乙型肝炎与肝硬化和肝细胞癌的关系

近年来,应用免疫组织化学技术观察肝组织内乙型肝炎表面抗原(HBsAg)的研究屡有报导。大多数作者认为乙型肝炎在肝硬化、肝癌的发病中起重要作用;但有的流行病学研究则认为在某些地区,肝炎不是肝癌的病因。我省是肝癌高发区之一,关于这方面尚未见有报道。本文应用免疫酶法标记定位观察肝硬化、肝癌病人肝组织中HBsAg,以探讨本地区肝炎与肝硬化和肝细胞癌的关系。     

Improving clinical trial design for hepatocellular carcinoma treatments

Despite its place as the third leading cause of cancer deaths worldwide, there are currently no approved chemotherapeutic agents, devices or techniques to treat hepatocellular carcinoma. Importantly, there have been no phase III studies demonstrating survival benefit, nor any randomized studies of treatment except for transarterial chemoembolization and most recently sorafenib. The importance of well-designed clinical trials of agents to treat HCC has never been greater. However, general clinical study design issues, combined with HCC-specific issues pose significant challenges in structuring such studies. HCC-related challenges include the heterogeneity of this cancer and the fact that it is frequently accompanied by significant comorbidities at diagnosis, such as active hepatitis B or C virus replication, substantial past or on-going alcohol use, and cirrhosis, itself often a fatal disease. The recently published comparison of a newer treatment, nolatrexed to doxorubicin, and comments about this study’s initial HCC diagnostic criteria, staging system, comparator therapy and choice of endpoints have provided a platform to discuss the challenges unique to the design of HCC clinical trials. The difficulty in accurately framing study results obtained from the constantly changing HCC clinical landscape and approaches to meet these challenges will be reviewed.     

Complete hepatic venous isolation and extracorporeal chemofiltration as treatment for human hepatocellular carcinoma: A phase I study

Background: We performed a phase I study of a novel system of complete hepatic venous isolation and extracorporeal chemofiltration in patients with unresectable hepatocellular carcinoma (HCC) to determine (a) whether systemic exposure to doxorubicin could be limited after high-dose hepatic arterial infusion (HAI), and (b) the hepatic maximum tolerated dose (MTD) of doxorubicin. Methods: Ten patients with biopsy-proven HCC were treated with 20-min HAI of doxorubicin (17 total treatments). Two patients were treated with doxorubicin 60 mg/m², three patients were treated at 90 mg/m², and five patients received 120 mg/m². A newly developed dual-balloon vena cava catheter was advanced from the femoral vein, and the balloons were inflated to isolate and capture total hepatic venous outflow. The hepatic venous blood was pumped through extracorporeal carbon chemofilters before return of the blood to the systemic circulation. Results: Peak systemic doxorubicin levels were an average 85.6% lower than were peak prefilter levels (p<0.01). Because all catheters were placed percutaneously and because the chemofiltration markedly limited systemic chemotherapy exposure, patients were discharged 1 day after 16 of the 17 treatments. The hepatic and systemic MTD of doxorubicin in this treatment protocol was 120 mg/m². Conclusions: This novel system of complete hepatic venous isolation and chemofiltration limits systemic chemotherapy toxicity and will allow use of higher doses of chemotherapeutic agents to treat HCC. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

大鼠肝癌发生发展过程中肝组织增殖细胞核抗原动态演变规律

目的研究原发性肝细胞癌发生、发展过程中肝组织增殖细胞核抗原(proliferatingcellnuclearanti-gen,PCNA)的动态演变规律。方法将60只SD大鼠按随机数字表法随机分为对照组(20只)和实验组(40只)。用化学致癌剂3,3′-二氨基联苯胺(3,3′-diaminobenzidine,DAB)诱发SD大鼠肝癌,采用免疫组织化学方法连续监测各时相肝组织中PCNA的表达,光镜下观察肝组织的病理变化。结果本实验的诱癌过程可分为炎性变期、增生纤维化期和癌变期3个阶段;PCNA的表达最早出现于炎性变早期汇管区的卵圆细胞中,并在汇管区呈区域性过表达分布;炎性变中期,PCNA表达阳性率达高峰,随后下降,在癌变期又升高,在整个病理演变过程中其表达具波动性。结论在致癌因素的存在下,PCNA首先表达于卵圆细胞;PCNA表达的动态演变对肝癌的发生有一定的预警作用。     

彩色多普勒超声对肝癌肝动脉化疗栓塞的疗效评价

目的 :探讨彩色多普勒超声 (CDFI)在评价肝癌肝动脉化疗栓塞 (TAE)疗效中的应用价值。方法 :对 4 8例原发性肝癌TAE术前、后行CDFI检查 ,观察肿瘤大小、血供及肝动脉、门静脉血流动力学改变。结果 :TAE术后大多数肿瘤均有不同程度缩小 ;肿瘤内部及周边血供明显减少 (P <0 0 5 ) ,以肿瘤内血流减少更明显 ,其血供减少程度与肿瘤缩小程度呈正相关 (r =0 75 ,P <0 0 0 1) ,肝动脉峰值流速明显下降 ,门静脉血流速度增快 (P <0 0 0 1)。结论 :CDFI能客观判断肿瘤大小及血流灌注状态 ,是目前检验肝癌TAE效果较理想的影像学检查方法     

国内丙型肝炎病毒感染与肝细胞癌关系的19个病例对照研究的 Meta 分析

本文对国内１９个有关丙型肝炎病毒（ＨＣＶ）感染与肝细胞癌（ＨＣＣ）关系的病例对照研究进行Ｍｅｔａ分析。经齐性检验表明，１９个研究中有１７个研究结果是一致的。对此１７个研究结果加权合并，累积ＨＣＣ病例１５７７例，ＨＣＶ感染率为２３．０％，累积对照１９８０例，ＨＣＶ感染率为４．０％；合并ＯＲ值为６．７。结果表明，国内ＨＣＶ感染与ＨＣＣ关系密切，ＨＣＶ感染是ＨＣＣ发生的一个危险因素。     

One-shot percutaneous ethanol injection of liver tumors under general anesthesia: Preliminary data on efficacy and complications

Purpose: To verify the efficacy of ultrasound (US)-guided injection of large amounts of ethanol into large or multiple liver lesions, in a single session under general anesthesia (one-shot PEI) for percutaneous ablation of hepatic tumors. Methods: Twenty-nine patients (27 with 51 hepatocellular carcinoma (HCC) nodules on cirrhosis, diameter range 1.0<+>–<+>9.0 cm; two patients with a single metastasis from the gastroenteric tract, 5.0 and 9.0 cm, respectively, in diameter) were treated with one-shot PEI. Results: The total volume of alcohol delivered per patient ranged from 16 to 210 ml. Mean ethanol volume in all patients was 49 ml. Dynamic computed tomography (CT) examination showed complete necrosis in 41 of 50 lesions. Two patients died of hypovolemic shock due to massive upper gastrointestinal bleeding, 3 and 7 days, respectively, after the interventional procedure. All the remaining patients are alive (follow-up 5<+>–<+>14 months) except one who died of liver failure 5 months after. New HCC nodules occurred in six patients within 6 months and one intralesional relapse was recorded. Conclusion: In this preliminary experience, one-shot PEI is as effective in inducing liver tumor necrosis as traditional PEI; its advantages are shorter treatment time and the capability of treating larger and multiple liver lesions.     

原发性肝癌介入治疗中化疗栓塞模式的探索

为探讨空气作为栓塞剂在原发性肝癌介入中的应用并作出评价，选择１３例不能切除的原发性肝癌经肝动脉静灌注化疗后用空气２０～３０ｍｌ栓塞，２～３周一次，反复治疗２～４次，疗程末用碘油阿霉素乳剂作最后栓塞，治疗中观察血象，肝功能，ＡＦＰ和肿瘤大小的变化，并作长期随访。结果：治疗后肿瘤缩小５０％以上者３例，不足５０％者９例，变化不明显１例，随访结果６例生存不足６月，３例生存１０月，２例１２月，另２例生存超过     

超液化碘油混合抗癌药物栓塞治疗中晚期肝癌

本文报告超液化碘油混合抗癌药物经皮肝动脉栓塞治疗51例中晚期肝癌。术后50例临床病情改善,治疗2次后肿瘤显著缩小(>50%)16例,中度缩小(20～50%)21例,轻度缩小(<20%)7例;5例为弥漫型难以判定肿块大小,另2例未复查。所有肿瘤缩小的病例均可见肿瘤血管减少。治疗后3个月、6个月、9个月和1年以上生存率分别为100%、82.4%、59.8%和23.5%,其中生存期大于9个月者均为团块型或多结节型。     

肝动脉化疗,栓塞与肝静脉暂时闭塞治疗肝癌

本文报道在10例肝癌患者中运用肝静脉暂时闭塞和肝动脉内灌注化疗、栓塞的方法治疗取得较好疗效。7例甲胎蛋白阳性患者5例下降大于50%,2例转阴。4例肿瘤缩小>50%。2例合并肝动-静脉瘘者成功实行碘油栓塞,1例经治疗后肝动-静脉瘘消失。对肝功能的影响与普通介入治疗相同。消化道反应相对较轻。并可提高肿瘤局部药物浓度,延长药物作用时间。配合肝段动脉或靶血管的插管可进一步提高疗效,减少并发症。