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.     

血浆血管内皮细胞生长因子与肝细胞癌临床特征的相关性

目的通过检测肝细胞癌(HCC)患者肝动脉栓塞术前血浆血管内皮细胞生长因子(VEGF),考察VEGF表达与肿瘤大小、边界、门脉癌栓、远隔转移之间的相关性。方法收集介入治疗前HCC患者46例,VEGF定量检测采用双抗体夹心酶ABC ELISA法。根据血浆VEFG表达水平将患者分为阳性组(32例)和阴性组(14例),对肿瘤大小、边界、门脉癌栓、远隔转移情况进行组间对比。CT和DSA间接门脉造影获得的图像进行对比评估。结果VEGF阳性表达率69.56%(32/46),阴性表达率30.44%(14/46)。VEGF阳性组肿瘤直径>5cm者26例(81.25%),阴性组12例(85.75%),两组间无显著性差异(P>0.05)。CT片上阳性组肿瘤边界清楚15例(46.88%),阴性组边界清楚8例(57.14%),组间无显著性差异。阳性组门脉癌栓发生率62.50%(20/32),阴性组14.29%(2/14),两组间有极显著性差异(P<0.01)。阳性组远隔转移8例;阴性组无远隔转移,经检验P<0.05。结论血浆VEGF高表达可以提示门脉癌栓或远隔转移的存在,而与肿瘤大小、边界无关。血浆VEGF可能成为观察肿瘤门脉癌栓及远隔转移的指标。     

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。     

HBV感染及复制状态在HCC家庭聚集性中的作用研究

应用ＰＣＲ方法研究ＨＢＶ感染及复制状态在ＨＣＣ家庭聚集性中的作用。研究结果发现，肝癌高发家庭成员和非癌家庭成员中的ＨＢＶ－ＤＮＡ阳性率分别为２１．８％（１２／５５）和７．３％（４／５５），经统计学分析，两组阳性率存在非常显著性差异（Ｐ〈０．０１）。同时发现肝癌高发家庭成员ＨＢＶ－ＤＮＡ也呈家庭聚集现象。研究结果提示，ＨＢＶ感染的家庭聚集性并处于复制状态可能是ＨＣＣ家庭聚集性的主要原因之一。     

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。     

人肝癌及癌周组织中γ-谷氨酰转肽酶、甲胎蛋白癌胚抗原的表达

用丫-谷氨酞转肽酶-甲胎蛋白(GGT-AFP)双染色法研究了人肝癌及癌周组织中GGT,AFP的表达,同时观察了癌胚抗原(CEA)的分布.20例肝癌组织中,11例GGT阳性,10例AFP阳性.13例CEA阳性.在癌周组织中,6例GGT阳性,2例AFP阳性,20例CEA阳性.证实肝细胞癌可表达GGT,AFP,增生结节属癌前期病变,与肝癌的发生有关,GGT,AFP的增高与肝癌密切相关,CEA无特异性.     

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。