds ratio [OR]: 10.308, P = 0.031) and HBV not treated with antiviral therapy (OR: 3.982, P = 0.011) were associated with immediate postoperative morbidity. Median overall survival (OS) after re-resection was 65.0 months (range: 2.1–119.3 months); cumulative OS rates were 1-year: 92.1%, 2-year: 78.2%, and 5-year: 54.4%. Independent risk factors for worse survival were serum AFP level > 20 ng/mL at first resection, portal hypertension (PH) and GVI at recurrence. In the non-PH group, microvascular invasion (micro-VI), GVI and pTNM III–IV disease were associated with poor prognosis; patients with pTNM I–II disease had significantly less micro-VI and GVI than did patients with advanced disease.ConclusionRepeat hepatectomy has favorable long-term outcomes. Cirrhosis and HBV not treated with antiviral therapy were associated with immediate postoperative morbidity. Serum AFP > 20 ng/mL at first resection, PH, and GVI at recurrence are independent prognostic factors. For patients without PH, TNM staging can predict prognosis.     

影响肝癌切除术预后的多因素分析

目的：回顾性研究肝硬化、Child-Pugh分级、肿瘤大小、门脉癌栓、术中输血、肝门阻断时间等与肝癌切除术预后的关系。方法回顾性分析2007—2009年华中科技大学同济医学院附属同济医院进行肝癌切除术的123例原发性肝癌患者临床资料,用Log-Rank检验和Cox风险比例模型分析肝癌切除术预后的相关危险因素。结果患者术后1、2、3、5年复发率分别为54.17%、66.67%、81.40%、87.50%,平均复发时间为19.5个月。1、2、3、5年生存率分别为93.50%、73.17%、58.54%、27.64%,平均生存时间为42.9个月。单因素分析显示肝硬化（χ2＝11.159,P ＝0.005）、Child-Pugh 分级（χ2＝7.715,P＝0.028）、肿瘤≥5 cm（χ2＝11.483,P＝0.004）、门脉癌栓（χ2＝22.271,P＝0.001）与肝癌复发有关;多因素分析显示肝硬化（χ2＝8.993,P＝0.003）、肿瘤≥5 cm（χ2＝4.022,P＝0.039）、门脉癌栓（χ2＝5.023,P＝0.027）与肿瘤复发有关。单因素分析显示肝硬化（χ2＝7.339,P＝0.025）、血清甲胎蛋白AFP﹥400 ng/ml（χ2＝5.431,P＝0.042）、Child-Pugh分级（χ2＝13.389,P＝0.002）、肿瘤≥5 cm（χ2＝11.342,P＝0.003）、门脉癌栓（χ2＝52.167,P﹤0.001）、肝门阻断（χ2＝5.801,P ＝0.037）、术中输血（χ2＝14.959,P＝0.001）等与患者术后生存率有关;多因素分析显示肝硬化（χ2＝9.133,P＝0.003）、Child-Pugh分级（χ2＝4.799,P＝0.028）、肿瘤≥5 cm（χ2＝9.101,P＝0.004）、门脉癌栓（χ2＝11.126,P＝0.001）、肝门阻断（χ2＝3.985,P＝0.046）与患者术后生存率相关。结论肝硬化、Child-Pugh分级、肿瘤大小≥5 cm、门脉癌栓、肝门阻断是影响肝癌患者切除术预后的独立因素。     

Altered cyclophosphamide and thiotepa pharmacokinetics in a patient with moderate renal insufficiency

Purpose  We report a patient with renal insufficiency (creatinine clearance, CL_cr = 38 mL/min) who received high-dose chemotherapy with cyclophosphamide (1,500 mg/m² day⁻¹), thiotepa (120 mg/m² day⁻¹) and carboplatin (AUC = 5 mg min/mL day⁻¹) for four consecutive days. Methods  Blood samples were collected on day 1 and 3 and plasma levels of cyclophosphamide, its active metabolite 4-hydroxycyclophosphamide, thiotepa, its main metabolite tepa and carboplatin were determined. Results  Pharmacokinetic analyses indicated that the elimination of cyclophosphamide, thiotepa, carboplatin, but especially tepa was strongly reduced in this patient, resulting in increased exposures to these compounds of 67, 43, 30 and 157%, respectively, compared to a reference population (n = 24) receiving similar doses. Exposure to 4-hydroxycyclophosphamide increased 11%. Conclusion  These results suggest that it may not be necessary to alter the dose of cyclophosphamide in patients with moderate renal impairment. However, because high exposures to thiotepa and tepa have been correlated with increased toxicity, caution should be applied when administering thiotepa to patients with renal insufficiency.     

大肠癌术后肝转移高危因素研究

目的 筛选大肠癌根治术后发生肝转移的高危因素,并建立数学模型.方法 分析168例患者5年随访资料,logistics回归明确术后肝转移的高危因素,ROC检验建立数学模型.结果 全组3年和5年肝转移发生率为25.0％和33.3％,高危因素为淋巴结转移、肿瘤浸润深度、组织学分级及术前肿瘤标志物水平,数学模型为logit(P)=-0.931+0.973×淋巴结转移+0.302×肿瘤浸润深度+0.637×组织学分级+0.042×术前肿瘤标志物水平.结论 大肠癌术后肝转移的高危因素为淋巴结转移、肿瘤浸润深度、组织学分级及术前肿瘤标志物水平,并可建立数学模型.     

化疗对肾功能不全老年肿瘤患者肾功能的影响

目的观察化疗对合并肾功能不全的老年恶性肿瘤患者肾功能的影响。方法选取60岁以上合并肾功能不全老年肿瘤化疗患者,按Cockcroft—Gauh公式计算其肌酐清除率（CrCl）代表患者的肾功能,比较患者化疗前后肾功能的变化。结果58例不同肿瘤患者,在充分评估和保护。肾功能的条件下,共完成204个疗程化疗,平均每例患者完成3．52次化疗。能评价疗效的28例患者中,获得CR2例,PR13例（RR54％）。治疗前患者CrCl均值为28．2±15．92ml／min,治疗后为35．26±19．27mL／min,较治疗前升高4．39±11．47ml／min（P=0．002）,有统计学意义,说明患者肾功能较化疗前好转。其中由于肿瘤引起肾功能不全和血液系统肿瘤合并肾功能不全这2组患者,治疗后与治疗前CrCI升高的均值分别为18．44±15．77ml／min和7．77±14．59ml／min（P值均为0．001）,患者CrCl升高有统计学意义。而非肿瘤原因所致肾功能不全和实体瘤这2组患者,化疗后与化疗前CrCl差值均值分别0．66±4．32ml／min和0．62±4．09ml／min,P值分别为0．312和0．375,没有统计学意义。部分患者应用含铂方案化疗,化疗前后CrCl的均值分别为48．89±5．50ml／min和53．39±8．99ml／min（P=0．304）,患者肾功能并未恶化。结论即使合并肾功能不全的老年恶性肿瘤患者,临床上采取适当的预防措施,患者也可以耐受化疗,部分患者仍可以从化疗中获益。