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。     

肝脏残留癌的动脉化疗栓塞及预后因素分析

目的 研究肝动脉化疗栓塞（transcather arterial chemoembolization,TACE)治疗原发性肝癌切除术后残癌的疗效,并分析影响疗效的因素。方法 原发性肝癌患者于术后2个月行B超和肝动脉造影检查,部分患者还行增强CT检查、证实残癌后行TACE。采用Kaplan-Meier方法分析TACE患者术后的生存期,以Cox比例风险模型分析影响TACE疗效的因素。结果 74例术后残癌患者经TACE术后,1,2,3年生存率分别为78．0％、57．6％和37．0％,中位生存期为33个月。单因素分析显示,原发癌体积＞5cm、有血管侵犯、TNM分期较晚为疗效差的影响因素;而合用其他局部治疗,如瘤内无水乙醇注射（PEI）或放射治疗则为疗效好的影响因素。但多因素分析显示,原发癌血管侵犯和合用其他局部治疗为独立的影响因素。结论 肝动脉化疗栓塞治疗术后残癌可取得较好疗效,如能合用PEI或放射治疗,还可进一步提高疗效。     

肝动脉化疗栓塞治疗原发性肝癌的预后因素分析

目的：探讨影响肝动脉化疗栓塞治疗原发性肝癌预后的相关因素,为原发性肝癌患者选择个体化治疗方案及估计预后提供参考。方法：回顾性分析2003年6月-2012年6月石河子大学医学院第一附属医院实施肝动脉化疗栓塞的153例患者的临床资料及随访数据,生存分析采用生命表法,相关因素分析行 Log -rank 检验,多因素分析采用 Cox 模型,筛选出影响预后的因素。结果：随访至2013年6月30日153例患者失访15例（9.8%）,原发性肝癌患者经肝动脉化疗栓塞后1、3、5年生存率分别为55.92%、31.02%、21.18%。单因素分析结果显示肝功能分级、甲胎蛋白（AFP）、肿瘤大小、肿瘤数目、门脉癌栓及治疗次数是影响预后的因素;Cox 风险回归分析显示肝功能分级、肿瘤数目、门脉癌栓及治疗次数是影响预后的独立因素（P <0.05）。结论：肝功能分级、肿瘤数目、门脉癌栓为影响原发性肝癌介入治疗预后的独立危险因素,而治疗次数是影响预后的保护性因素。     

肝动脉化疗栓塞对原发性肝癌伴门静脉癌栓的治疗作用

目的:研究肝动脉化疗栓塞(HACE)对原发性肝癌伴门静脉癌栓的治疗作用及影响患者预后的临床病理因素。方法:随访35例HACE治疗的原发性肝癌伴门静脉癌栓患者,其中14例患者经导管肝动脉化疗栓塞,21例患者术中行肝动脉插管,术后经药物泵定期化疗栓塞。单因素分析各临床病理因素对患者预后的影响。多因素分析用Cox比例风险模型。结果:原发性肝癌伴门静脉癌栓行HACE治疗的患者中位生存时间8·3个月,其半年、1和2年生存率分别为57·5%、15·7%和0。单因素分析提示门静脉癌栓部位、化疗栓塞次数是影响患者预后的主要因素。多因素分析仅提示门静脉癌栓部位影响患者的预后。结论:HACE治疗原发性肝癌伴门静脉癌栓可以延长患者的生存期。门静脉癌栓的部位是影响患者预后的独立因素。     

切除术前、后辅助性肝动脉栓塞化疗对巨块型肝癌预后的影响

目的：研究术前和术后辅助性肝动脉栓塞化疗对肿瘤直径为8cm以上的巨块型肝癌病人切除术后的影响。方法：采用病例对照研究的方法,将 本所1995－1998年的病例资料,用Kaplan-Meier方法研究单纯切除术病人,术后辅助性肝动脉栓塞化疗,术前辅助性肝动脉栓塞化疗病人生存曲线。Log-rank方法比较各生存曲线的差别。结果：单纯切除组病人、术后辅助性肝动脉栓塞化疗、和术前辅助性肝动脉栓塞化疗病人的中位生存期分别为17．0月,33．0月,和49．0月（P＝0．011）。结论：提示术前辅助性肝动脉栓塞化疗效果优于术后辅助性肝动脉栓塞化疗的结果。对于肿瘤直径在8cm的肝癌,应该在术前或术后给予辅助性肝动脉栓塞化疗。     

影响肝癌动脉灌注药物和栓塞治疗效果的因素分析

为了分析影响肝癌动脉灌注药物和栓塞治疗效果的因素，作者采用Ｌｏｇｉｓｔｉｃ回归多因素方法对９２例做肝动脉灌注化疗或栓塞治疗患者的１９个因素进行分析，结果显示：肿瘤有无包膜、Ｏｋｕｄａ分期、治疗方式是影响疗效的独立因素。作者认为做肝癌动脉灌注药物和栓塞治疗，应了解肿瘤包膜、临床分期情况，给予适当治疗。     

原发性肝癌介入治疗的影响因素

目的探讨原发性肝癌介入治疗的影响因素。方法对98例不能切除的原发性肝癌，行肝动脉化疗栓塞术后，进行单因素分析。结果有意义的影响因素为肿块类型、肿瘤的大小、肿瘤的血供、肝功能、碘油用量、重复治疗等。结论血供丰富的巨块型肝癌，肝功能好，门脉无癌栓，行尤其带包膜化疗、栓塞效果显著。     

肝动脉化疗栓塞治疗5 cm以下肝癌的疗效及预后因素

目的研究肝动脉化疗栓塞(TACE)治疗直径＜5 cm肝癌的效果以及预后因素.方法对1995年2月～2004年2月间肝动脉化疗栓塞治疗的直径＜5 cm的原发性肝癌患者160例的效果进行回顾性分析,log-rank方法单因素分析影响预后的因素,多因素分析采用Cox比例风险模型确定独立的危险因素.结果肝动脉化疗栓塞后的1年、3年、5年生存率分别为77.52%、47.42%、33.68%.血清胆红素水平＞17.0μmol/L、凝血酶原时间超过14 s、有门静脉癌栓和有远处转移是影响预后的独立的危险因素.结论对于手术不能切除的直径＜5 cm的肝癌,肝动脉化疗栓塞是可供选择的有效治疗方法,但有血清胆红素升高或凝血酶原延长的病人,或有门静脉癌栓和远处转移的病人,预后较差.     

中晚期肝癌经肝动脉化疗栓塞术后二期切除的临床分析

９６例中晚期肝癌经导管肝动脉化疗栓塞治疗，其中１３例在肿瘤病灶明显缩小后，施行二期手术切除。首次治疗至二期手术时间为３２－２０６天，中位时间８６天。手术后标本经病理检查，发现１２例肿瘤病灶大部分坏死，但癌周有少量癌细胞存活，１例肿瘤病灶完全性凝固性坏死。这提示中晚期肝癌行肝动脉化疗栓塞后，应争取施行二期手术，消灭残癌。     

原发性肝癌介入治疗的影响因素

目的探讨原发性肝癌介入治疗的影响因素。方法对98例不能切除的原发性肝癌,行肝动脉化疗栓塞术后,进行单因素分析。结果有意义的影响因素为肿块类型、肿瘤的大小、肿瘤的血供、肝功能、碘油用量、重复治疗等。结论血供丰富的巨块型肝癌,肝功能好,门脉无癌栓,行尤其带包膜化疗、栓塞效果显著。     

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.     

经肝动脉化疗栓塞联合射频消融治疗原发性肝细胞癌合并门静脉癌栓的预后影响因素分析

背景与目的：经肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE)是否为治疗原发性肝细胞癌（hepatocellular carcinoma,HCC）合并门静脉癌栓（portal vein tumor thrombus,PVTT）的绝对禁忌,目前尚无定论。该研究旨在探讨TACE联合射频消融（radiofrequency ablation,RFA）治疗HCC合并PVTT的预后影响因素。方法：回顾性分析2011年1月1日—2013年12月31日于郑州大学附属肿瘤医院行TACE联合RFA治疗的HCC合并PVTT的157例患者的临床资料及随访数据,单因素及多因素Cox回归分析人口学资料、实验室指标及临床资料与生存时间和肿瘤转移复发情况的关系。结果：多因素Cox回归结果显示,在调整和控制其他因素后,血清白蛋白（albumin,ALB）水平为TACE联合RFA治疗后HCC合并PVTT患者3年生存及降低肿瘤复发转移风险的保护性因素,术前甲胎蛋白（alpha-fetoprotein,AFP）、丙氨酸转氨酶（alanine aminotransferase,ALT）、天门冬氨酸转氨酶（aspartate transaminase,AST）水平、门静脉癌栓部位及肝功能Child Pugh分级为患者3年生存的独立危险因素;AFP、AST水平及门静脉癌栓部位为肿瘤复发转移的独立危险因素。结论：TACE联合RFA并非治疗HCC合并PVTT的绝对禁忌,在治疗前对患者进行相关因素评估有助于更好地选择治疗方法和时机,从而提高HCC治疗水平。     

Advanced ovarian cancer

Opinion statement Ovarian cancer spreads early in the disease into the abdomen. An en bloc resection of the tumor, according to surgical principle, is not possible in patients with highstage ovarian cancer. At surgery, large pelvic tumor lesions are found together with multiple tumor lesions involving the omentum, bowel, and mesentery together with a diffuse peritoneal carcinomatosis and diaphragmatic involvement. A multimodality approach with cytoreductive surgery and taxol platinum-based chemotherapy is therefore the mainstay of treatment of advanced ovarian cancer. The size of residual disease after surgery is one of the most important prognostic factors for survival. Patients with an optimal tumor cytoreduction (residual lesions smaller than 1 cm) have a significant longer survival (almost two times the median survival) than patients with larger residual lesions [1-5]. This holds true even for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease [6-10]. Patients in whom all macroscopic tumor is resected do have the longest survival. The 2-year survival of patients with a radical resection of all macroscopic tumors is 80%, in contrast to less than 22% for the patients with lesions larger than 2 cm [4]. An optimal primary cytoreductive surgery can generally be performed in 30% to 50% of patients [11]. Only in more experienced gynecologic oncology centers is the percentage as high as 85%, but sometimes at the cost of an increased morbidity and even mortality [12,13,14-16,17]. The worse prognosis of the patients with a suboptimal primary cytoreductive surgery can be improved by an interval cytoreductive surgery after platinum-containing induction chemotherapy [18,19]. The median survival and progression-free survivals are significantly lengthened by cytoreductive surgery. After more than 5-years follow-up there is still a significant survival benefit: the 5-year survival of the surgery patients was 24% versus 13% for the no-surgery patients (P = 0.0032). All patients, including those with unfavorable prognostic factors (stage IV disease, peritonitis carcinomatosis, or ascites at primary surgery), and even patients with stable disease after induction chemotherapy, seem to benefit from interval cytoreductive surgery. The increase in progression-free survival and overall survival does outweigh the morbidity associated with interval debulking surgery, which is not different from those associated with primary surgery.     

Prospective study on the survival of HCC patients treated with transcatheter arterial lipiodol chemoembolization

Aim: Tanscatheter arterial embolization irrespective of with or without an anticancer agent and lipiodol has been controversial with regard to survival benefit. Therefore, we conducted a prospective study to analyze the effect of transcatheter arterial lipiodol chemoembolization (TACE) on the survival of HCC. Methods: A prospective study was conducted, and a total of 326 patients with primary liver cancer who were newly diagnosed were collected from January 2004 to January 2005 in Zhejiang Provincial People’s Hospital of China. A univariate Cox’s regression analysis was used to assess the survival of the HCC cases receiving TACE. Results: The duration of follow-up for the HCC patients treated with TACE ranged from 3 months to 60 months. For the overall patients, survival rate at 5 years was 42%. Both HBV Ag and HCV Ab positive patients showed significantly low survival rate at 5 years. The multivariate analysis revealed The IV TNM stage was related to an heavy increased risk of death of HCC patients, and Child C grade group showed a significant moderate increased risk. Conclusion: Our study showed TACE is associated with a better prognosis of HCC patients, and the HBV infection, TNM stage, Child-Pugh grade and number of TACE may influence the survival probability. Further TACE studies should be assess the quality of life of HCC patients, so as to provide more information for treatment of HCC.     

Hepatectomy for ruptured hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer stage 0/A: The optimal treatment

Background and aimsRuptured hepatocellular carcinoma (rHCC) generally has a very poor prognosis and is currently classified as T4 in the tumor–node–metastasis (TNM) staging system. In this study, we aimed to demonstrate the actual impact of rHCC, as well as the positive effect of hepatectomy in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0/A rHCC.MethodsWe enrolled 86 patients with rHCC after surgery and 526 patients with non-rHCC after surgery or transcatheter arterial chemoembolization (TACE). Survival curves were plotted using the Kaplan–Meier method to compare the postoperative prognosis of patients with rHCC with that of patients with non-rHCC. Univariate and multivariate Cox regression analyses were used to identify the risk factors affecting patient survival.ResultsBCLC stage 0/A rHCC treated with surgery had a worse prognosis than BCLC stage 0/A non-rHCC treated with surgery (overall survival [OS]: hazard ratio [HR] = 3.12 [2.24–4.34], P < 0.001; recurrence-free survival [RFS]: HR = 2.26 [1.65–3.09], P < 0.001). Rupture was an independent prognostic factor in patients with BCLC stage 0/A rHCC (OS: HR = 1.685 [1.416–2.006], P < 0.001; RFS: HR = 1.484 [1.267–1.737], P < 0.001), and patients with BCLC stage 0/A rHCC who underwent surgery had a comparable prognosis to patients with BCLC stage B HCC who underwent surgery or TACE (OS: P = 0.78).ConclusionsPatients classified as having BCLC stage 0/A rHCC can achieve comparable outcomes to patients with BCLC stage B HCC after hepatectomy. However, not all patients with rHCC should be classified as T4 in the TNM staging system.     

84例原发性肝癌患者肝动脉化疗栓塞术后预后的影响因素分析

目的 探讨原发性肝癌患者肝动脉化疗栓塞(TACE)术后预后影响因素及预后诊断指标的价值.方法 选取行TACE治疗的84例原发性肝癌患者,采用Cox风险比例模型分析患者的预后因素,另选取80例肝囊肿患者为对照组,采用酶联免疫吸附法测定两组患者的血清AFP、SCC、CYFRA21-1水平.结果 经Cox风险比例模型分析可知,门脉癌栓、肝内转移、Child-Pugh分级、AFP术后阳性、SCC术后阳性、CYFRA21-1术后阳性是原发性肝癌患者远期预后的独立危险因素.原发性肝癌组患者TACE术前、术后血清AFP、SCC、CYFRA21-1水平及AFP、SCC、CYFRA21-1阳性率均高于对照组,而TACE术后血清AFP、SCC、CYFRA21-1水平及AFP、SCC、CYFRA21-1阳性率低于TACE术前,差异均有统计学意义(P<0.05).结论 AFP术后阳性、SCC术后阳性、CYFRA21-1术后阳性是原发性肝癌患者TACE术后预后的独立危险因素,在预测原发性肝癌患者TACE术后预后方面具有潜在的临床价值.     

原发性肝癌根治切除后介入治疗对复发防治的疗效评价

目的 探讨原发性肝癌根治切除术后肝动脉介入综合治疗对肝昨发的防治效果。方法 根治术后定期复查肝功能、甲胎蛋白（ＡＦＰ）、Ｂ超、胸片等,于术后２个月按Ｓｅｌｄｉｎｇｅｒ法行肝动脉造影或碘化油ＣＴ检查,根据有无残癌分为两组;无残癌者为预防组,有残癌者为治疗组。预防组术后２个月和５个月分别行预防量的肝动脉化疗栓塞治疗,以观察复发率和生存期,治疗组按常规量行肝动脉化疗栓塞治疗,每２个月得１次以观察生存期。     

HS-AFP 对肝癌病情及TACE 术疗效预后判断的价值

 目的 探讨肝癌特异性甲胎蛋白（HS-AFP）对肝癌病情、肝动脉化疗栓塞术（TACE）术后疗效及预后判断的临床价值。方法 HS-AFP采用聚丙烯酰胺凝胶电泳方法（PAGE）结合免疫印迹技术（Western blot）分离检测。对41例肝癌患者行TACE术前后血清HS-AFP进行动态观察，分析HS-AFP与肿瘤大小、分期以及TACE术后疗效及生存期之间的关系。结果 TACE术前，HS-AFP阳性率在肿瘤≥5cm组高于肿瘤〈5cm组，临床分期Ⅱa＋b期组高于Ⅰ期组。TACE术治疗有效率在HS-AFP阳性组为4．5％低于阴性组73．7％（P〈0．001）。单因素分析及多因素分析均显示术后HS-AFP与肝癌患者预后有关。结论 HS-AFP有助于术前肝癌的病情判断，对TACE术后肝癌预后判断具有重要价值。     

可切除大肝癌TACE后手术切除标本的病理研究(英文)

目的探讨可切除大肝癌 TACE 后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前 TACE 组(36例)与一期手术组(47例),术前 TACE组31例二期切除(二期手术组),5例失去手术切除机会,78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE 组除较一期手术组肿瘤坏死广泛、包膜更完整外,两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异;TACE 组TACE 后肿瘤体积缩小并不显著,子灶、门脉癌栓完全坏死者少,肝硬化加重。结论可切除大肝癌术前 TACE 不能使肿瘤完全坏死,部分患者耽误手术时机,应严格选择应用。