中性粒细胞/淋巴细胞比值血小板/淋巴细胞比值与TACE治疗肝癌患者预后的相关性

  目的  本研究探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）与接受肝动脉栓塞化疗（transarterial chemoembolization,TACE）肝癌（hepatocellular carcinoma,HCC）患者术后生存期的相关性。  方法  回顾性分析2007年1月至2015年6月中山大学肿瘤防治中心肝胆胰科确诊为肝癌并行TACE治疗的216例患者。研究患者依照NLR和PLR的界值分成两组。分析并比较NLR和PLR在不同随访时间点的受试者工作曲线（ROC）下面积。单因素和多因素分析用于评价NLR和PLR与TACE术后肝癌患者预后的相关性。  结果  本研究中位随访时间为431.1 d。全体研究对象1、2、3年生存率分别为61.3%、44.2%和40.5%。中位生存时间为410.5 d。术前NLR＜1.77组和术前NLR≥1.77组1、2、3年生存率分别为81.6%、63.0%、45.7%和43.1%、27.0%、19.3%,差异具有统计学意义（P < 0.001）。术前PLR < 94.62组和术前PLR≥94.62组1、2、3年生存率分别为62.7%、47.0%、37.0%和46.8%、29.0%、18.5%,差异具有统计学意义（P=0.002）。多因素分析显示NLR≥1.77与TACE术后肝癌患者较差预后相关,是肝癌患者TACE治疗后的危险因素。  结论  TACE介入术前HCC患者的NLR水平,作为系统炎症的一个反应指标,是影响其预后的危险因素。      

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。     

肝动脉化疗栓塞次数对肝癌根治术后复发的影响

  目的  比较不同次数肝动脉化疗栓塞术（TACE）预防原发性肝癌（HCC）术后复发的作用。  方法  回顾性收集2008年1月至2009年6月HCC根治术后接受1次和3次预防性TACE的患者45例, 其中接受1次TACE组23例, 接受3次TACE组22例, 两个组均在术后1~2个月给予首次TACE, 此后接受3次TACE组每隔2~4个月重复1次。全部病例在根治术后随访36~40个月, 对比分析两组间的累计复发率。  结果  HCC根治术后, 接受1次TACE组1、2、3年累计复发率分别为30.43%, 47.83%, 47.83%;接受3次TACE组1、2、3年累计复发率分别为4.55%, 27.27%, 36.36%。统计学分析结果显示接受3次TACE组的1年内复发率明显低于接受1次TACE组（P=0.022）, 而2、3年累积复发率两组间差异无统计学意义（P=0.086、P=0.225）。  结论  HCC根治术后给予3次预防性TACE能明显降低术后复发高峰期的复发率, 延长肝癌患者术后的无瘤生存时间。      

术中出血400 ml以上是BCLC B期肝癌患者预后不良的独立危险因素

目的 探讨BCLC B期肝癌患者进行手术治疗的预后及危险因素.方法 回顾性分析经手术治疗的805例BCLC A期和B期肝癌患者的临床资料及预后情况,对比BCLC A期及BCLC B期患者的预后差异,应用Kaplan-Meier法及Cox回归法分析BCLC B期患者的生存相关因素,并对相关因素进行危险分级.结果 365例BCLC B期肝癌患者中位随访时间为26.0个月(2.0~135.0个月);中位生存时间为50.8个月,1、3、5年生存率分别为76%、54%和40%;中位无病生存时间为25.8月,1、3、5年无病生存率分别为53%、38%和31%.单因素分析提示脉管瘤栓、肿瘤多发、术中出血≥400 ml为患者总生存时间的预后不良因素;肿瘤多发、术中出血≥400 ml是患者无病生存时间的危险因素.多因素分析显示术中出血≥400 ml是影响BCLC B期患者总生存时间及无病生存时间的独立危险因素.结论 大部分BCLC B期肝癌患者能够从手术治疗中获益,术中出血≥400 ml是提示预后不良的独立危险因素.     

TACE序贯联合PMCT治疗原发性肝癌的预后因素分析

  目的  分析影响动脉化疗栓塞术(transarterial chemoemlolization, TACE)序贯联合微波凝固消融(percutaneous micro wave coagulation therapy, PMCT)治疗原发性肝癌预后的主要因素。   方法  本研究收集本科收治的97例接受TACE序贯联合PMCT治疗的原发性肝癌患者。对可能影响预后的各变量进行单因素分析, 再利用多因素Cox逐步回归分析影响预后的主要因素。   结果  本组肝癌患者的1、2、3、5年累积生存率分别为68.2%、43.2%、28.8%、13.4%。单因素分析与预后有关的因素为肿瘤大小、临床分期(BCLC)、Child-Pugh分级、门脉癌栓、动静脉瘘、PMCT治疗次数及体力状况(ECOG评分)。Cox逐步回归多因素分析与预后有关并具有显著意义的因素为肿瘤大小、临床分期、门脉癌栓、PMCT治疗次数及体力状况。   结论  适当重复PMCT治疗可以延长肝癌患者的生存期限。大肝癌、门脉癌栓为预后的危险性因素, 巨块型肝癌及伴门脉主干癌栓患者的中位生存时间明显缩短。      

抗病毒治疗对乙型肝炎病毒相关性肝细胞癌患者根治性术后的影响

  目的  评价抗病毒治疗对乙型肝炎病毒(hepatitis B virus,HBV)相关性肝细胞癌(hepatocellular carcinoma,HCC)患者根治性手术预后的影响。  方法  回顾性分析478例HBV-HCC根治性术后患者,分为拉米夫定抗病毒治疗组141例和空白对照组337例,比较两组无瘤生存率、总生存率、复发时再治疗措施选择和死亡原因。经倾向性评分匹配法(propensity score matching,PSM)平衡组间协变量,再次分析以上指标。  结果  经平均28个月随访,治疗组和对照组术后1、3、5年无瘤生存率分别为73.1%、54.7%、44.5%和70.8%、58.2%、52.0%(P=0.778);总生存率分别为92.1%、84.4%、79.1%和86.9%、66.1%、54.5%(P=0.002);PSM后观察到相似结果;匹配后亚组分析显示抗病毒治疗明显提高巴塞罗那肝癌分期(Barcelona Clinical Liver Cancer staging system,BCLC)A/B期患者总生存率(P=0.035),但未能显著提高BCLC-C期患者总生存率(P=0.775);治疗组复发时获得再次根治性、姑息性治疗的例数分别为28例和24例,对照组19例和38例(P=0.031);治疗组死于肿瘤复发进展、肝功能衰竭的例数分别为18例和11例,对照组23例和36例(P=0.041)。  结论  HBV-HCC根治性术后抗病毒治疗虽未能有效提高患者无瘤生存率,但使患者在复发时获得更多根治性治疗的机会并减少肝衰竭发生,明显延长了术后生存时间,尤其对于早、中期患者。      

索拉非尼治疗进展期肝细胞癌的疗效及预后因素分析

  目的  评价索拉非尼治疗进展期肝细胞癌（HCC）的疗效及分析其预后影响因素。  方法  前瞻性分析2007年8月至2009年7月间110例接受索拉非治疗的进展期HCC患者,评价其疗效、不良反应,以总生存期和无肿瘤进展生存期为预后指标进行单因素和Cox比例风险模型多因素分析。  结果  110例患者随访中位时间9（2~18）个月,服用索拉非尼中位时间6.5（2~18）个月。14例（12.7%）获得完全缓解（CR）,16例（14.5%）部分缓解（PR）,40例（36.4%）病情稳定（SD）,总有效率为70例（63.6%）。中位生存期和无肿瘤进展生存期分别为10.5个月（95%CI:8.7~12.3）和5.0个月（95%CI:3.7~6.3）。多因素分析显示:联合局部治疗（肝动脉化疗栓塞或氩氦刀）、美国东部肿瘤协作组活动状态评分（Eastern Cooperative Oncology Group performance status score,ECOG PS）和Child-Pugh分级是影响无肿瘤进展生存时间的独立预后因素,而联合局部治疗、ECOG PS评分和AFP（alfa-fetopro? tein）水平是影响总生存期的独立预后因素。亚组分析显示:在肝癌进展组患者中继续服用索拉非尼其总生存期明显长于终止索拉非尼治疗者（11个月vs. 7.5个月,P < 0.001）。  结论  索拉非尼治疗进展期HCC,ECOG PS评分是影响生存期的一个重要因素,联合局部治疗有益于改善生存期。      

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。      

血清LDH的水平与肝癌介入治疗预后的关系

  目的  探讨行TACE治疗肝癌患者血清乳酸脱氢酶水平与预后的关系。  方法  分析山东省肿瘤医院2005年2月至2009年2月行肝动脉化疗栓塞术(transarterial chemoembolization, TACE)治疗的145例中晚期肝癌患者临床资料和实验室数据, 分别于术前和术后1个月内监测乳酸脱氢酶的水平。  结果  据术前血清乳酸脱氢酶浓度, 将患者分为两组, 对照组(LDH≤450 U/L)86例和观察组(LDH > 450 U/L)59例。对照组平均疾病进展时间(TTP)和总生存期(OS)分别为14.2个月和19.3个月, 观察组患者TTP和OS分别为9.1个月和11.2个月, 两组患者TTP和OS差异有统计学意义(P < 0.05)。治疗后64例患者LDH值下降, 其TTP和OS分别为11.3和18.8个月, 而术后81例患者LDH水平升高, 其TTP和OS分别为9.1和9.8个月, 两组患者TTP和OS差异有统计学意义(P < 0.05)。  结论  初诊患者血清乳酸脱氢酶活性检测能够预测行TACE肝癌患者的临床疗效, 术前高LDH水平患者可能在TACE和抑制肿瘤血管生成的综合治疗方法中受益, 可提高TTP和OS。      

TACE联合放疗对原发性肝癌合并门静脉癌栓患者生存的影响

  目的  观察TACE联合放疗对原发性肝癌合并门静脉癌栓患者生存的影响。   方法  收集福建省肿瘤医院2005年1月至2010年1月间收治的原发性肝癌合并门静脉癌栓患者52例,分为观察组和对照组:观察组32例,采用肝动脉化疗栓塞联合三维适形放射治疗;对照组20例,单纯采用肝动脉化疗栓塞治疗。观察两组患者的疗效及患者的生存时间和1年生存率,对患者生存质量进行评分。   结果  观察组患者总有效率78.1%,显著优于对照组（45.0%）;观察组患者总生存时间和1年生存率均显著优于对照组;两组不良反应的发生率无显著性差异;治疗后生存质量评分观察组低于对照组,但治疗后3个月生存质量评分观察组显著优于对照组。   结论  TACE联合放疗可显著提高患者的疗效,延长生存时间,提高1年生存率,改善患者生存质量。      

Role of hepatic resection in patients with intermediate‐stage hepatocellular carcinoma: A multicenter study from Japan

Transarterial chemoembolization (TACE) is recommended for patients with intermediate‐stage (Barcelona Clinic Liver Cancer criteria B [BCLC‐B]) hepatocellular carcinoma (HCC). However, patients with BCLC‐B HCC can differ in background factors related to hepatic function, as well as tumor size and number. In the present study, we clarified the role of hepatic resection in patients with BCLC‐B HCC. A total of 489 BCLC‐B HCC patients with Child–Pugh class A disease initially treated with hepatic resection or TACE were included. After propensity score matching (n = 264), hepatic resection (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.35–0.91) was independently associated with survival in the multivariate analysis. We then divided patients into two groups based on the results of statistical analysis. There were 170 patients treated with resection and 319 with TACE. Child–Pugh score and number of tumors (cut‐off, three tumors) were independently associated with type of HCC treatment in the multivariate analysis. We then divided patients in Group A (Child–Pugh score of 5 and ≤3 tumors; n = 186) and Group B (Child–Pugh score of 6 or ≥4 tumors; n = 303). In Group A, cumulative survival was significantly higher in the hepatic resection group than in the TACE group (P = 0.014). In Cox proportional hazards models, hepatic resection (HR, 0.38; 95% CI, 0.23–0.64) was independently associated with survival in Group A patients. In Group B, treatment status was not associated with overall survival. Hepatic resection should be considered in patients with a Child–Pugh score of 5 and ≤3 tumors, despite having BCLC‐B HCC.     

Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Background & Aims

According to the Barcelona Clinic Liver Cancer (BCLC) staging system, hepatic resection and transarterial chemoembolization (TACE) should be recommended in patients with hepatocellular carcinoma (HCC) within and beyond the BCLC stage A, respectively. We conducted a systematic review and meta-analysis to compare the overall survival between HCC patients undergoing hepatic resection and TACE.

Methods

PubMed, EMBASE, and Cochrane library databases were searched. All relevant studies were considered, if they reported the survival data in HCC patients undergoing hepatic resection and TACE. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for the comparison of cumulative overall survival. Odds ratios (ORs) with 95%CIs were calculated for the comparison of 1-, 3-, and 5-year survival rates. Subgroup analyses were performed according to the BCLC stages and portal vein tumor thrombus (PVTT). Sensitivity analyses were performed in moderate- and high-quality studies and in studies published after 2005.

Results

Fifty of 2029 retrieved papers were included. One, 15, and 34 studies were of high-, moderate-, and low-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher overall survival in hepatic resection group than in TACE group (HR=0.60, 95%CI=0.55-0.66). Additionally, 1-, 3-, and 5-year survival rates were statistically significantly higher in hepatic resection group than in TACE group (OR=1.82, 95%CI=1.56-2.14; OR=3.09, 95%CI=2.60-3.67; OR=3.48, 95%CI=2.83-4.27). The subgroup meta-analyses confirmed the statistical significance in HCC within the BCLC stage A (HR=0.72, 95%CI=0.64-0.80), in HCC beyond the BCLC stage A (HR=0.60, 95%CI=0.51-0.69), in HCC within the BCLC stage B alone (HR=0.48, 95%CI=0.25-0.90), and in HCC with PVTT (HR=0.78, 95%CI=0.68-0.91). The statistical significance was also confirmed by sensitivity analyses in moderate- and high-quality studies (HR=0.62, 95%CI=0.53-0.71) and in studies published after 2005 (HR=0.59, 95%CI=0.53-0.66).

Conclusions

Based on a systematic review and meta-analysis, hepatic resection may be considered in HCC beyond the BCLC stage A. However, given the limitations of study quality, more well-designed randomized controlled trials should be warranted to confirm these findings.     

Efficacy and Toxicity of Stereotactic Body Radiotherapy for Early to Advanced Stage Hepatocellular Carcinoma – Initial Experience From an Australian Liver Cancer Service

AimsIntrahepatic progression remains the predominant mode of cancer-related death in hepatocellular carcinoma (HCC) underscoring the need for effective local therapies. We report our initial experience with liver stereotactic body radiotherapy (SBRT) in the management of early to advanced stage HCC at an Australian tertiary liver cancer service.Materials and methodsPatients with liver-confined HCC unsuitable for surgical resection or thermal ablation treated with SBRT between October 2013 and December 2018 were retrospectively evaluated. The primary end point was freedom from local progression. Secondary end points were progression-free survival, disease-specific survival, overall survival and toxicity.ResultsNinety-six patients were treated for 112 lesions (median size 3.8 cm, range 1.5–17 cm). The median follow-up was 13 months (range 3–65). Forty-six patients had received prior local therapies (median 1, range 1–5), 83 (86%) patients had cirrhosis with baseline Child–Pugh scores of A (88%) and B7–8 (12%). Fifty-nine (61%) patients had Barcelona Clinic Liver Cancer (BCLC) stage 0/A disease and 37 (39%) had stage B/C. Macrovascular invasion was present in 20 (21%). The median biologically effective dose (BED₁₀) was 86 and 60 Gy for the BCLC 0/A and B/C cohorts, respectively. Freedom from local progression at 18 months was 94% for BCLC 0/A and 74% for BCLC B/C. Progression-free survival and overall survival at 12 months were 80 and 95% for BCLC 0/A and 40 and 71% for BCLC B/C, respectively. Five patients (7%) with cirrhosis and without disease progression had an increase in Child–Pugh score >1 within 3 months of SBRT, four of whom had intercurrent infections. Clinical toxicities grade ≥2 were reported in 20% of patients.ConclusionSBRT is an effective ablative modality for early stage HCC with low rates of significant toxicity. Lower dose SBRT can provide durable local control for advanced stage HCC. However, out-of-field relapse remains common, providing a rationale to investigate SBRT in combination with other therapies.     

Comparison of Overall Survival between Transarterial Chemoembolization and Best Supportive Care in Intermediate- Stage Hepatocellular Carcinoma

Objective: The Thailand management guideline allows the use of transarterial chemoembolization (TACE) for the treatment of intermediate-stage hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis, whereas other guidelines do not. The aim of this study was to compare the overall survival between TACE and the best supportive care (BSC) in HCC patients with Child–Pugh score 5–8 cirrhosis and in subgroups with compensated cirrhosis (Child–Pugh score 5–6) and early decompensated cirrhosis (Child–Pugh score 7–8). Methods: This retrospective study comprised 118 patients with intermediate-stage HCC. The overall survival was compared between TACE and BSC using the Kaplan–Meier method. Results: The median overall survival time for all patients was 21.4 months in the TACE group and 8.2 months in the BSC group (P <0.001). In the subgroup analyses, the overall survival times for TACE and BSC were 26 months and 9 months, respectively, for compensated cirrhosis (P <0.001), and 14.5 months and 6.9 months, respectively, for early decompensated cirrhosis (P <0.001). In the Cox proportional-hazards model, TACE was an independent prognostic factor for prolonged overall survival in all patients [hazard ratio (HR) 0.29; 95% confidence interval (CI), 0.17–0.49; P <0.001], patients with compensated cirrhosis (HR, 0.31; 95% CI, 0.16–0.62; P <0.001), and patients with early decompensated cirrhosis (HR, 0.16; 95% CI, 0.061–0.44; P <0.001). Conclusion: TACE improves the overall survival in patients with intermediate-stage HCC and compensated or early decompensated cirrhosis.     

Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma.

AIMS: To study the effect of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival after hepatic resection for hepatocellular carcinoma (HCC), we conducted a comparative analysis in 235 HCC patients who underwent hepatic resection with a curative intent. METHODS: We compared clinicopathologic background, mortality, and survival rates after hepatic resection between those who underwent preoperative TACE (n=109) and those who did not (n=126). RESULTS: One hundred and two patients in the TACE group (93.6%) received TACE only once. The mean interval between TACE and hepatic resection was 33.1days. Patients in the TACE group were younger than those in the non-TACE group, and liver cirrhosis and non-anatomical hepatic resection were more prevalent in this group. The 5-year overall survival rate after hepatic resection was significantly lower in the TACE group (28.6%) than in the non-TACE group (50.6%), especially in patients without cirrhosis or with stage I or II tumor. There was no difference between the two groups in mortality or disease-free survival after hepatic resection. Multivariate analysis showed preoperative TACE, preoperative aspartate aminotransferase elevation, and microscopic portal invasion to be independent risk factors for a poor outcome after hepatic resection. CONCLUSIONS: Preoperative TACE should be avoided for patients with resectable HCC, especially for those without cirrhosis or with an early stage tumor.     

Clinically significant portal hypertension (CSPH) on early-stage HCC following hepatectomy: What's the impact?

Background and aimThe impact of currently clinically significant portal hypertension (CSPH) for patients with early-stage HCC after surgery remains controversial. The purpose of this study is to understand the specific effect of CSPH on patients with early-stage (BCLC A stage) HCC after surgery.MethodsWe collected data from 386 HCC patients treated at two centers from December 2009 to January 2017.224 patients (all treated by hepatectomy) were in BCLC stage A, of which, 122 had no CSPH, and 102 had CSPH. There were 162 patients in BCLC stage B (who underwent surgery, TACE, and conservative treatment). The prognosis of the CSPH and non-CSPH groups in BCLC stage A was compared using the Kaplan-Meier method. We used multivariate Cox regression to analyze prognostic factors in patients in BCLC stage A and compared the prognosis of the two groups with the BCLC stage B group.ResultsAmong the 224 BCLC stage A patients after surgery, the overall survival (OS) and recurrence-free survival (RFS) of the CSPH group were worse than those of the non-CSPH group (P < 0.001, HR = 2.340[1.554–3.523]; P < 0.001, HR = 2.577[1.676–3.812]) The multivariate Cox proportional hazards model indicated that CSPH was an independent prognostic factor for OS and RFS in BCLC stage A patients. BCLC stage A patients with CSPH treated by hepatectomy had a comparable prognosis to BCLC B stage patients (P = 0.378), and the OS and RFS (P = 0.229; P = 0.077) in the CSPH (BCLC A) group were also comparable to BCLC stage B patients treated with surgery alone.ConclusionsCSPH can affect the surgical prognosis of early-stage (BCLC stage A) HCC. BCLC stage A patients with CSPH have a prognosis comparable to patients with BCLC stage B. An additional stage, such as the BCLC stage A-B, can be considered.     

Distribution of tumor stage and initial treatment modality in patients with primary hepatocellular carcinoma

Objective

This study reviewed the distribution of each tumor stage and each type of initial treatment modality among patients with primary hepatocellular carcinoma (HCC) treated at a tertiary tumor hospital between January 2003 and October 2013.

Methods

Baseline data of patients with primary hepatocellular carcinoma treated between January 2003 and October 2013 were retrospectively collected. Tumor stage was determined according to the Barcelona Clinic Liver Cancer (BCLC) staging system and Hong Kong Clinic Liver Cancer (HKLC) staging system.

Results

A total of 6241 patients with primary hepatocellular carcinoma were included in the analysis. In accordance with the BCLC, 28.9% of patients were in stage 0/A, 16.2% in stage B, 53.6% in stage C, and 1.3% in stage D. According to the HKLC stage system, 8.4% patients were in stage I, 1.5% in stage IIa, 29.0% in stage IIb, 10.0% in stage IIIa, 33.6% in stage IIIb, 3.4% in stage IVa, 2.5% in stage IVb, 0.2% in stage Va, and 11.4% in stage Vb. Treatment modalities applied to this patient group were as follows: 33.3% of patients underwent hepatic resection, 36.7% underwent transarterial chemoembolization (TACE), 2.2% underwent radiotherapy, 0.9% underwent local ablated therapy, 8.8% underwent systemic chemotherapy, 4.2% underwent traditional herbal medicine therapy, 0.1% underwent targeted drug therapy, and 13.8% received no treatment. Hepatic resection was the most frequent therapy for patients with BCLC 0/A/B disease, and TACE was the initial therapy for patients with BCLC C disease. In the Hong Kong Clinic Liver Cancer staging system, the main treatments for HKLC I to IIIb disease is hepatic resection and TACE. Systemic chemotherapy was the initial therapy for patients with HKLC IVa/IVb disease. Most HKLC Va/Vb patients received traditional Chinese medicine treatment.

Conclusion

Prevalence of stage BCLC B and C disease was high among our hepatocellular carcinoma patients. In Hong Kong Clinic Liver Cancer staging system, HKLC I to IIIb disease was high among our HCC patients. Hepatic resection and TACE are initial therapies.

     

低分割三维适形放射结合介入治疗肝细胞癌伴门静脉癌栓的疗效

背景与目的肝细胞癌常伴有门静脉癌栓且预后极差,有学者用三维适形放射治疗常规剂量分割模式进行治疗取得了较好的疗效。本研究的目的是评价低分割三维适形放射治疗(3-dimensionalconformalradiationtherapy,3DCRT)结合经皮肝动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)治疗肝细胞癌(hepatocellularcarcinoma,HCC)伴门静脉癌栓(portalveintumorthrombus,PVTT)的疗效。方法对35例不能手术切除的HCC伴PVTT患者,采用低分割3DCRT结合TACE进行治疗,根据肿瘤体积大小,放射采用每次4～8Gy,3次/周;48～60Gy,8～12分次,3.0～3.5周完成。观察近期疗效,用Kaplan-Meier法进行生存分析,采用Cox比例风险模型作多因素分析。结果肿瘤缓解率为71.4%,1、2、3年累积生存率分别是59.3%、31.6%、26.6%,中位生存期11个月。多因素分析显示Child分级是影响预后的主要因素(P<0.05)。放射性肝炎和胃肠道出血是最常见的并发症。结论大分割3DCRT结合TACE治疗HCC伴PVTT有较好的疗效。肝功能Child分级与患者的预后有密切关系。