Prognostic benefit in cytoreductive surgery for curatively unresectable hepatocellular carcinoma - comparison to transcatheter arterial chemoembolization

As a strategy for treating advanced hepatocellular carcinoma (HCC), cytoreductive surgery was studied comparing to transcatheter arterial chemoembolization (TACE). Patients who had curatively unresectable intrahepatic multiple HCC with the main tumor 30 mm or more in size were selected for this study. The patients were classified into two groups; i) cytoreductive surgery group (CRS group): 28 patients in whom the main tumor was resected but other cancer nodules remained in the remnant liver, ii) TACE group: 25 patients at Child A grade who underwent TACE, and in whom it was also evaluated retrospectively that the main tumor had been resectable. The cumulative 5-year survival rate was significantly higher in CRS (48.7%) than TACE (17.1%) group. Multivariate analysis revealed that performing cytoreductive surgery was a significant and independent factor to prolong survival. However, 6 of 28 patients died within one year of surgery. Residual tumor thrombus, and the absence or non-effectiveness of adjuvant therapy were significant high risk factors for postoperative death within one year. Conclusively, cytoreductive surgery contributes to a significant lengthening of survival in patients with advanced HCC. To reduce the risk of early postoperative death, the importance of postoperative adjuvant therapy is also recognized.     

53例肝细胞癌患者根治性切除术后辅助肝动脉化疗栓塞的生存分析

  目的   探讨肝细胞癌根治性切除术后辅助肝动脉化疗栓塞对无瘤生存率及累积生存率的影响。   方法   收集53例肝细胞癌根治性切除术后辅助TACE治疗患者和64例单纯行肝细胞癌根治术后患者的临床资料,采用回顾性研究的方法,对其治疗的1、2、3、5无瘤生存率和累积生存率进行对比分析,从而探讨肝细胞癌根治性切除术后辅助TACE治疗对无瘤生存率及累积生存率的影响。   结果   术后+TACE组1、2、3、5年的无瘤生存率和累积生存率分别为84.9%、60.4%、39.6%、18.9%和98.1%、86.8%、69.8%、47.2%,单纯手术组1、2、3、5年的无瘤生存率和累积生存率分别为70.3%、43.8%、21.9%、12.5%和87.5%、71.9%、50.0%、31.3%,两组的无瘤生存率和累积生存率差异均有统计学意义。Cox回归结果显示术后+TACE治疗是影响患者无瘤生存率和累积生存率的独立影响因素。   结论   肝细胞癌根治性切除术后辅助TACE治疗可提高患者的无瘤生存率和累积生存率,术后辅助TACE治疗是影响患者术后无瘤生存率和累积生存率的独立影响因素。      

Postoperative adjuvant transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond the Milan criteria: a retrospective analysis

Objective: To clarify the value of postoperative adjuvant transcatheter arterial chemoembolization (TACE) for resectable multiple hepatocellular carcinoma beyond the Milan criteria. Background: Patients with multiple HCC have been shown to have a worse survival after a partial hepatectomy (PH) because of the high incidence of intrahepatic tumor recurrence. Postoperative adjuvant TACE is an optional strategy for HCC patients with a high recurrence risk. Its effects and range of applications are debatable. Methods: This retrospective study enrolled 135 HCC patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria, and those patients underwent a hepatectomy with/without postoperative adjuvant TACE from Jan. 2004 to Dec. 2008. The patients were divided to the PH cohort or the PH+TACE cohort. The prognosis measures were the disease-free survival (DFS) and overall survival (OS) from the date of treatment. Univariate and multivariate analyses were used to assess the prognostic factors associated with DFS and OS, using the Cox proportional hazards model. Results: The 1-, 2-, and 5-year DFS and OS for the PH+TACE group differed significantly from the PH group (p = 0.004, p = 0.002, respectively). Multivariate analysis revealed that the significant independent risk factors associated with the DFS and OS were postoperative TACE treatment (p = 0.002, p = 0.001, respectively) and the number of tumors (p = 0.006, p = 0.037, respectively). Conclusions: Our results show that postoperative adjuvant treatment resulted in delayed intrahepatic recurrence and better survival for patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria. Postoperative adjuvant TACE should be regarded as a common strategy for patients with resectable multiple HCC beyond the Milan criteria.     

Sorafenib in combination with transarterial chemoembolization and bronchial arterial chemoinfusion in the treatment of hepatocellular carcinoma with pulmonary metastasis

Aim: Hepatocelluar carcinoma (HCC) with pulmonary metastasis is considered incurable. This study addresses the efficacy of the combination of systemic therapy using sorafenib and local treatment using transarterial chemoembolization (TACE) for intrahepatic and bronchial transarterial chemoinfusion (TAI) for pulmonary lesions for this condition. Methods: In all, 52 HCC patients with pulmonary metastasis were treated with sorafenib and TACE/TAI for intrahepatic and intrapulmonary lesions. Response to treatment, progression‐free survival (PFS), overall survival (OS) and treatment‐induced adverse effects were analyzed. Results: With a median follow‐up time of 11.4 months, radiologically confirmed complete response (CR), partial response (PR), stable disease and disease progression for intrahepatic disease were observed in 0, 22, 23 and seven patients, respectively; radiologically confirmed CR, PR, stable disease and disease progression observed for intrapulmonary lesions were in 1, 8, 25 and 18 patients, respectively. Median OS and PFS was 12.0 and 10.0 months, respectively. Median OS of patients who achieved response (i.e., CR + PR + stable disease) in their gross lesion(s) was 14.0 and 13.0 months, respectively, as compared to 4.0 and 3.0 months for patients who progressed (P < 0.003). Significant prognosticators for OS and PFS included performance status, Barcelona Clinic Liver Cancer stage and response to treatment. The combined treatment strategy was well tolerated. Conclusion: The combination of sorafenib, TACE and TAI produced median OS and PFS of 12 and 10 months, respectively, in HCC patients with lung metastasis. The outcomes of patients who achieved a response to their gross lesions were significantly better than those who had disease progression. Further investigation is warranted to test the efficacy of this treatment combination.     

核苷类似物联合TACE治疗HBV相关性肝细胞癌的预后分析

目的 比较肝切除术后核苷类似物联合经肝动脉化疗栓塞（TACE）与单用TACE治疗对提高乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）患者总生存率的效果。方法 回顾性分析345例行肝切除术的HBV相关性HCC患者资料,其中术后接受核苷类似物抗病毒联合TACE治疗者89例（观察组）,术后单用TACE治疗者256例（对照组）。采用倾向性匹配法均衡组间混杂因素的影响。结果 观察组的90天死亡率（2.2%）稍低于对照组（3.1%, P=0.672）。同时,观察组患者的1、3、5年累积总生存率显著高于对照组,分别为93%、66%、45%和90%、54%、36%（P=0.014）。倾向性分析显示,观察组患者的1、3、5年累积总生存率为93%、67%和45%,亦显著高于对照组患者的87%、46%和24%（P<0.001）。基于肿瘤分期的亚组分析显示,巴塞罗那临床肝癌分期A/B期的患者中,观察组患者的累积总生存率显著优于对照组（P=0.011）。结论 HBV相关性HCC肝切除术后核苷类似物联合TACE治疗有利于降低存在高危复发因素且术前HBV DNA≥103 IU/ml患者围手术期死亡率并提高其总生存率。     

A long-term survival case after two resections of the peritoneal metastasis from hepatocellular carcinoma

A 70-year-old man with type B hepatitis had ruptured HCC in segment 5, and he underwent with TAE at other hospital in June 2007. Then, he was introduced to our hospital in July 2007. Partial hepatectomy( S5) was performed in August 2007 (pT2N0M0, Stage II). Afterward, he underwent TACE therapy twice because of multiple intrahepatic recurrences. Abdominal CT revealed a viable recurrence lesion (S5), and peritoneal dissemination (surface of S3) in June 2009. We carried out partial hepatectomy (S5), and removal of peritoneal dissemination because of good liver function and without any other extra hepatic recurrence in July 2009. Histologically, the intrahepatic lesion( S5) and the S3 surface lesion were diagnosed as moderately differentiated HCC. In July 2010, abdominal CT revealed three lesions of peritoneal dissemination (right subphrenic lesion, hepatic flexure of the colon, neighborhood of left ureter, then the second removal of peritoneal dissemination was performed. In January 2011, he had multiple lung metastatic lesions, and multiple bone metastatic lesions were occurred in March 2011, then his general condition was getting worse. In April 2011, he was dead 46 months after the first TAE therapy for ruptured HCC, or 21 months after the first resection of peritoneal dissemination. Surgical resection of peritoneal dissemination of HCC may improve a survival for patients whose intrahepatic lesion is contorollable.     

Three (3) cases of advanced hepatocellular carcinoma (HCC) treated successfully by transcatheter arterial infusion of cisplatin followed by gelatin particles

Hepatic artery chemotherapy with transarterial infusion (TAI) of a cisplatin formulation designed for intra-arterial injection (IA-call?) is recognized as an established treatment for advanced hepatocellular carcinoma (HCC). We experienced three patients whose multiple HCC(Stage III) was successfully treated by TAI using IA-call combined with embolization by porous gelatin particles (Gelpart?), after a series of treatments such as hepatectomy, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), and TAI. Cisplatin-based TAI was not effective, but porous gelatin particles showed a therapeutic effect in one patient by reducing his hepatic arterial blood flow. The two other patients responded to combination therapy after the second treatment. Adverse events from the treatment were mild. This therapy has benefits even for multiple intra-hepatic lesions that are resistant to TACE and TAI because of its widespread effect on the entire liver, and it could be an effective treatment option for advanced HCC.     

原发性肝癌综合介入治疗的疗效分析

目的探讨原发性肝癌综合介入治疗的疗效。方法回顾性分析1126例原发性肝癌患者手术前后行经导管肝动脉化疗栓塞术(TACE)、TACE后射频消融(RFA)治疗、TACE或经导管肝动脉化疗灌注治疗(TAI)后辅以中药和生物治疗的临床资料,分析患者肝功能、肿瘤标志物、癌灶影像资料和生存率等,比较各种综合介入治疗的价值。结果全组患者1、3、5年生存率分别为67.8%、28.7%和18.8%。其中术前TACE组1、3、5年生存率分别为74.7%、41.4%和36.9%,术后TACE组1、3、5年生存率分别为78.9%、40.4%和37.5%;TACE RFA组的近期有效率为93.4%,1、3年生存率分别为74.5%和36.8%;TACE组的近期有效率为83.2%,1、3、5年生存率分别为69.3%、21.7%和8.4%;TAI治疗的近期有效率为27.5%,1、3年生存率分别为11.6%和0。TACE RFA组和TACE组间肝功能Child降级、瘤内与瘤周血流信号消失和甲胎蛋白转阴率差异均无统计学意义,TACE RFA组、TACE组与TAI组肝功能Child降级差异无统计学意义。结论原发性肝癌手术切除前后TACE效果最佳,手术前与手术后行TACE疗效相近;TACE RFA疗效优于TACE;TAI疗效较差。     

Combination therapy with radiofrequency ablation and transcatheter chemoembolization for the treatment of hepatocellular carcinoma: Short-term recurrences and survival

To evaluate short-term clinical results of radiofrequency (RF) ablation combined with transcatheter chemoembolization for the treatment of hepatocellular carcinoma (HCC) and to identify factors having influence on early intrahepatic recurrence. Sixty-four patients with 92 HCC lesions underwent RF ablation within 2 weeks after chemoembolization. The maximum tumor size was small (5 cm) were significantly linked with higher probability of early intrahepatic recurrence. In the multivariate analysis, tumor number was the only independent factor having significant impact on early intrahepatic recurrence. The estimated 1- and 2-year survival rates were 100% and 93%, respectively. This combined therapy showed good early therapeutic effects on treated lesions and survival. Tumor number and maximum tumor size are important factors for early intrahepatic recurrence.     

肝细胞癌切除术后肝内复发患者的预后影响因素分析

目的 探讨肝细胞癌(HCC)切除术后肝内复发的预后影响因素以及复发后治疗方式的选择.方法 收集184例HCC切除术后肝内复发患者的临床病理资料,回顾性分析21项临床病理学因素以及复发后治疗方式对HCC患者肝内复发后生存期的影响.结果 单因素分析结果 表明,术前血清甲胎蛋白(AFP)水平较高(>100 ng/ml)、有微血管浸润、首次诊断复发时肿瘤的Child-Pugh分级为B或C级、有多个肝内复发肿瘤以及早期肝内复发(≤12个月)的患者预后不良.Cox多因素分析结果 表明,首次诊断复发时肿瘤的Child-Pugh分级、复发肿瘤的数目和复发时间是影响HCC患者复发后生存期的独立危险因素.69例单个复发肿瘤患者中,经再次肝切除手术和局部消融治疗患者的复发后中位生存期分别为34和23个月,而经肝动脉插管化疗栓塞治疗和未进行治疗患者的复发后中位生存期分别为15和9个月,4种治疗方式患者的生存期差异有统计学意义(P<0.05).结论 首次诊断复发时肿瘤的Child-Pugh分级为A级、单个复发肿瘤、复发时间较晚(>12个月)、经过再次肝癌切除手术或局部消融治疗的HCC肝内复发患者的预后较好.     

A long-term survival case of hepatocellular carcinoma with portal vein and inferior vena cava tumor thrombi

We report a case of advanced hepatocellular carcinoma (HCC) successfully treated by hepatic arterial infusion of 5-fluorouracil (5-FU) combined with systemic administration of interferon (IFN)-α and trans-arterial infusion (TAI) therapy of cisplatin (CDDP). A case was a 60-year-old man who had right upper abdominal pain and back pain. The abdominal CT revealed an early enhanced lesion in the posterior segment of the liver with portal vein and inferior vena caval tumor thrombi and multiple intrahepatic metastases. Tumor markers were elevated, AFP 2,480 ng/mL, PIVKA-II 31,900 mAU/mL. The patient underwent 4 courses of IFN-α/5-FU combination therapy and 8 times of TAI therapy of CDDP. After these therapies, tumors in the liver disappeared and tumor markers returned to the normal range. The patient is alive more than 58 months after the initial treatment. This case suggests that some patients with advanced HCC with tumor thrombus can get a long-term survival when intrahepatic lesions are controlled by various therapies including IFN-α/5-FU combination therapy.     

Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study.

BACKGROUND: Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective locoregional therapies for hepatocellular carcinoma (HCC). This study aimed to investigate whether HCC patients who had initial complete response to these treatments had a subsequent lower risk of intrahepatic metastasis. PATIENTS AND METHODS: A total of 152 patients who underwent locoregional therapy (94 received PAI and 58 received both TACE and PAI) for HCC (tumor size < or =5 cm) were prospectively evaluated. RESULTS: In all, 60 (39%) patients had a complete tumor necrosis after treatment. The cumulative incidence of the development of intrahepatic metastasis was lower for patients with complete remission (P = 0.005) and for patients with smaller (< or =3 cm) tumor size (P = 0.083). Cox multivariate survival analysis showed that absence of complete remission [relative risk (RR) 2.7; 95% confidence interval (CI) 1.4-5.3; P = 0.003] was the only independent factor that predicted the occurrence of intrahepatic metastasis. Patients with complete remission had a significantly better long-term survival than those without (P = 0.002), and the occurrence of intrahepatic metastasis over time independently predicted a decreased survival (RR 3.2; 95% CI 2.0-6.1; P = 0.019). CONCLUSIONS: Induction of complete tumor necrosis in HCC patients undergoing locoregional therapy may decrease the risk of intrahepatic metastasis and improve survival.     

Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients

OBJECTIVES: To evaluate the role of radiotherapy (RT) for hepatocellular carcinoma (HCC) patients with abdominal lymph node (LN) metastasis at our institution in the past 7 years. METHODS AND MATERIALS: We identified 125 patients with HCC metastasis to regional LNs treated with or without external beam RT (EBRT) between 1998 and 2004. Clinical characteristics collected included alpha-fetoprotein status, gamma-glutamyltransferase, status of intrahepatic tumors (size and number), previous therapy for intrahepatic tumors, metastatic LN status (location, number, and size), tumor thrombi, and Child-Pugh classification. Of the 125 patients, 62 received local limited EBRT and were classified as the EBRT group. They received locoregional LN irradiation. The tumor dose ranged from 40 to 60 Gy in daily 2.0-Gy fractions, 5 times weekly. Another 63 patients, who did not receive EBRT, were selected from hospitalized patients in the same period and were classified as the non-EBRT group. The parameters studied included survival rates and tumor response to EBRT both as demonstrated by clinical symptoms and as seen on CT. The Kaplan-Meier method was used to evaluate the survival rates, and the Cox regression model was used to identify predictors of outcome. RESULTS: After EBRT, partial responses and complete responses were observed in 37.1% and 59.7% of patients, respectively. The median survival was 9.4 months (95% confidence interval 5.8-13.0) for the EBRT group and 3.3 months (95% confidence interval, 2.7-3.9) for the non-EBRT group (p < 0.001). Multivariate analysis showed that multiple intrahepatic primary tumors, occurrence of tumor thrombi, no therapy for intrahepatic tumors, and greater Child-Pugh classification were related to a poorer prognosis in all patients. In the EBRT group, the survival periods decreased as the distance of LN involvement from the liver increased (following the natural flow of lymph) and was also associated with the intrahepatic primary tumor size. The incidence of death resulting from LN-related complications was lower in the EBRT group. CONCLUSION: Lymph node metastasis from HCC is sensitive to EBRT. EBRT with 25 fractions of 2 Gy is an effective palliative treatment for patients with LN metastases from HCC presenting with good performance status and may prolong overall survival.     

Transcatheter arterial infusion chemotherapy prior to radiofrequency thermal ablation for single hepatocellular carcinoma reduces the risk of intrahepatic distant recurrence

The aim of the present study was to elucidate the effectiveness of transcatheter arterial infusion chemotherapy (TAI) of the whole liver using an epirubicin-mitomycin-lipiodol emulsion, prior to radiofrequency thermal ablation (RFA), in preventing intrahepatic distant recurrence (IDR) from single hepatocellular carcinoma (HCC). Of the 269 consecutive patients who underwent RFA in our institute for single HCC, a total of 182 patients were analyzed in the present study. The primary endpoint was comparison of the post-RFA IDR-free survival rates in patients treated using TAI with an epirubicin-mitomycin-lipiodol emulsion via the proper hepatic artery (TAI-EML) prior to RFA, and patients that received lipiodol infusion-alone prior to RFA. The secondary endpoints were local tumor progression (LTP) and overall survival (OS). Lipiodol infusion-alone prior to RFA was performed in 88 patients and TAI-EML prior to RFA in 94 patients. The mean tumor size was 2.06 cm (range, 0.9-3.2 cm) in the TAI group and 1.97 cm (range, 0.9-3.3 cm) in the lipiodol-alone group, respectively. The cumulative IDR-free survival rates at 1, 2 and 3 years were 74.0, 50.8 and 34.9%, respectively, in the lipiodol-alone group, and 90.8, 74.8 and 70.0%, respectively, in the TAI group (P<0.001). In terms of the OS, there was a significant difference between these two groups (P=0.048), although there was no significant difference in terms of the LTP (P=0.145). We concluded that TAI-EML prior to RFA appears to be useful in reducing post-RFA IDR and may contribute to improved survival rates.     

残癌危险因素对肝癌切除术后肝动脉栓塞化疗效果的影响

目的 探讨术后辅助性肝动脉栓塞化疗对残癌低危和残癌高危患者预后的不同影响。方法 进入研究的病例分为干预组(辅助性动脉栓塞化疗组)和对照组(未行辅助性动脉栓塞化疗),根据残癌的高危因素将肝癌切除术的患者分为残癌高危者和残癌低危者,采用病例对照实验设计,以单因素统计方法和Cox模型,分析研究术后辅助性肝动脉栓塞化疗对肝癌切除术患者预后的影响,以及残癌高危因素对辅助性动脉栓塞化疗作用的影响。结果 对于残癌低危患者,干预组和对照组术后1,2,3,4年生存率分别为97．2％、78．0％、66．5％、66．5％和91．2％、81．4％、70．3％、54．4％,生存率差异无显著性(P=0．7667);而对于残癌高危患者,干预组和对照组术后1,2,3,4年生存率分别为89．5％、73．4％、59．2％、53．8％和70．5％、61．9％、46．8％、46．8％,生存率差异有显著性(P=0．0029)。Cox比例风险模型分析结果显示,辅助性动脉栓塞化疗对切除术后肝癌患者预后的影响,决定于患者有无残癌的危险因素,辅助性动脉栓塞化疗不是影响患者预后的独立因素。结论 术后给予辅助性肝动脉栓塞化疗,可延长有残癌高危因素患者的生存期,而对于无残癌危险因素的患者,术后辅助性肝动脉栓塞化疗不能延长生存期。     

Debulking surgery followed by intraarterial 5-fluorouracil chemotherapy plus subcutaneous interferon alfa for massive hepatocellular carcinoma with multiple intrahepatic metastases: A pilot study

Background

The prognosis in advanced hepatocellular carcinoma (HCC) with multiple intrahepatic metastases is extremely poor. Combination therapy with subcutaneous interferon (IFN) alfa and intraarterial 5-fluorouracil was reported to be effective against such advanced HCC. We describe results of debulking surgery followed by combination therapy with IFN alfa and 5-FU for massive HCC with multiple intrahepatic metastases.

Methods

In 27 HCC patients with massive tumors and multiple intrahepatic metastases, we performed combination therapy with IFN alfa and 5-FU after maximal liver tumor resection.

Results

Mean patient age was 63.3 years. Including intrahepatic metastases, tumors numbered 5 or more in 17 patients (63%). Portal or hepatic vein branches were invaded in 22 (81%). The mean maximum tumor diameter was 102 mm. Among 24 patients whose results were analyzed, an objective response by residual intrahepatic metastases was observed in 13 (54%; complete response in 12, and partial response in 1). Overall 1-, 3-, and 5-year survival was 73.2%, 38.7%, and 38.7%, respectively; 1-, 3-, and 5-year progression-free rates were 38.2%, 22.3%, and 22.3%.

Conclusions

Debulking surgery followed by IFN alfa and 5-FU combination chemotherapy offers possibility of long-term survival despite massive HCC with multiple intrahepatic metastases.     

ABO Blood Group Differentials on Survival in Hepatocellular Carcinoma Patients Treated with Chemoembolization

Background: The association between ABO blood group and the prognosis of hepatocellular carcinoma (HCC) remains unclear. We investigated the impact of ABO blood groups as a prognostic factor in HCC patients treated with transarterial chemoembolization (TACE). Materials and methods: We revisited records of all HCC patients who underwent TACE between January 2007 and December 2019 at a tertiary care hospital. The inclusion criteria were HCC patients, Child-Pugh score A5-B7, and treated with TACE monotherapy. The baseline characteristics of each patient were compared against their blood group and the survival analysis was carried out using Cox’s regression. With Bonferroni adjustment for multiple comparisons, P-values <.0125 were considered statistically significant. Results: Of 211 eligible patients, the frequencies of blood groups O, A, B, and AB were 89, 54, 56, and 12, respectively. Their respective months of median survival were 41, 20, 21, and 42. After adjustments in the six-and-twelve criteria and Child-Pugh scores, and using blood group O as the referent group, the coefficients (SE) of groups A, B, and AB were 0.69 (0.24), 0.47 (0.23), and 0.49 (0.49), respectively. A significant difference in survival was found only between patients with blood group O vs A (hazard ratio, 2.00; confidence interval, 1.25-3.21). Conclusions: ABO blood group is associated with the prognosis of HCC patients treated with TACE monotherapy. In our data, patients with blood group O tended to have the best survival. However, only blood group A patients had a significantly shorter survival rate comparing to blood group O.     

以手术为主治疗108例ⅢA期肝细胞癌的疗效分析

背景与目的：目前ⅢA期肝癌的治疗选择尚未统一。本研究分析以手术为主的综合方法治疗108例ⅢA期肝癌的疗效。方法：从2002年1月到2003年12月,108例ⅢA期肝癌患者在我院接受以手术为主的综合治疗。入组患者随机分成单纯手术组和综合治疗组,单纯手术组仅行肝切除术,综合治疗组行肝切除术联合肝动脉栓塞化疗（transcatheter arterial chemoembolization,TACE）。以无瘤生存率和生存率作为评价指标分析疗效。结果：全组患者中位无瘤生存期5．0（2．0～69．0）个月,1、3、5年无瘤生存率分别为25．0％、8.3％和6．5％;中位生存期21．0（4．0～69．0）个月,1、3、5年生存率分别为72．2％、25．9％和19．4％。其中综合治疗组的中位无瘤生存期7．0个月,1、3、5年无瘤生存率分别为40．0％、16．0％和12．0％,单纯手术组中位无瘤生存期4．0个月,1、3、5年无瘤生存率分别为15．5％、1．7％和1．7％（log-rank 16．01,P〈0．01）。综合治疗组中位生存期24．5个月,1、3、5年生存率分别为86．0％、36．0％和24．0％;单纯手术组中位生存期15．5个月,1、3、5年生存率分别为60．3％、17．2％和13．8％（log-rank 6．17,P=0．013）。结论：手术并术后辅助性肝动脉栓塞化疗治疗ⅢA期肝癌的疗效确切,可提高ⅢA期肝癌的治疗效果。     

What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma?

PURPOSE: This study aimed to analyze the effect of each therapeutic modality to clarify the treatment strategy for adrenal metastases from hepatocellular carcinoma (HCC). METHODS: Adrenal metastasis from HCC was observed in 45 patients. Fifteen patients who were determined to have multi-organ metastasis including the adrenal glands were excluded, and the remaining 30 patients were reviewed. RESULTS: The location of adrenal metastasis was right side, left side, and both in 17, 9, and 4 patients, respectively. Treatment for adrenal metastasis consisted of adrenalectomy in 5 patients, non-surgical treatment such as TACE, or chemotherapy and radiotherapy in 19 patients, while 6 patients received no treatment. The median survival duration was 11.05 months in the 30 patients with adrenal metastasis. In the 25 patients with well-controlled intrahepatic lesions, the median survival time of those patients who received adrenalectomy, non-surgical treatment, and no treatment was 21.41, 11.05, and 5.64 months, respectively. The difference in cumulative survival according to mode of treatment of adrenal metastasis in the well-controlled intrahepatic lesion group was statistically significant. CONCLUSION: We envisage increased benefit after adrenalectomy in terms of survival in patients with well controlled intrahepatic lesions at the time of adrenal metastasis and good general medical condition.     

Transarterial Chemoembolization Monotherapy in Combination with Radiofrequency Ablation or Percutaneous Ethanol Injection for Hepatocellular Carcinoma

Purpose: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. Methods: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACERFA or TACEPEI). The long-term survival rates were evaluated in those patients by various statistical analyses. Results: The cumulative survival rates in the combined TACERFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE RFA/PEI group than in the RFA/PEI alone group. Conclusions: In terms of the effect on the survival period, combined TACE RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.