影响肝切除术后行TACE患者预后因素的分析

目的：对原发性肝细胞肝癌（HCC）肝部分切除术后行经肝动脉化疗栓塞（TACE）的病人和未行TACE病人影响其预后的多种因素进行分析和评价,为肝切除术后是否行TACE治疗寻找筛选条件。方法：对我院2003～2008年期间在我院肝胆外科行原发性肝细胞肝癌手术治疗221例（术后介入治疗103例,术后非介入治疗118例）患者进行全面随访了解患者的预后情况,分别对术后接受介入治疗和非介入治疗两组通过Kaplan-Meier及COX回归分析影响预后的因素,包括：年龄、性别、血清HBsAg、肿瘤直径、肿瘤大体分型、有无癌栓形成,肿瘤分期（TNM）共7项指标。结果：在1年生存期内介入治疗组中的性别、年龄、血清HBsAg、肿瘤直径、肿瘤大体分型无统计学意义（p〉0.05）,有无癌栓形成及肿瘤分期有意义（p〈0.05）;非介入组内年龄、性别、血清HBsAg无统计学意义,肿瘤直径、肿瘤大体分型、有无癌栓形成,肿瘤分期有意义;在3年生存期内介入治疗组中的以上指标无统计学意义,而非介入组在肿瘤直径、有癌栓形成及肿瘤分期方面与统计学意义。结论：对于肿瘤直径〉5cm及术后病理证实为低分化的患者给予积极TACE治疗可明显提高近期生存率。     

凋亡诱导因子AIF在肝癌组织中的表达及临床意义*

目的:探讨凋亡诱导因子(AIF)在肝细胞癌组织中的表达及其临床意义。方法:采用免疫组织化学Envision法检测75例肝细胞癌组织及其相应癌旁肝组织、30例正常肝组织中AIF的表达,并分析其表达与肝细胞癌临床病理因素的相关性。结果:肝癌组织中AIF阳性表达率明显高于癌旁组织及正常肝组织,差异均具有统计学意义(P<0.01)。AIF在肝癌组织中的表达仅与病理分级密切相关(P<0.01),而与年龄、性别、肿瘤大小、临床分期、肿瘤数目、有无肿瘤包膜和有无淋巴结转移、有无门静脉癌栓均无关。结论:AIF表达可能参与了肝癌的发生和发展过程。     

不同方案治疗直径小于10cm肝细胞癌合并门静脉癌栓患者影响生存率的观察

目的：探讨两种不同方案治疗直径小于10cm肝细胞癌合并门静脉癌栓患者影响生存率。方法：将我院100例直径小于10cm肝细胞癌合并门静脉癌栓患者按照抽签法随机地均分为A、B两组,A组行单纯肝动脉插管化疗栓撒（TACE）治疗,B组肝癌手术切除联合癌栓切除＋TACE术,比较两组患者治疗前后DLIA蛋白与VEGF蛋白阳性表达率、五年生存率以及影响患者生存率的因素。结果：（1）A组治疗前后DLL4蛋白与VEGF蛋白阳性表达率差异无统计学意义（P〉0．05）,B组治疗前后上述蛋白阳性表达率差异具有统计学意义（P〈0．05,P〈0．01）;（2）根据Kaplan—Meir计算方法,B组五年生存率均明显大于A组（P〈0．001）;（3）经Pearson单因素与COX多因素分析,影响患者预后的危险独立因素为肿瘤大小与手术方式。结论：综合治疗方案用于治疗直径小于10cm肝细胞癌合并门静脉癌栓患者之中,疗效显著,患者五年生存率明显提高。     

TACE联合抗病毒治疗HBV相关性肝癌的预后观察及相关因素分析

摘要 目的：分析影响肝动脉化疗栓塞（TACE）联合抗病毒治疗乙型肝炎病毒（HBV）相关性肝癌预后的相关因素。方法：纳入的130例HBV相关性肝癌选自于本院2018年2月至2020年3月期间所收治，所有患者均行TACE联合抗病毒治疗，记录其生存情况，并对影响患者预后的相关因素进行分析与探讨。结果：130例患者随访截止时，死亡58例，存活72例，中位生存期为24个月，1年生存率为82.31%，2年生存率为55.38%；单因素及多因素Cox回归分析结果显示，肿瘤最大直径、血清AFP、Child-Pugh分级、腹腔转移、门静脉癌栓是患者预后不良的的危险因素。结论：肿瘤最大直径、血清AFP、Child-Pugh分级、腹腔转移、门静脉癌栓是影响TACE联合抗病毒治疗HBV相关性肝癌病患预后的影响因素。     

线粒体促凋亡因子Omi/HtrA2在肝癌组织中表达的研究

目的探讨丝氨酸蛋白酶Omi/HtrA2在肝癌组织、癌旁组织与正常肝组织中的表达及意义。方法应用免疫组化SABC法检测43例肝癌、30例癌旁组织及10例正常肝组织中Omi/HtrA2的表达。结果29例(67·44%)肝癌中Omi/HtrA2蛋白表达阳性,30例癌旁组织和10正常肝组织没有或只有少量很弱的表达。肝癌高分化组中Omi/HtrA2蛋白的表达明显高于中、低分化组(P<0·01)。另外,Omi/HtrA2表达与肿瘤大小及临床分期相关,但Omi/HtrA2表达与肝硬化、有无癌栓、HBsAg和AFP无关。结论肝细胞癌可能需要Omi/HtrA2的表达来促进凋亡,Omi/HtrA2的表达对肝癌的发展有重要作用。     

肝细胞癌化疗栓塞术后血清TGFβ1、bFGF和VEGF浓度变化

目的:研究肝细胞癌(HCC)患者肝动脉化疗栓塞术(TACE)前后血清转化生长因子β1(TGFβ1)、血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)浓度的变化及其临床意义。方法:采用双抗体夹心酶联免疫法(EUSA),检测32例HCC患者TACE前后血清TGFβ1、VEGF和bFGF浓度的改变,并与正常对照组比较。分析HCC患者TACE前后血清bFGF,TGFβ1与VEGF浓度的相关性。结果:HCC组TACE治疗前TGFβ1、VEGF浓度均升高,与正常对照组比较有显著性差异(P<0.05);TACE术后患者血清TGFβ1、VEGF和bFGF浓度均升高,治疗前后比较有统计学差异(P<0,05);TACE术前或术后,血清TGFβ1与VEGF浓度均具有正相关性(r前=0.581,P<0.01;r后=0.577,P<0.01)。结论:HCC患者TACE术后TGFβ1、VEGF和bFGF三种促血管生长因子浓度的升高,对肿瘤血管及侧枝循环的形成有着重要作用,影响TACE的远期疗效。     

凋亡诱导因子AIF在肝癌组织中的表达及临床意义

目的：探讨凋亡诱导因子（AIF）在肝细胞癌组织中的表达及其临床意义。方法：采用免疫组织化学Envision法检测75例肝细胞癌组织及其相应癌旁肝组织、30例正常肝组织中AIF的表达,并分析其表达与肝细胞癌临床病理因素的相关性。结果：肝癌组织中AIF阳性表达率明显高于癌旁组织及正常肝组织,差异均具有统计学意义（P〈0.01）。AIF在肝癌组织中的表达仅与病理分级密切相关（P〈0.01）,而与年龄、性别、肿瘤大小、临床分期、肿瘤数目、有无肿瘤包膜和有无淋巴结转移、有无门静脉癌栓均无关。结论：AIF表达可能参与了肝癌的发生和发展过程。     

TACE 联合其他介入手段治疗肝癌伴门静脉癌栓

肝癌是世界范围内恶性程度最高的恶性肿瘤之一。门静脉癌栓的出现加速了肝功衰竭以及门静脉高压的发生概率,严重影响了肝癌患者的预后,临床上对于肝癌合并门静脉癌栓的诊疗尤为棘手。传统的治疗手段对于肝癌合并门静脉癌栓的疗效欠佳,且创伤大、住院时间长、并发症多。介入治疗因其创伤小、住院时间短、并发症少,疗效确切等优势逐渐被人们认可。以往单独应用经导管肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)治疗肝癌取得了可喜的成果,随着介入治疗的发展,TACE联合其他介入手段治疗肝癌伴门静脉癌栓引起了越来越多的学者重视。本文回顾了近几年来国内外的相关文献,对TACE联合其他介入手段治疗肝癌合并门静脉癌栓的方式及疗效做一综述,以期对肝癌的临床诊疗工作提供一些帮助。     

SSBP1在乙肝相关性肝细胞癌中的表达及临床意义

目的:研究SSBP1在乙肝相关性肝细胞癌(hepatocellular carcinoma,HCC)组织中的表达及其与患者临床病理特征的关系,为肝癌的诊断和预后判断提供参考依据。方法:收集血清乙肝病毒表面抗原(HBVs Ag)阳性的HCC患者组织标本216例,采用免疫组化和Western blot检测癌及癌旁组织中SSBP1的表达水平,并进行统计分析。结果:SSBP1蛋白在癌组织中的表达水平明显高于癌旁组织(P0.05)。SSBP1表达水平与肿瘤数量、肿瘤大小、门静脉癌栓和肿瘤分级具有显著的相关性(P0.05)。SSBP1低表达患者术后总生存期及无复发生存期明显优于SSBP1高表达的患者(P0.05)。结论:SSBP1在HCC的发生发展过程中发挥重要作用,特对患者的预后判断具有一定的参考价值。     

HIF-1α、HSP90α在肝细胞癌中的表达及临床意义

目的:探讨缺氧诱导因子-1α(HIF-1α)和热休克蛋白9Oα(HSP90α)在肝细胞癌中的表达及其与临床病理特征之间的关系。方法:采用免疫组织化学Envision二步法检测H HIF-1α和HSP90α蛋白在65例肝细胞癌和癌旁组织、20例正常肝组织中的表达,并分析其与肝细胞癌临床病理因素的关系。结果:HCC组织中HIF-1α和HSP90α阳性表达率均明显高于癌旁组织及正常肝脏组织,差异均具有统计学意义(P<0.01)。HIF-1α在HCC组织中的表达与肿瘤大小、临床分期、病理分级、有无淋巴结转移、有无门静脉癌栓密切相关(P<0.01),HSP90α在HCC组织中的表达与临床分期、病理分级、有无淋巴结转移、有无门静脉癌栓密切相关(P<0.01)。Spearman相关性检验分析提示HIF-1α和HSP90α表达阳性程度呈正相关(r=0.536,P<0.01)。结论:HIF-1α和HSP90α参与肝细胞癌的发生、发展,并起协同作用,可能作为判断肝细胞癌预后的指标。     

Patterns of sorafenib and TACE treatment of unresectable hepatocellular carcinoma in a Chinese population: subgroup analysis of the GIDEON study

To analyze safety and efficacy of patterns of sorafenib and TACE therapy under real-life clinical practice conditions. A total of 338 Chinese patients with unresectable hepatocellular carcinoma (HCC) from the international database of the GIDEON non-interventional trial were included in this analysis. Endpoints were overall survival (OS), progression-free survival (PFS), time to progression (TTP) and safety. Two major patterns in the use of sorafenib observed in current Chinese clinical practice were: sorafenib administration subsequent to transarterial chemoembolization (TACE) treatment (n?=?226, 66.9%) and sorafenib administration concomitant to TACE (n?=?80, 35.4%). Patients receiving TACE prior to sorafenib had worse liver function (43.8% BCLC stage Cat diagnosis and 62.1% BCLC stage C at study entry) than those receiving TACE concomitant to sorefenib (35.0% BCLC stage C at diagnosis and 51.3% BCLC stage three at study entry). For patients undergoing prior TACE and concomitant TACE treatment, median OS time was 354 days vs. 608 days, PFS time was 168 days vs. 201 days, and TTP was 214 days vs. 205 days; and the percentage of patients who experienced drug-related adverse effects after sorafenib therapy in these two groups were 33.3 and 50.0%, respectively. Sorafenib treatment is usually administered in cases of tumor progression or poor liver function status after TACE treatment in China. Under such conditions, patients still gained a relatively satisfactory survival outcome. In addition, the present study suggests that concomitant sorafenib and TACE treatments may lead to a better prognosis, although differences in baseline characteristics may have contributed in part to the better outcomes.     

不同方式治疗原发性肝癌合并门静脉癌栓的治疗效果比较

目的:对不同方式治疗原发性肝癌(HCC)合并门静脉癌栓(PVTT)的治疗效果进行比较。方法:收取我院2010年2月至2013年3月收治的HCC合并PVTT患者83例进行回顾性分析,按照治疗方法的不同分为A组(手术+经导管动脉化疗栓塞TACE)26例、B组(手术+门静脉化疗PVC)25例以及C组(手术+TACE+PVC)32例。对三组患者不良反应发生情况、生存率、生存质量进行考察与比较,并对可能影响生存率的因素进行分析。结果:三组患者均行手术切除,切除率为100%。三组患者化疗后不良反应发生率方面比较差异无统计学意义(P0.05)。C组患者生存质量提高总有效率及改善率分别为78.13%和50.00%,均显著高于其他两组,差异有统计学意义(P0.05)。C组患者中位生存时间及半年、1年、2年、3年生存率均显著高于A组和B组,差异具有统计学意义(P0.05)。影响HCC合并PVTT患者的主要因素包括肿瘤大小、肿瘤数目、病理分级及癌栓类型(P0.05)。结论:HCC合并PVTT患者术后使用TACE+PVC联合治疗可有效提高患者生存率,改善生活质量。     

Comparison of Long-Term Survival of Patients with Solitary Large Hepatocellular Carcinoma of BCLC Stage A after Liver Resection or Transarterial Chemoembolization: A Propensity Score Analysis

Background

The aim of this study was to compare the long-term outcome of patients with a solitary large (>5 cm) hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage A who received liver resection (LR) or transarterial chemoembolization (TACE).

Methods

Our study examined 128 patients treated by LR and 90 treated by TACE. To reduce bias in patient selection, we conducted propensity score analysis in the present study and 54 pairs of patients after propensity score matching were generated, their long-term survival was compared using the Kaplan–Meier method. Independent predictors of survival were identified by multivariate analysis.

Results

Long-term survival was significantly better for the LR group by log-rank test (P<0.001). In multivariate analysis, tumor size, serum ALT level and TACE independently predicted survival. Despite similar baseline characteristics after propensity score matching, LR group still had significantly better survival (1 year, 68.5 vs. 55.0%; 3 years, 47.6 vs. 21.2%; 5 years, 41.3 vs. 18.5%; P = 0.007) than TACE group. The LR and TACE groups had comparable 30- and 90-day post-treatment mortality. Multivariate analysis showed that serum ALT level, serum AFP level and TACE independently predicted survival by multivariate analysis after propensity score matching.

Conclusion

Our propensity-score-matched study suggested that LR provided significantly better long-term survival than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.     

The Intracellular HBV DNAs as Novel and Sensitive Biomarkers for the Clinical Diagnosis of Occult HBV Infection in HBeAg Negative Hepatocellular Carcinoma in China

This study aimed to investigate the virological status in liver (both tumor and adjacent non-tumor tissue), the clinical features and the contribution of occult HBV infection (OBI) to postoperative prognosis in HBeAg-negative(−) hepatocellular carcinoma (HCC) patients in China. Using quantitative TaqMan fluorescent real-time PCR assays, HBV covalently closed circular DNA (cccDNA) and total DNA (tDNA) were both quantified in 11 (HBsAg(−)) and 57 (HBsAg-positive(+)) pairs of tumor tissue (TT) and adjacent non-tumor tissue (ANTT) obtained from HBeAg(−) HCC patients who received no antiviral treatment and were negative for anti-HCV before surgical treatment. Of 11 HBsAg(−) patients, 36% were with HBsAb(+) HBeAb(+) HBcAb(+). However, only 9% of the HBsAg(−) patients were HBsAb(−) HBeAb(+) HBcAb(+), which accounted for the majority (93%) in the HBsAg(+) group. TT and ANTT HBV tDNAs in 11 HCC patients with HBsAg (−) and HBeAg (−) were all detectable. HBV cccDNA and tDNA were all lower in the HBsAg(−) group than those in the HBsAg(+) group. By Kaplan-Meier analysis, patients with OBI were associated with a lower risk of cirrhosis and better overall survival (OS). The intracellular HBV DNAs, such as HBV cccDNA and tDNA are valuable biological markers for the diagnosis of occult HBV infection in HCC patients. This would assist the clinical implementation of a more personalized therapy for viral re-activation control and improve the survival rate of OBI patients.     

全胸腔镜肺叶切除术治疗早期非小细胞肺癌患者的预后分析

目的:探讨全胸腔镜肺叶切除术治疗早期非小细胞肺癌(NSCLC)患者的疗效及预后状况。方法:选择2010年6月至2013年6月我院收治的早期NSCLC患者80例作为研究对象,随机分为对照组(n=40)和实验组(n=40)。对照组患者行常规开胸肺叶切除术,实验组患者行全胸腔镜肺叶切除术,所有患者于术后视具体情况给予化疗或放疗。记录两组患者术中及术后临床相关指标,术后并发症发生率,术后随访3年,比较两组患者3年生存率,并分析全胸腔镜肺叶切除术后患者预后影响因素。结果:实验组患者手术时间、术中出血量、胸腔引流时间及住院时间均明显低于对照组(P0.05)。实验组患者术后并发症发生率、术后3年生存率分别为12.50%、57.50%,与对照组的17.50%、50.00%相比,差异均无统计学意义(P0.05)。Cox多因素分析结果显示,肿瘤直径和术后是否放化疗是影响全胸腔镜肺叶切除术后患者预后的危险因素(P0.05)。结论:全胸腔镜肺叶切除术治疗早期NSCLC患者具有微创、安全及远期生存率较高的特点,术后辅以放化疗能够延长患者的生存率。     

Analysis of Prognostic Factors for Survival after Hepatectomy for Hepatocellular Carcinoma Based on a Bayesian Network

Background

The prognosis of hepatocellular carcinoma (HCC) after hepatectomy involves many factors. Previous studies have evaluated the separate influences of single factors; few have considered the combined influence of various factors. This paper combines the Bayesian network (BN) with importance measures to identify key factors that have significant effects on survival time.

Methods

A dataset of 299 patients with HCC after hepatectomy was studied to establish a BN using a tree-augmented naïve Bayes algorithm that could mine relationships between factors. The composite importance measure was applied to rank the impact of factors on survival time.

Results

124 patients (>10 months) and 77 patients (≤10 months) were correctly classified. The accuracy of BN model was 67.2%. For patients with long survival time (>10 months), the true-positive rate of the model was 83.22% and the false-positive rate was 48.67%. According to the model, the preoperative alpha fetoprotein (AFP) level and postoperative performance of transcatheter arterial chemoembolization (TACE) were independent factors for survival of HCC patients. The grade of preoperative liver function reflected the tendency for postoperative complications. Intraoperative blood loss, tumor size, portal vein tumor thrombosis (PVTT), time of clamping the porta hepatis, tumor number, operative method, and metastasis were dependent variables in survival time prediction. PVTT was considered the most significant for the prognosis of survival time.

Conclusions

Using the BN and importance measures, PVTT was identified as the most significant predictor of survival time for patients with HCC after hepatectomy.     

Hepatic Arterial Infusion Chemotherapy for Patients with Huge Unresectable Hepatocellular Carcinoma

Background and Aim

The optimal treatment for huge unresectable hepatocellular carcinoma (HCC) remains controversial. The outcome of transcatheter arterial chemoembolization (TACE) for patients huge unresectable HCC is generally poor and the survival benefit of TACE in these patients is unclear. The aim of the study is to compare the effect of hepatic arterial infusion chemotherapy (HAIC) versus symptomatic treatment in patients with huge unresectable HCC.

Methods

Since 2000 to 2005, patients with huge (size >8cm) unresectable HCC were enrolled. Fifty-eight patients received HAIC and 44 patients received symptomatic treatment. In the HAIC group, each patient received 2.4+1.4 (range: 1–6) courses of HAIC. Baseline characteristics and survival were compared between the HAIC and symptomatic treatment groups.

Results

The HAIC group and the symptomatic treatment group were similar in baseline characteristics and tumor stages. The overall survival rates at one and two years were 29% and 14% in the HAIC group and 7% and 5% in the symptomatic treatment group, respectively. The patients in the HAIC group had significantly better overall survival than the symptomatic treatment group (P<0.001). Multivariate analysis revealed that HAIC was the significant factor associated with the overall survival (relative risk: 0.321, 95% confidence interval: 0.200–0.515, P<0.001). None of the patients died due to immediate complications of HAIC.

Conclusions

HAIC is a safe procedure and provides better survival than symptomatic treatment in patients with huge unresectable HCC.     

放射性粒子^125I联合TACE治疗兔VX2肝肿瘤的实验研究

目的：通过研究不同活度的125I粒子以及联合TACE治疗兔VX2肝移植癌的疗效及其病理基础,探讨125I粒子组织间植入治疗肝癌的有效性。方法：建立兔VX2肝癌模型。60只肝癌模型兔随机分成5组,对照组（A组）植入空白剂量（0mCi）125I粒子,B组植入1.0mCi125I粒子,C组植入0.7mCi125I粒子,D组植入0.4mCi125I粒子,E组植入0.7mCi125I粒子＋TACE。观察植入前后各组肿瘤体积并计算抑瘤率,切除肿瘤组织及周围正常组织进行常规病理检查。结果：各治疗组肿瘤大小在治疗前后比较具有统计学差异（P〈0.01）,均小于同期对照组（A组）（P〈0.01）。在不同观察时期抑瘤率差别均有统计学意义（P〈0.05）,各个组间抑瘤率差异在治疗后2周最为明显（P〈0.01）,但均高于D组（P〈0.01）。治疗后6周病理提示D组部分组织内仍可见少量肿瘤细胞,而其余各治疗组均未见明显的肿瘤细胞残存,B组对周围肝组织损伤较大,C组、E组适中。总体疗效E组优于其余各治疗组。结论：125I粒子联合TACE治疗肝癌效果明显优于单一的治疗方案,是肝癌目前较为理想的治疗方案,其中单个粒子活度以0.7mCi左右较为适宜。