肝癌肝移植术后复发的诊治

目的：分析影响肝癌肝移植术后复发的危险因素,总结复发后治疗经验。方法：根据46例肝癌肝移植患者术后有无复发转移分为未复发组（33例）和复发组（13例）。结果：肝癌肝移植术后随访2年,未复发组与复发组的原发肿瘤直径分别为（8．7±2．3）cm和（9．2±2．5）cm（P〈0．05）;未复发组与复发组有门静脉癌栓等血管侵犯分别为12．1％和69．2％（P=0．001）。复发组经积极治疗后6个月、1年和2年生存率分别为100％、92％和16％。结论：肝癌肝移植术后肿瘤复发患者的总体预后差,治疗棘手,因此,重点为预防,并尽可能早期发现,积极治疗,以提高患者的生存期。     

肝癌术后复发转移的相关影响因素研究进展

肝癌是全球第五位常见肿瘤，死亡率位于第三位，每年新诊断病例1万多例。我国肝癌的死亡率每年为34.7／105人，是癌症导致死亡的第四位原因。虽然肝脏外科技术和诊断水平取得很大进展，但长期随访发现多数肝癌根治性切除术后仍死于肿瘤复发转移，5年复发率32．5％～61.5％，无瘤生存率16％～38．6％。复发转移已成为影响病人疗效和获得长生存的关键之一，也是当前肝癌研究的重点。本文就肝癌术后复发转移的部分相关因素研究进展作一综述。     

肝癌术后复发原因的探讨

OBJECTIVE: To analyze the causes of recurrence of hepatocellular carcinoma (HCC) after resection according to pathologic findings of the resected primary tumor and angiographic features of the recurrent tumor. METHODS: In this series, 142 cases with recurrent HCC were analyzed with respect to (1) size, number, gross and histologic findings of the primary tumor, (2) time when recurrence occurred, (3) size, number, blood supply, staining property of, and deposition of lipiodol oil in the recurrent tumor. Following angiography, arterial embolization was performed. RESULTS: In 101 of the 142(71.1%) cases, the primary tumor was > 5 cm in diameter, and in 41 cases (28.9%) it was < 5 cm. In 67.7% of the cases, the capsule of the primary tumor was incomplete or absent. In 47 cases (33.1%), satellite tumor nodules were seen during operation but they were seen on pathologic sections in 94 cases (66.2%). Tumor thrombus was present in the portal vein in 26 (18.3%) and 121 cases (85.2%) during operation and on pathologic examination, respectively. In the majority of the cases (99/142), recurrence occurred within 6 months after operation. The recurrent foci consisted of multiple tumor nodules of < 5 cm in 68.3% of the cases. On angiography, the recurrent tumors were rich in blood supply with good deposition of lipiodol. CONCLUSION: Recurrence is apt to occur in HCC patients with large (> 5 cm) primary tumor which has incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus. It is suggested to perform angiography 1-2 months after surgery to detect early recurrence and, if confirmed, the patients can be treated by transcatheter arterial chemo-embolization.     

肝癌术后转移复发的治疗进展

本文综述并分析了经过随机分组试验的结果.目前尚无针对肝癌术后复发的统一治疗模式;多数研究结果否定了术后化疗/栓塞的作用,而肯定了过继性免疫、干扰素和维甲酸治疗的效果.针对目前存在的问题,下一步的研究方向包括制定更为个体化的治疗模式,以及发展毒副作用更低的治疗手段等.     

子宫体癌术后复发诸因素研究

我科十年间手术治疗宫体癌病人１３８例，３２例复发，复发率２３．１９％，其中Ｉ期－Ⅲ期复发率为１４．２８％，１４．６６％和７７．７８％；内膜样腺癌复发率为２０％，其中Ⅲ级为６６．６７％，桨液性腺癌为７５％，透时细胞癌为６６．６７％；对肿瘤肌层浸润深度、大小、血管、宫颈、附件受侵及淋巴结转移情况进行分析显示复发率均发生依其程度加重而上升；术后补充放疗组与非放疗组盆腔复发率相近；术后两年内为复发高峰。     

直肠癌术后复发及转移的外科治疗

１９８０年￣１９９０年，作者行直肠癌治愈性切除术共１６０例，随访４年￣１４年。术后复发及转移４４例（２７．５％）。再次手术１７例（３８．６％）。其中治愈性切除６例（１３．６％），姑息性切除５例（１１．４％），单纯结肠造瘘６例（１３．６％）。全部再手术患者有６例生存超过５年，５年生存率３５．３％，未经手术治疗者无１例存活超过５年，两者比较差异非常显著（Ｐ〈０．００５）。即使行姑息手术者，２年生存率（     

肝癌术后复发转移的相关影响因素研究进展

肝癌是全球第五位常见肿瘤,死亡率位于第三位,每年新诊断病例1万多例[1]。我国肝癌的死亡率每年为34.7/105人,是癌症导致死亡的第四位原因。虽然肝脏外科技术和诊断水平取得很大进展,但长期随访发现多数肝癌根治性切除术后仍死于肿瘤复发转移,5年复发率32.5%~61.5%,无瘤生存率16%~38.6%[2,3]。复发转移已成为影响病人疗效和获得长生存的关键之一,也是当前肝癌研究的重点。本文就肝癌术后复发转移的部分相关因素研究进展作一综述。1复发转移的机制及其特点肝癌根治性切除术后复发有两种来源[4]:一是肝内播散,肿瘤局部浸润,侵犯肝内微血管,再…     

肝细胞肝癌复发转移相关因子

肝细胞肝癌的复发与转移是其预后不良的主要原因,除临床病理指标外,相关因子的研究日益受到重视,包括细胞增殖相关因子、细胞周期调节因子、端粒酶活性、凋亡相关因子、细胞黏附因子、血管生成因子等,尤其对黏附因子、蛋白水解酶、相关基因如骨桥蛋白、p97等的研究更加深入。     

肝细胞肝癌复发转移相关因子

肝细胞肝癌的复发与转移是其预后不良的主要原因,除临床病理指标外,相关因子的研究日益受到重视,包括细胞增殖相关因子、细胞周期调节因子、端粒酶活性、凋亡相关因子、细胞黏附因子、血管生成因子等,尤其对黏附因子、蛋白水解酶、相关基因如骨桥蛋白、p97等的研究更加深入。     

Postoperative recurrence of solitary small hepatocellular carcinoma

The prognosis of hepatocellular carcinoma after hepatic resection remains poor. The major cause is postoperative recurrence, most frequently intrahepatic. During the past 7 years, we conducted a detailed study of recurrence after hepatectomy in 34 patients with solitary small hepatocellular carcinoma measuring no larger than 4 cm in diameter, in which 13 cases had postoperative recurrent tumors. and two cases were considered multicentric. Eighty-five percent of recurrences were diagnosed at 6–18 months after the operation. The cumulative recurrence rates were 61% at 5 years after operation. When analyzing the factors affecting recurrence, a significant difference was observed regarding tumor diameter. After recurrence, most patients underwent percutaneous ethanol injection treatment and/or transcatheter arterial chemoembolization and lipiodolization. Four patients died of progressive disease within 1 year after recurrence; the treatment thus seemed to have no effect. The other patients with recurrence remain alive with the disease. The overall cumulative survival rates in this series were 76% at 3 years and 60% at 5 years after operation. To obtain better results after hepatectomy, even for small hepatocellular carcinoma, careful, long-term follow-up evaluation is therefore necessary for the multidisciplinary treatment of the postoperative recurrence, as well as the early diagnosis of tumors in high-risk patients. © 1996 Wiley-Liss, Inc.     

肝细胞癌术后转移复发:临床与相关基础研究进展

转移复发已成为进一步延长肝细胞癌病人生存、改善预后的主要障碍.其主要原因有二:肝内播散或非同步多中心癌变.已发现许多因素与肝细胞癌转移复发有关,包括病人的一般状态、肿瘤大体病理学特征与病理组织学特征以及治疗相关因素等.近年来,随着对肿瘤生物学特征的进一步了解以及分子生物学技术的发展,已发现许多与肝细胞癌转移复发相关的分子标志物.已尝试包括术前、术后经导管动脉化疗栓塞、全身或局部化疗、生物治疗等多种新辅助或辅助疗法以降低或避免肝细胞癌术后复发.但其中仅少数研究被设计为随机对照试验.尚无足够证据提示这些新辅助或辅助疗法可使病人获益.大多数尚需进一步研究,其中生物疗法可能成为较为理想的途径.手术再切除、经动脉导管化疗栓塞、局部消融疗法、化疗、及放疗等多种疗法均可用于肝细胞癌转移复发的治疗.但很少有随机对照试验评价这些疗法对肝细胞癌转移复发的疗效.     

肝癌肝移植复发的干预

肝细胞肝癌传统的根治方法是手术切除,应用范围窄,肝移植术为肝癌患者提供了一个理想的根治性治疗方法,但肿瘤的复发和转移往往造成手术失败,因此对于手术而言,把握合理的手术指征是治疗成功的关键,新的化疗药物的发展,以及分子靶向药物的出现和在临床的广泛应用,进一步提升了围手术期全身化疗的作用,结合免疫抑制剂的合理调整,为肝癌根治治疗提供了希望。     

肝癌术后复发患者96例临床分析

目的探讨如何选择肝癌术后复发患者的治疗方式。方法回顾性分析2007年4月至2012年3月间在我院进行肝癌切除手术后发现复发并接受治疗的96例患者的临床资料。患者分为二次手术组、射频消融(radiofrequency ablation,RFA)组和肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)组,分析治疗方式与临床特征间的关系及对生存的影响。结果各组肝癌术后复发患者的各项临床资料基本无差异,只有肿瘤直径,术中出血量和切缘有显著性差异。但二次手术组患者的无病生存时间和复发后生存时间及总生存时间均高于RFA组和TACE组。结论手术切除在治疗肝癌复发时依然是最佳选择。无法进行二次手术的患者,采取RFA和TACE治疗,复发后生存时间无差异。     

Serum interferon gamma level predicts recurrence in hepatocellular carcinoma patients after curative treatments

Host immunity may have important role in the prognosis of hepatocellular carcinoma (HCC). The aim of this study was to evaluate the correlation between circulating immune regulators and clinical outcome in patients with HCC. Sixty‐three HCC patients were prospectively enrolled. Serum levels of interleukin‐10 (IL‐10), transforming growth factor‐beta (TGF‐β), interferon‐gamma (IFN‐γ) and interferon gamma‐inducible protein 10 (IP‐10) were measured, as well as the prevalence of regulatory T cells (Treg), NK⁺ T cells, invariant natural killer T cells (iNKT), programmed cell death‐1 (PD‐1)⁺CD8⁺ T cells, T helper 17 cells (Th17), CD69⁺ and CD45RO⁺ T cells in peripheral blood mononuclear cells (PBMC). Correlation between these immune regulators and clinical outcome were analyzed. A low serum IFN‐γ level (<50 pg/mL) was significantly associated tumor stage (BCLC stage B: 61.25% vs. stage A: 25%, p = 0.010) and tumor size (>5 cm: 53.8% vs. <5 cm: 25%, p = 0.047). Recurrence‐free survival was evaluated in 48 patients receiving curative treatment of HCC. By multivariate analysis, BCLC stage [hazard ratio (HR) = 32.180, p < 0.001], tumor size (HR = 15.373, p = 0.005), AST (HR = 3.796, p = 0.011) and IFN‐γ (HR = 0.354, p = 0.018) levels were independent factors associated with recurrence‐free survival. In conclusion, serum IFN‐γ level correlates with tumor stage and tumor size in HCC patients. Patients with lower baseline IFN‐γ levels have a higher risk of tumor recurrence after curative treatment. IFN‐γ may reflect host anti‐tumor immunity and may be a potential marker of HCC recurrence after curative treatment.     

Imaging of hepatocellular carcinoma recurrence post liver resection: A pictorial essay

This pictorial essay presents and discusses the imaging findings of patients with hepatocellular carcinoma recurrence post liver resection. A broad range of recurrence patterns is reviewed including intrahepatic and extrahepatic recurrences.     

30例肝癌术后肝内复发灶的再切除治疗

目的探讨原发性肝癌术后复发的治疗措施,旨在提高肝癌术后的远期疗效。方法回顾性分析我院自1990年1月至2004年12月手术切除的30例肝癌术后复发的再切除治疗资料。结果30例肝癌术后复发再切除34例次,二次手术30例,三次手术4例,其中包括3例肝移植;第一次手术与第二次手术平均间隔时间为(40.8±13.1)个月,第二次手术与第三次手术平均间隔时间为(23.0±19.9)个月(P<0.05);30例原发肿瘤平均最大直径为(6.5±2.1)cm,复发病灶平均最大直径为(3.8±1.2)cm(P<0.05)。结论再切除治疗复发性肝细胞癌是延长肝癌病人生存时间的有效手段;肝移植治疗复发性肝癌仍在探索中。