可切除大肝癌TACE后手术切除标本的病理研究

目的 探讨可切除大肝癌TACE后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前TACE组(36例)与一期手术组(47例)，术前TACE组31例二期切除(二期手术组)，5例失去手术切除机会，78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE组除较一期手术组肿瘤坏死广泛、包膜更完整外，两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异；TACE组TACE后肿瘤体积缩小并不显著，子灶、门脉癌栓完全坏死者少，肝硬化加重。结论 可切除大肝癌术前TACE不能使肿瘤完全坏死，部分患者耽误手术时机，应严格选择应用。     

可切除大肝癌TACE后手术切除标本的病理研究

To investigate pathological changes in surgically excised specimens from resectable large hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE ) and their significance. From January 2002 to January 2003, 83 patients with resectable large HCC were randomized into two groups: group A, 36 patients who underwent preoperative TACE, and group B, 47 patients who underwent one-stage operation without TACE. Hepatectomy was performed in 31 patients of group A (two-stage operation group) and 47 patients of group B (one-stage operation group). The remaining 5 patients in group A were not operable. The diagnosis of HCC was pathologically confirmed in all 78 patients after hepatectomy. Pathological changes of the excised specimens between the two groups were compared, including main tumors, capsular containment, daughter nodules, tumor thrombi and liver cirrhosis. There were no significant differences in the incidence of daughter nodules, portal vein tumor thrombi (PVTT) and extrahepatic metastasis between the two groups, but the area of main tumor necrosis was more extensive and the rate of encapsulation was higher in two-stage operation group than those in one-stage operation group. No significant shrinkage in the average tumor size was seen in two-stage operation group, where daughter nodules and PVTT necrosis were less, and liver cirrhosis was more serious. Preoperative TACE for resectable large HCC should be used on the basis of strict selection because it does not provide complete tumor necrosis and may result in delayed surgery in some cases.     

肝癌栓塞化疗后的病理学研究

 本文研究了15例肝细胞癌经肝动脉栓塞化疗后的组织病理学变化。患者年龄25～72岁，男性13例，女性2例。显著的组织形态学特点可归纳为(1)在肿瘤区域有不同数量的血管内皮增生、管壁增厚及透明变性和管腔闭塞；(2)栓塞化疗3天以后癌组织发生广泛性凝固性坏死，坏死的肿瘤组织周围常有炎细胞浸润或泡沫细胞积聚，(3)癌巢间胶原纤维组织增生，并常聚结在一起或呈纤维化改变，将癌细胞分隔或包绕起来；(4)癌块周围形成肿瘤性包膜；(5)肿瘤区域可发生钙化或骨化。另外，作者还探讨了肝癌栓塞化疗后的组织形态变化与预后的关系。     

TACE及手术切除治疗肝癌破裂出血疗效观察

目的:探讨经导管肝动脉化疗栓塞术(TACE)及手术切除治疗肝癌破裂出血的临床价值。方法:对我院30例肝癌破裂出血患者的临床资料进行回顾性分析,其中经TACE治疗21例、手术切除9例以及TACE后再手术切除10例。结果:经TACE治疗21例,其中1例患者因肝功能欠佳,治疗后两个月死于肝功能衰竭。10例患者1月后进行II期手术。单纯TACE治疗患者术后1年存活率为27.3%(3/11),10例经TACE治疗后II期手术患者1年存活率为70.0%(7/10),9例行Ⅰ期手术切除的患者中,死亡1例,发生腹腔种植转移者5例,术后1年存活率为44.4%(4/9)。TACE治疗后行II期手术患者治疗明显高于单纯TACE治疗患者(P<0.01)及I期手术切除患者(P<0.05)。结论:TACE治疗肝癌破裂出血安全、迅速,TACE治疗后行手术切除可显著降低肿瘤腹腔种植转移率,提高患者生存率。     

肝癌切除术加肝血管小剂量灌注化疗对提高疗效的影响(附102例分析)

目的　探讨肝癌根治性切除后联合肝动脉栓塞化疗和门静脉化疗对预防复发和提高生存率的作用。方法　回顾分析 1993年 1月～ 1997年 12月治疗符合根治性切除的原发性肝癌患者 10 2例。其中术后联合HACE和PVC(观察组 ) 49例 ,未作特殊处理 5 3例 (对照组 ) ,全部患者随访 3年以上。将两组作对比分析。结果　患者 1、3、5年复发率观察组分别为 10 .2 %、36 .7%、6 1.2 % ;对照组分别为 37.7%、73.6 %、79.2 %。患者 1、3、5年生存率观察组分别为 95 .9%、5 7.1%、48.9% ;对照组分别 77.3%、37.7%、2 8.0 %。结论　肝癌根治性切除术后 ,通过联合应用HACE和PVC可以明显降低术后复发率 ,提高术后生存率 ,是提高肝癌术后疗效的有效方法。     

手术切除原发性肝癌333例的经验

本文报告手术探查肝癌604例,切除333例,其中小肝癌55例。切除率55.1％、手术死亡率2.4％。小肝癌和大肝癌的术后5、10年生存率分别为50.0％与12.4％、33.3％与8.9％。我们的体会是:(1)临时阻断患侧第一肝门血流法是术中控制出血的最佳方法。(2)经右肋缘下切口行右半肝切除术明显优于胸腹联合切口。(3)随着癌热的升高,切除率和生存率均趋下降,当癌热>39℃时,应视为手术禁忌症。(4)复发性肝癌的最有效疗法是再切除术(5)小肝癌的外科治疗是治愈肝癌的关键。     

手术切除联合肝动脉化疗栓塞(TACE)对晚期结肠癌肝转移患者生存状况的影响

目的 探讨手术切除联合肝动脉化疗栓塞对晚期结肠癌肝转移患者生存状况的影响.方法 回顾性研究接受手术切除联合肝动脉化疗栓塞治疗的晚期结肠癌肝转移85例患者的临床及随访资料、生存状况,并对影响远期生存率的因素进行统计学分析.结果 85例患者在经过手术切除联合肝动脉化疗栓塞治疗后,1、3、5年生存率分别达到85.9％ (73/85),27.1％(23/85)和7.1％(6/85).单因素分析表明年龄、化疗时间、肝外转移、肿瘤大小数目和结肠癌肿瘤原发位置为晚期结肠癌肝转移患者生存状况的影响因素.多因素分析结果表明肝内肿瘤大小及数目(P =0.003)、化疗时间的选择(P =0.024)、患者的年龄(P=0.031)以及合并肝外转移(P =0.029)为患者生存状况的独立影响因素.结论 采用手术切除联合肝动脉化疗栓塞治疗晚期结肠癌肝转移,其预后主要受肝脏肿瘤的数目和大小、化疗时间的选择以及患者的年龄和是否有肝外转移的影响.     

NLR对肝癌TACE患者预后影响的分析

目的:评价不能手术切除的肝癌患者肝动脉化疗栓塞术(TACE)前后外周血中性粒细胞与淋巴细胞比值(NLR)对生存期的影响。方法:分析本院2006-02-2009-02 154例TACE治疗的肝癌患者临床资料,单因素分析年龄、性别、肝功能、乙肝抗原阳性、肿瘤直径、血管侵犯、肝外转移、甲胎蛋白水平、NLR以及术后患者NLR下降等对生存期的影响,对有统计学意义的术前单因素行Cox回归模型多因素分析。结果:TACE治疗前患者NLR的平均值为2.5,其中NLR≥2.5(69例)和NLR<2.5(85例)患者中位生存期分别为8和13个月,两组患者的总生存期差异有统计学意义(P=0.003)。单因素分析显示,年龄≥50岁、术前高水平的NLR、术后NLR水平下降、肿瘤直径≥5cm、血管侵犯和甲胎蛋白水平升高与短的生存期相关。Cox回归分析显示,术前高水平NLR(OR=0.678,95%CI:0.476-0.897;P=0.038)和血管侵犯(OR=1.489;95%CI:1.002-2.234;P=0.039)为降低总生存期的独立影响因素。结论:术前高水平的NLR是降低不能手术切除的肝癌患者总生存期的独立影响因素;术后患者的NLR升高与下降相比,NLR水平的升高对患者的预后更有利。     

肝癌介入治疗模式的探讨(英文)

目的探讨肝癌介入治疗的合理模式。方法回顾性总结1000例以不同方式进行介入治疗的肝癌病例资料,通过分析其病理、生化、影像及生存率等临床因素,比较各种治疗方式的价值及优缺点。结果经导管节段性肝动脉栓塞化疗(S-TOCE)与常规肝动脉注射碘油抗癌药混悬剂栓塞化疗(C-TOCE)比较,前者对肿瘤的杀伤作用大,对非癌肝组织的损害较 C-TOCE 轻,生存率优于 C-TOCE;经皮无水酒精注射术(PEI)联合栓塞治疗可起到杀死残余癌灶的作用,对非癌肝组织未造成明显损害,生存率较单纯栓塞明显提高。对肝癌的各种并发症采取不同方式的介入治疗,能不同程度地改善患者生存质量或提高生存率。结论肝癌的介入治疗应根据肿瘤大小和类型选择不同的介入治疗方式;对肝癌的各种并发症采取积极的介入治疗是有效和必要的。     

乏氧对肝癌TACE治疗影响的分析

肝细胞癌是临床常见的高发恶性肿瘤,发现时大多处于中晚期,传统的手术及化疗难以使中晚期患者受益。近年来,尽管肝动脉化疗栓塞术(tanscathether arterial chemotherapy embolization,TACE)对于肝细胞癌的治疗已取得突破性进展,然而由于各种原因,部分患者产生了对TACE耐受。目前,有许多研究显示,各种乏氧因子对于肝癌的抗药性以及TACE耐受起重要作用,为了较详细了解该研究现况,作者针对乏氧对肝癌TACE治疗影响的相关研究进展进行了综述。     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

微导管亚肝段栓塞技术在小肝癌中的应用评价

[目的]探讨微导管亚肝段栓塞治疗小肝癌的价值。[方法]16例小于3cm的小肝癌,用微导管行亚肝段动脉栓塞,4例联合无水酒精消融,4例手术切除。治疗后定期复查CT和AFP,4例手术切除后病理分析。[结果]摇栓塞后1个月CT复查病灶直径缩小1/2以上6例,缩小1/3以上8例,其中14例AFP定量升高的病例治疗后降至正常6例,明显下降4例,4例下降不明显。2个月复查病灶缩小1/2以上增至9例。对4例AFP降低不明显者,施加经皮无水酒精注射(PEI)治疗,术后1个月复查病灶和AFP均有明显缩小和降低。另有4例栓塞1个月后手术切除,病理检查显示病灶内癌细胞完全坏死3例,1例病灶边缘有少许存活癌细胞。[结论]微导管亚肝段栓塞技术能有效阻断肿瘤血供,使病灶缩小和AFP降低,并能绝大部分杀灭癌细胞。对肿瘤缩小、AFP下降不明显的患者,PEI是一个有效的补充治疗。     

肝癌介入治疗的一些体会

本文就肝癌介入治疗中一些有争议的问题如碘油用量,化疗药物用量、疗效评价、肝癌合并AVS、APVS的治疗、老年肝癌的介入治疗、DSA在肝癌诊断上的意义等结合文献进行讨论,并结合作者的临床实践提出一些自己的心得。     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

目的: 探讨恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的疗效及安全性。 方法: 选取30例中晚期肝癌患者入组研究,均给予恩度肝动脉灌注联合介入化疗栓塞治疗,同时选取30例中晚期肝癌患者作为对照组,仅行介入化疗栓塞治疗。于1～2个治疗周期后比较RECIST疗效,甲胎蛋白转阴率及生活质量评分,同时比较治疗副作用。 结果: 实验组30例患者中29例可评价疗效。实验组治疗后K氏评分显著升高(80.39±8.37Vs73.93±9.22,P=0.002);恩度治疗组的治疗有效率及甲胎蛋白转阴率显著高于对照组(P=0.021,P=0.046)。治疗副作用轻微。 结论: 采用恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌,患者生活质量及近期疗效提升明显,甲胎蛋白转阴率亦有明显改善,而治疗相关副作用不大,值得临床推广及进一步研究。     

Nausea and Vomiting after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Incidence and Risk Factor Analysis

Background: Nausea and vomiting after transcatheter arterial chemoembolization (TACE) for hepatocellularcarcinoma (HCC) are common in clinical practice, but few studies have reported the incidence and risk factorsof such events. Objective: The purpose of this study was to analyze the incidence and risk factors of nausea andvomiting after TACE for HCC. Methods: This study was a single-center retrospective analysis of a prospectivelymaintained database. Between May 2010 and October 2012, 150 patients with HCC were analyzed for incidenceand preprocedural risk factors. Results: The incidence of postembolization nausea and vomiting was 38.8%and 20.9%, respectively, in patients with HCC. Patients who developed nausea had lower levels (<100 IU/L)of serum alkaline phosphatase (ALP) compared to those without nausea (123.04 ± 69.38 vs. 167.41 ± 138.95,respectively, p=0.044). Female gender correlated to a higher incidence of nausea as well (p=0.024). Patients whodeveloped vomiting, compared to those who did not, also had lower levels (<100 IU/L) of serum ALP (112.52 ±62.63 vs. 160.10 ± 127.80, respectively, p=0.010), and serum alanine transferase (ALT) (35.61 ± 22.87 vs. 44.97± 29.62, respectively, p=0.045). There were no statistical significances in the incidences of nausea and vomitingbetween male patients over 50 years old and female patients who have entered menopause (p=0.051 and p=0.409,respectively). Multivariate analysis by logistic regression analysis demonstrated that female gender and ALP>100IU/L were the most independent predictive factors of postembolization nausea (odds ratio (OR): 3.271, 95%CI: 1.176-9.103, p=0.023 and OR: 0.447, 95% CI: 0.216-0.927, p=0.030, respectively). ALP>100 IU/L was alsothe most independent predictive risk factor of postembolization vomiting (OR: 0.389, 95% CI: 0.159-0.952,p=0.039). Conclusions: Postembolizaiton nausea and vomiting are common in patients with HCC. Recognitionof the risk factors presented above before TACE is important for early detection and proper management ofpostembolization nausea and vomiting. Nevertheless, future studies are required.     

Health-Related Quality of Life of Patients with Intermediate Hepatocellular Carcinoma after Liver Resection or Transcatheter Arterial Chemoembolization

Background: The aim of our present study was to compare quality of life (QoL) between intermediate-stage(BCLC-B) HCC patients who had undergone either liver resection or transcatheter arterial chemoembolization(TACE). Materials and Methods: A total of 102 intermediate-stage HCC patients participated in our study,including 58 who had undergone liver resection and 44 who had undergone TACE. Baseline demographiccharacteristics, tumor characteristics, and long-term outcomes, such as tumor recurrence, were compared andanalyzed. QoL was assessed using the Short Form (SF)-36 health survey questionnaire with the mental andphysical component scales (SF-36 MCS and PCS). This questionnaire was filled out at HCC diagnosis and 1,3, 6, 12, 24 months after surgery. Results: For the preoperative QoL evaluation, the 8 domains related to QoLwere comparable between the two groups. The PCS and MCS scores were significantly decreased in both theTACE and resection groups at1 month after surgery, and this decrease was greater in the resection group.These scores were significantly lower in the resection group compared with the TACE group (P<0.05). However,these differences disappeared at 3 and 6 months following surgery. One year after surgery, the resection groupshowed much higher PCS scores than the TACE patients (P=0.018), and at 2 years after surgery, the PCS andMCS scores for the resection group were significantly higher than those for the TACE group (P<0.05). Elevenpatients (19.0%) in the resection group and 17 (38.6%) in the TACE group suffered HCC recurrence (P<0.05).Univariate and multivariate analyses indicated that tumor recurrence (HR=1.211, 95%CI: 1.086-1.415, P=0.012)was a significant risk factor for poorpostoperative QoL in the HCC patients.Conclusions: Due to its effectson reducing HCC recurrence and improving long-term QoL, liver resection should be the first choice for thetreatment of patients with intermediate-stage HCC.     

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

The prognostic value of the tumor growth rate (TGR) in huge hepatocellular carcinoma (HHCC) patients treated with transcatheter arterial chemoembolization (TACE) as an initial treatment remains unclear. This two-center retrospective study was conducted in 97 patients suffering from HHCC. Demographic characteristics, oncology characteristics, and some serological markers were collected for analysis. The TGR was significantly linear and associated with the risk of death when applied to restricted cubic splines. The optimal cut-off value of TGR was −8.6%/month, and patients were divided into two groups according to TGR. Kaplan–Meier analysis showed that the high-TGR group had a poorer prognosis. TGR (hazard ratio (HR), 2.06; 95% confidence interval (CI), 1.23–3.43; p = 0.006), presence of portal vein tumor thrombus (PVTT) (HR, 1.93; 95% CI, 1.13–3.27; p = 0.016), and subsequent combination therapy (HR, 0.59; 95% CI, 0.35–0.99; p = 0.047) were independent predictors of OS in the multivariate analysis. The model with TGR was superior to the model without TGR in the DCA analysis. Patients who underwent subsequent combination therapy showed a longer survival in the high-TGR group. This study demonstrated that higher TGR was associated with a worse prognosis in patients with HHCC. These findings will distinguish patients who demand more personalized combination therapy and rigorous surveillance.     

Efficacy of Prophylactic Entecavir for Hepatitis B Virus- Related Hepatocellular Carcinoma Receiving Transcatheter Arterial Chemoembolization

Background and Aims: Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE. Methods: A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints. Results: Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation. Conclusion: Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.