2009 WCIO肝转移癌研究

1 TACE治疗结直肠癌肝转移疗效评价 德国学者对207例结直肠癌肝转移患者接受肝动脉化疗栓塞治疗（TACE）的效果进行了分析。实体瘤疗效评价标准（RECIST）结果显示，12％部分缓解，51％疾病稳定，37％疾病进展。患者1年生存率为62％，2年生存率为38％。从诊断肝转移起的中位生存期为3．4年，从TACE治疗起的中位生存期为1．34年。     

结直肠癌肝转移治疗的研究进展

结直肠癌肝转移的发生率和死亡率很高,是影响结直肠癌预后的重要因素.因此,找到合理的治疗方案显得尤为重要.目前手术切除仍被认为是唯一可能有效的治愈手段,但能手术根治的患者仅占少数.因此,随着医疗技术的发展,肝转移癌治疗经验的积累,多学科综合治疗理念逐渐被广泛应用,是确保结直肠癌肝转移患者获得最佳治疗策略的根本,亦是今后结直肠癌肝转移治疗的发展方向.多学科综合治疗方案包括手术切除、新辅助化疗、肝动脉化疗栓塞、放射疗法、射频消融术、冷冻疗法、无水乙醇注射术及中医药治疗等,一种或多种方法联合应用可明显提高患者的生存率并改善生活质量,本文对结直肠癌肝转移的综合治疗进展作一综述.     

应用雷替曲塞行介入治疗结直肠癌肝转移的疗效

<正>结直肠癌是常见的恶性肿瘤。肝脏是结直肠癌远处转移的最常见器官,报道近23%⁵1%的结直肠癌患者发现时即伴有肝转移〔1〕。手术切除是肝转移瘤唯一的根治性治疗手段,而80%51%的结直肠癌患者发现时即伴有肝转移〔1〕。手术切除是肝转移瘤唯一的根治性治疗手段,而80%⁹0%的患者因各种原因无法进行手术治疗〔2〕,肝脏介入治疗通过肝动脉化疗栓塞(TACE)和灌注提高肝脏局部血药浓度,同时阻断肿瘤供血,达到姑息性治疗甚至治愈肝脏肿瘤〔3〕。1材料和方法 1.1临床资料收集吉林大学白求恩第一医院2012年6月至2014年1月收治有病理组织学或细胞学检查证实为结直肠癌、两项影像学检查证实肝转移癌、无法外科手术切除、同期未进行化疗且根据Karnofsky功能状态评分(KPS)≥50分、预计     

经导管动脉栓塞化疗为基础的多烯紫杉醇联合方案治疗结直肠癌肝转移效果分析

目的探讨经导管动脉栓塞化疗(TACE)为基础的多烯紫杉醇联合方案对结直肠癌肝转移的治疗效果。方法随机将82例结直肠癌术后肝转移患者分为两组,实验组41例给予多烯紫杉醇联合方案TACE+全身化疗,对照组41例给予多烯紫杉醇联合方案全身化疗,治疗3个周期。评估两组临床疗效及Ⅱ~Ⅲ度化疗毒副反应、功能状态(KPS)评分、肿瘤病人生活质量评分量表(QOL)评分;出院后第1天采用电话或门诊随访至2015年6月,记录肝外转移率、肝外转移时间。结果实验组治疗总有效率为70.73%,显著高于对照组的39.02%(P0.05);实验组肝外转移率为17.07%,显著低于对照组的39.02%,肝外转移时间显著慢于对照组(P0.05)。实验组治疗后KPS评分和QOL评分显著高于对照组(P0.05);两组化疗毒副反应无显著差异(P0.05)。结论多烯紫杉醇联合方案TACE+全身化疗治疗结直肠癌肝转移,能够提高有效率、延缓肝外转移时间、改善生活质量。     

结直肠癌肝转移预后因素分析及治疗方式对生存期的影响

目的研究在原发癌切除术后,结直肠癌肝转移患者的临床特征与预后之间的相关性。方法对118例结直肠癌肝转移患者13个临床病理特征进行单因素生存分析及多因素COX风险回归模型的分析。各种治疗方法对1、3、5 a生存率及中位生存期的影响应用生存寿命表法进行比较。结果手术组的生存期明显长于姑息治疗组和未治疗组。原发癌的TNM分期、术前CEA、肝转移灶的最大径和发现时间、肝外转移的存在以及原发癌切除术后的治疗方式等6个因素对结直肠癌肝转移患者的中位生存期存在显著性影响（P〈0.05）。原发癌的TNM分期、术前CEA、肝转移灶的大小与结直肠癌肝转移长期生存的危险性呈正相关。结论结直肠癌肝转移患者的临床病理特征与患者预后有着密切关系。手术治疗,特别是手术联合全身化疗、肝动脉介入化疗等综合治疗比单纯治疗具有更佳的疗效。     

肝动脉化疗栓塞治疗结直肠癌肝转移50例

1999年1月～2004年5月,我们采用肝动脉化疗栓塞治疗结直肠癌肝转移患者50例,获得满意疗效。现报告如下。     

中山医院结直肠癌MDT讨论治疗策略分析

目的分析结直肠癌多学科诊疗团队（MDT）讨论后制定的治疗策略。 方法回顾性分析2010年7月至2019年2月复旦大学附属中山医院进行MDT讨论的结直肠癌患者的临床资料,对MDT讨论结果进行统计分析。 结果结直肠癌MDT总计为1 953例结直肠癌患者进行4 535人次讨论制定个体化治疗方案。其中,553例患者肝转移灶和111例患者肺转移灶被认为可切除。另有261位最初不可切除的结直肠癌肝转移患者,在接受系统化疗联合分子靶向以及介入等综合治疗后,转化为可切除,建议接受肝转移灶切除手术。实际上总计772位结直肠癌患者接受肝转移灶切除,其中同时性肝转移患者有581例,而接受结直肠癌原发灶和肝转移灶同步切除的患者有248例。肝切除手术中仅有87例患者（11.3%）实施解剖性肝切除,绝大多数实施非解剖性肝切除。肝转移灶切除手术中联合射频消融的有62例（8.0%）。术后病理提示R1切除的有18位（2.3%）。 结论复杂结直肠癌病例推荐行MDT讨论。扩展手术适应证、应用二步肝切除术、联合射频消融等局部毁损治疗可以扩大肝转移灶手术的适应人群。初始无法手术切除的患者,如状况耐受,建议给予强烈的个体化转化治疗,争取转化后手术切除。     

肝动脉化疗栓塞联合卡培他滨治疗老年结直肠癌术后肝转移的临床疗效评价

[目的]观察肝动脉化疗栓塞术(TACE)联合卡培他滨治疗老年结直肠癌术后肝转移患者的疗效及不良反应。[方法]入选66例老年结直肠癌肝转移患者,依据治疗方案分为卡培他滨组(对照组,34例)及TACE+卡培他滨组(联合治疗组,32例),以RECIST标准评价近期疗效,以CTCAE 4.0版评价毒性反应,以卡氏评分评价患者生活质量,随访记录患者生存时间。[结果]联合治疗组、对照组近期有效率分别为75.00%、61.76%,2组比较差异有统计学意义(P0.05)。联合治疗组的3年中位生存时间为21个月,优于对照组的16个月。2组患者经过治疗后生活质量方面都得到有效提高,2组治疗后生活质量比较差异无统计学意义。2组均未出现Ⅲ度及以上不良反应。[结论]在老年结直肠癌术后肝转移的治疗中,TACE联合卡培他滨治疗是一种安全、有效的治疗模式。     

结直肠癌肝转移的预后因素

目的:评价结直肠癌肝转移的临床预后因素及治疗方案对预后的影响.方法:收集71例结直肠癌肝转移患者的临床资料及预后情况,用Kaplan-Meier生存分析及Log-rank检验进行单因素分析,将有统计学意义的预后因素纳入Cox回归模型进行多因素分析.结果:Kaplan-Meier单因素分析及Log-rank检验显示,肝转移灶最大直径、有无区域淋巴结转移及诊断肝转移时碱性磷酸酶(ALP)最高值3个因素对其预后影响有显著意义;将这3个预后因素纳入Cox回归多因素分析显示,有无区域淋巴结转移、诊断肝转移时ALP最高值是结直肠癌肝转移的独立预后因素.全组3种治疗方式比较差别无统计学意义,但对手术切除组和化疗组两组进行比较,差异有统计学意义(P<0.05),而局部治疗组和手术组之间,局部治疗组和化疗组之间差别无统计学意义.结论:肝转移灶最大直径、原发病灶有无区域淋巴结转移、诊断肝转移时最高ALP值是结直肠癌肝转移患者的预后因素;肝转移灶最大直径越小、无区域淋巴结转移、诊断肝转移时最高ALP值正常的患者预后越好;手术切除联合化疗目前是结直肠癌肝转移的首选治疗方案,可获得较好的远期生存.     

经导管肝动脉化疗栓塞联合SOX方案治疗结直肠癌肝转移的效果观察

目的探讨经导管肝动脉化疗栓塞(TACE)联合SOX方案治疗结直肠癌肝转移的临床疗效及对肿瘤标志物的影响。方法本组研究对象选取2015年1月至2016年1月到我院住院治疗的86例结直肠癌肝转移患者,根据随机区组设计法,将患者分为观察组和对照组(n=43)。对照组采用TACE治疗,观察组采用TACE联合SOX方案治疗。比较两组患者近期疗效、生活状态评分、肝功能、肿瘤标志物、生存率及不良反应发生率。结果观察组的客观缓解率(ORR)、疾病控制率(DCR)(69.8%、86.0%)显著高于对照组(51.2%、72.1%)(P0.05)。观察组KPS评分、QOL评分均显著高于对照组(P0.05)。治疗后3 d、7 d,观察组ALT、AST显著低于对照组,Alb显著高于对照组(P0.05)。观察组VEGF、CEA、CYFRA21-1均显著低于对照组(P0.05)。观察组患者1年、2年生存率(76.7%、46.5%)均显著高于对照组(55.8%、34.9%)(P0.05)。两组患者不良反应发生率差异无统计学意义(P0.05)。结论 TACE联合SOX方案可显著提高结直肠癌肝转移的生存质量,延长患者生存期。     

Liver metastases from esophageal carcinoma: is there a role for surgical resection?

Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer. All underwent esophagectomy and were referred to our unit with metastatic recurrent liver disease, two with solitary metastases and two with multi‐focal disease. The patients underwent multidisciplinary assessment and proceeded to a course of neoadjuvant chemotherapy followed by open or laparoscopic liver resection. Three patients were male, and the mean age was 57.5 (range 44–71) years. Response to chemotherapy ranged from partial to complete response. Following liver resection, two patients developed recurrent disease at 5 and 15 months, and both had disease‐specific mortality at 10 and 21 months, respectively. The other two patients remain disease free at 22 and 92 months. Recurrent metastatic esophageal cancer continues to have a poor prognosis, and the majority of patients with liver involvement will not be candidates for hepatic resection. However, this series suggests that in selected patients, liver resection of metastases from esophageal cancer combined with neoadjuvant and adjuvant chemotherapy is feasible, but further research is required to determine whether this can offer a survival advantage.     

Accuracy of CT in predicting malignant potential of cystic pancreatic neoplasms

Background. Cystic lesions of the pancreas are being identified more frequently. Deciding which asymptomatic lesions can be safely followed with serial imaging and which require resection due to malignant potential is an increasingly common question. Current clinical practice is to rely on characteristics of the lesions on CT scan, and additional information from endoscopic ultrasound with fine-needle aspiration (EUS-FNA) and cyst fluid analysis or endoscopic retrograde pancreatography (ERCP) to assess malignant potential. Hypothesis. The malignant potential of pancreatic cystic lesions cannot be accurately predicted by CT scan. Methods. CT scans from 48 patients with cystic lesions of the pancreas were stripped of patient identifiers and retrospectively presented to two expert radiologists. The radiologists recorded specific characteristics of the lesions thought to be important in the differential diagnosis and their opinion of the likely diagnosis. Diagnostic accuracy was assessed by comparing the radiologists’ diagnoses to the final pathologic diagnosis after resection. To determine if clinical history, EUS-FNA or ERCP findings improved diagnostic accuracy, medical records were retrospectively reviewed and scored as either supporting or not supporting malignant potential of the lesion. Results. Specific diagnoses based on CT findings alone were correct in an average of 39% of the cases. Even when diagnoses were dichotomized as benign (43%) or potentially malignant (57%, papillary mucinous neoplasms, mucinous cystic neoplasms, cancer), determinations based on CT alone were accurate in an average of 61% of cases. Accuracy rates were 60.4 and 62.5% for the two radiologists, although there was only fair agreement between them (Kappa=0.28, 95% CI=(0.01–0.55), p=0.05). When all clinical information available was considered together as a single dichotomous indicator of malignant potential, the indicator was accurate in 90% of the cases (Kappa=0.73, 95% CI=(0.51–0.95, p<0.0001)). Conclusion. Specific preoperative diagnosis of pancreatic cystic neoplasms by CT alone is substantially inaccurate. Complementary tests such as EUS-FNA with fluid analysis and ERCP should be recommended to improve diagnosis especially if nonoperative treatment is planned.     

Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study

Early detection of synchronous esophageal squamous cell neoplasm (ESCN) in head and neck squamous cell carcinoma (HNSCC) patients can significantly affect their prognosis. We investigated the prevalence of synchronous ESCN and the risk factors for developing ESCN in patients with HNSCC, and evaluated the effect of routine endoscopic screening in these patients. Subjects who were diagnosed as HNSCC from May 2010 to January 2014 were eligible. All patients underwent conventional white light endoscopic examinations with narrow band imaging and Lugol chromoendoscopy. Among 458 subjects screened, 28 synchronous ESCN were detected in 24 patients (5.2%). The prevalence of ESCN was greatest in patients with hypopharyngeal cancer (20.9%). In multivariate analysis, pyriform sinus involvement was independent risk factor for developing synchronous ESCN (odds ratio 171.2, P < 0.001). During the follow‐up period (median, 24 months), the 3‐year overall survival rates was significantly lower in patients with ESCN than in patients without ESCN (54.2% vs. 78.3%, P = 0.0013). Routine endoscopic screening for detecting synchronous ESCN should be recommended for patients with HNSCC, especially those with pyriform sinus involvement.     

Papillary cystic neoplasm (PCN) of the pancreas with lymph node metastasis: Case report of a 77-year-ood woman and a review of 198 reported cases

A case of papillary cystic neoplasm (PCN) of the pancreas in a 77-year-old woman, the oldest patient in the English literature, is reported. Distal pancreatectomy with regional lymphadenectomy was performed for the tumor in the pancreatic tail. Postoperative pathology examination revealed a metastatic lesion in one of the regional lymph nodes. This patient is well doing without recurrence 5 years after surgery. One hundred and ninety-eight cases of PCN, including the present case, have been reported in the English literature. The patients were aged from 2 to 77 years (mean, 25.8); there were 187 females and 11 males. Sixteen patients with metastasis, 22 with local invasion, and 3 with peritoneal dissemination were reported. Complete resection of the tumor was performed in 151 patients, including 6 with metastasis and 11 with local invasion. Only one patient died of recurrent tumor.     

Chronic immunosuppression does not potentiate the malignant progression of mucinous pancreatic cystic lesions

BackgroundPremalignant mucinous pancreatic cystic lesions (mPCLs) are increasingly identified.AimsIn this study, we aim to assess the effect of selected immunosuppressive therapies on the progression of mPCLs, including side-branch intraductal papillary mucinous neoplasms and mucinous cystic neoplasms.MethodsWe performed a retrospective cohort study of patients with mPCLs diagnosed over a 24-year period who received chronic immunosuppression. Controls were matched on age at cyst diagnosis (±11 yrs) and cyst size (±8 mm). Measured outcomes included increase in cyst size, development of “worrisome features” as defined by consensus guidelines, progression to malignancy, and rate of surgical resection.Results39 patients (mean age 60 yrs) with mPCLs were on immunosuppression. Leading indications for immunosuppression were solid organ transplant (n = 14), inflammatory bowel disease (n = 6), and rheumatoid arthritis (n = 5). 33% were on biologics, 77% on antimetabolites and 79% on multiple medications. Mean cyst size increased from 12.6 mm to 17.8 mm over a median of 16.5 months. 6 patients elected for surgical resection, and none ultimately developed malignancy. 26 cases with follow-up were matched to control subjects, with no significant differences among cases and controls in initial cyst size (12.8 mm vs 11.9 mm, P = 0.69), mean size increase (6.9 mm vs 5 mm, P = 0.47), follow-up interval (24.3 months vs 21.5 months, P = 0.44). No significant differences in the rate of worrisome features, malignancy, or surgical resection.ConclusionsPatients with mPCLs exposed to immunosuppressive medications did not have higher rates of malignancy or development worrisome features in the short term. This suggests that patients with mPCLs can be initiated or maintained on these agents without changes to surveillance practices.