Significant Long-Term Survival After Radiofrequency Ablation of Unresectable Hepatocellular Carcinoma in Patients with Cirrhosis

Background Radiofrequency ablation (RFA) offers an alternative treatment in some unresectable hepatocellular carcinoma (HCC) patients with disease confined to the liver. We prospectively evaluated survival rates in patients with early-stage, unresectable HCC treated with RFA.Methods All patients with HCC treated with RFA between September 1, 1997, and July 31, 2002, were prospectively evaluated. Patients were treated with RFA by using a percutaneous or open intraoperative approach with ultrasound guidance and were evaluated at regular intervals to determine disease recurrence and survival.Results A total of 194 patients (153 men [79%] and 41 women [21%]) with a median age of 66 years (range, 39–86 years) underwent RFA of 289 sonographically detectable HCC tumors. All patients were followed up for at least 12 months (median follow-up, 34.8 months). Percutaneous and open intraoperative RFA was performed in 140 (72%) and 54 (28%) patients, respectively. The median diameter of tumors treated with RFA was 3.3 cm. Disease recurred in 103 (53%) of 194 patients, including 69 (49%) of 140 patients treated percutaneously and 34 (63%) of 54 treated with open RFA (not significant). Local recurrence developed in nine patients (4.6%). Most recurrence was intrahepatic. The overall complication rate was 12%. Overall survival rates at 1, 3, and 5 years for all 194 patients were 84.5%, 68.1%, and 55.4%, respectively.Conclusions Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.Presented at the 57th Annual Cancer Symposium of the Society of Surgical Oncology, New York, New York, March 18–21, 2004.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

不能手术的妇科恶性肿瘤的介入治疗

目的 探讨介入治疗对不能手术的妇科恶性肿瘤的疗效。方法27例患,其中卵巢癌14例,子宫内膜癌5例,宫颈癌8例,经妇检、B超、CT确诊为晚期且失去手术机会。采用selding氏法,经单侧股动脉插管,行DSA后,将导管超选至双侧髂内动脉供血动脉近端,注入以铂类为主的3种化疗药,并栓塞肿瘤或／和转移灶供血动脉。结果介入治疗1至4次后,所有病入临床症状明显改善,瘤体有不同程度缩小。其中5例于首次治疗后2周,行肿瘤根治术,术后3个月继续介入治疗,随访结果表明,患生存质量提高,中位生存期19个月。化疗的副作用明显低于全身静脉给药。结论介入治疗为不能手术的妇科恶性肿瘤患提供了一种安全、有效的治疗方法。     

仑伐替尼联合程序性死亡受体-1抗体治疗不可切除或进展期肝细胞癌的临床疗效

目的:探讨仑伐替尼联合程序性死亡受体-1（PD-1）抗体治疗不可切除或进展期肝细胞癌（以下简称肝癌）的临床疗效。方法:采用回顾性描述性研究方法。收集2018年9月至2020年1月复旦大学附属中山医院收治的59例不可切除或进展期肝癌病人的临床病理资料;男54例,女5例;中位年龄为52岁,年龄范围为25~73岁。59例病人...     

TACE联合TKI及PD-1抑制剂在不可切除肝细胞癌患者转化治疗中的疗效

目的 探讨经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKI)及程序性死亡受体-1(programmed death-1,PD-1)抑制剂在不可切除肝细胞癌患者转化治疗中的效果...     

Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer

Background: Ductal carcinoma of the pancreas is unresectable for cure in the majority of patients. We reviewed our results and cost effectiveness of surgical and endoscopic biliary bypass for unresectable pancreatic cancer to evaluate the comparable outcomes. Methods: Between 1990 and 1992, 136 patients were managed operatively or endoscopically for pancreatic carcinoma. Excluding potentially curative resections and patients without follow-up, 34 patients endoscopically stented and 32 patients surgically bypassed were evaluated. Results: Mean patient age was older (72.1 vs. 69.3 years) but average performance status was comparable (0.8 vs. 0.9 Eastern Cooperative Oncology Group grading) in the medical treatment group. The initial hospital stay was significantly longer for surgical patients (mean 14 vs. 7 days, p<0.001), with higher average charges ($18,325 vs. $9,663). Twelve stented patients required rehospitalization (average charge of $4,029), and eight surgical patients were readmitted (average charge of $6,776). An average of 1.7 stent changes (average charge $1,190) were required. Mean survival was longer for the stented group (9.7 vs. 7.3 months, p=0.13). Conclusions: Endoscopic stenting for unresectable pancreatic cancer provides equivalent duration of survival at reduced cost and shorter hospital stay, although subsequent stent changes are necessary. When curative resection is not possible, endoscopic biliary drainage should be considered a good first choice for palliative management. Presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Prognosis following transcatheter arterial embolization for 121 patients with unresectable hepatocellular carcinoma with or without a history of treatment

AIM: To retrospectively evaluate the prognosis of patients with hepatocellular carcinoma (HCC) with or without a history of therapy for HCC following transcatheter arterial embolization (TAE). METHODS: One hundred and twenty-one patients with HCC treated with TAE from 1992 to 2004 in our hospital were enrolled in this study. Eighty-four patients had a history of treatment for HCC, while 37 did not. At the time of entry, patients with extra-hepatic metastasis, portal vein tumor thrombosis, or Child-Pugh class C were excluded. TAE was repeated when recurrence of HCC was diagnosed by elevated tumor markers, or ultrasonography or dynamic computed tomography findings. RESULTS: Tumor size was larger and the number of tumors was fewer in patients without past treatment (P<0.01). However, there were no differences in tumor node metastasis (TNM) stage or survival rate between the 2 groups. A bilobular tumor and high level of alpha-fetoprotein (AFP) (>100 ng/mL) were factors related to a poor prognosis in patients with a history of HCC. CONCLUSION: The prognosis following TAE is similar between HCC patients with and without past treatment. Early diagnosis of HCC or recurrent HCC and obtaining good local control against HCC before entry to a repeated TAE course can improve prognosis.     

塑料胆管支架置入方式对不可切除肝门部胆管癌伴梗阻性黄疸治疗效果的影响

目的　对比塑料胆管支架3种末端开口留置方式在解除不可切除肝门部胆管癌梗阻性黄疸方面的临床应用效果。方法　回顾性分析2014年4月—2020年12月在中国医学科学院肿瘤医院内镜科行塑料胆管支架置入减黄治疗的不可切肝门部除胆管癌患者61例，其中胆管支架末端开口胃内留置18例（胃内留置组），十二指肠乳头留置31例（十二指肠乳头留置组），十二指肠水平部留置12例（十二指肠水平部留置组）。对随访2周发热率、围手术期死亡率、术后90 d支架梗阻率、支架中位通畅时间进行分析。结果　胃内留置组、十二指肠乳头留置组和十二指肠水平部留置组3组患者术后2周内发热率比较［66.7%（12/18），58.1%（18/31）和16.7%（2/12），χ2=7.30，P=0.026］差异有统计学意义，围手术期死亡率［0（0/16），3.2%（1/31）和0（0/10），χ2=1.09，P=1.000］、术后90 d内支架梗阻率［52.9%（9/17），48.3%（14/29）和40.0%（4/10），χ2=1.91，P=0.589］和支架中位通畅时间（66.0 d，91.5 d和94.0 d，Z=4.96，P=0.084）比较差异无统计学意义。结论　与胆管支架末端开口胃内留置和十二指肠乳头留置比较，十二指肠水平部留置术后2周发热率低，但支架中位通畅时间、术后90 d支架梗阻率及围手术期死亡率相似。支架末端开口留置于十二指肠水平部可作为首选置入方式。     

胃部分隔断的胃空肠吻合术治疗无法切除远端胃癌的效果分析

目的：研究胃部分隔断的胃空肠吻合术治疗无法切除远端胃癌的临床效果。方法将64例远端胃癌患者根据手术方式的不同分为两组,即胃部分隔断的胃空肠吻合术治疗组（实验组）及单纯胃空肠吻合术治疗组（对照组）。比较两组的并发症、生活质量情况及生存率。结果实验组的手术时间、术中出血量、术后拔除胃管时间与对照组比较,差异无统计学意义（P＞0.05）;实验组的远期并发症发生率低于对照组（P＜0.05或P＜0.01）;实验组的生活质量高于对照组（P＜0.05）;实验组的1年生存率高于对照组（P＜0.05）。结论胃部分隔断的胃空肠吻合术治疗无法切除的远端胃癌的效果良好,能够改善患者的生活质量。