Ziel: Evaluation der Effektivit t verschiedener Methodiken der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms. Material und Methoden: Bei mannlichen ACI Ratten erfolgte die Implantation eines sol...Ziel: Evaluation der Effektivit t verschiedener Methodiken der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms. Material und Methoden: Bei mannlichen ACI Ratten erfolgte die Implantation eines soliden Morris Hepatom 3924A subkapsular in den Leberlappen. 12—14 Tage nach Implantation wurden die Tumorvolumina kernspintomographisch bestimmt. Nach Laparotomie und retrograder Katheterisierung der Arteria gastroduodenalis wurden anschlieend unterschiedliche Therapieprotokolle der TACE angewendet: Mitomycin C , Degradiere Starke Mikrospharen , Mitomycin C+DSM , Mitomycin C + Ligatur , Mitomycin C+Lipiodol , Mitomycin C+Lipiodol+Ligatur , Mitomycin C+DSM+Ligatur , Mitomycin C+Poly Laktide co Glykolide , DSM + Ligatur , Lipiodol + Ligatur , Ligatur , Lipiodol , 0,9% NaCl . Zur Effektivitatsbeurteilung der verschiedenen Methodiken erfolgte 12—14 Tage nach Therapie eine erneute kernspintomographische Volumenbestimmung der Tumoren. Ergebnisse: Im Vergleich zur Kontrollgruppe zeigten Gruppe D, E, F, G, H und J eine statistisch signifikant geringere Tumorvolumenzunahme, wahrend Gruppe A, B, C, I, K, L keine statistisch signifikanten Unterschiede hinsichtlich der Tumorvolumenzunahme zeigten. Schlufolgerung: Die Effektivitat der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms wird nur bei kombinierter Applikation von Zytostatikum und Carrier/Ligatur signifikant erhoht. Die alleinige Applikation des Zytostatikums/der Carrier/Ligatur hatte keinen signifikanten Effekt bezuglich der Effektivitat.展开更多
Von Mai 1990 bis September 1993 wurden 106 Patienten mit hepatozellularem Karzinom (HCC) durch 354 repetitiv durchgefuhrte transarterielle Chemoembolisation behandelt. Die Beobachtungszeit variierte zwischen 10-50 Mon...Von Mai 1990 bis September 1993 wurden 106 Patienten mit hepatozellularem Karzinom (HCC) durch 354 repetitiv durchgefuhrte transarterielle Chemoembolisation behandelt. Die Beobachtungszeit variierte zwischen 10-50 Monaten bei allen Patienten. Je nach dem Embolisationsmaterial wurde n106 Patienten in zwei Gruppen geteilt, namlich Lipiodol-MMC mit Gelfoam als vorlaufige Embolisationsmethode (Gruppe A, n=50) und Lipiodol-MMC mit Bletilla striata-Pulver (BS; chinesisches traditionelles Medikament fur Koagulation)als permanente Embolisationsmethode (Gruppe B,n=56), Bei der Analyse zeigte sich,daβ auβer anderen wichtigen Faktoren,wie der Infiltration der Portalvene und dem klinischen Stadium der Patienten sowie dem Wachstumstyp des Tumors, die klinischen Effekte eng von den Embolisationsmethoden abhangig waren. Die Uberlebenraten betrugen bei Gruppe A 48, 9%,16,0% nach 1, 2, 3Jahren, bei Gruppe B 81,9 %, 44,9 %, 33,6 % nach 1, 2, 3 Jahren. Die Uberlebensraten zwischen der beiden Gruppen zeigten beim U-Test einen signifikanten Unterschied展开更多
Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Person...Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking.This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.Methods From a multi-institutional database,2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled,and randomly assigned to the training and validation cohorts.Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort,and subsequently used to construct a model and corresponding prediction calculator.The predictive performance of the model was validated using concordance indexes(C-indexes)and calibration curves,and compared with conventional HCC staging systems.The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.Results The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence:alpha-fetoprotein level,maximum tumour size,tumour number,macrovascular and microvascular invasion,satellite nodules,resection margin and adjuvant TACE.The model demonstrated good calibration and discrimination in the training and validation cohorts(C-indexes:0.799 and 0.778,respectively),and performed better among the whole cohort than four conventional HCC staging systems(C-indexes:0.797 vs 0.562–0.673,all p<0.001).An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.Conclusions The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Previous studies have indicated that adjuvant transarterial chemoembolisation(TACE)may im-prove long-term survival in certain subgroups of patients with hepatocellular carcinoma(HCC)after hepatectomy.⇒However,these studies did not provide personalised risk assessment or net benefit estimation for indi-vidual patients,highlighting the need for a more refined prediction model.WHAT THIS STUDY ADDS⇒This study developed a risk prediction model in-corporating eight independent factors associat-ed with early recurrence after hepatectomy for HCC,demonstrating good predictive accuracy and discrimination.⇒The model outperformed four commonly used con-ventional HCC staging systems and facilitated the development of an online calculator to estimate in-dividual patient’s reduced risk of early recurrence using adjuvant TACE.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒The study’s findings may assist clinicians in decid-ing whether to use adjuvant TACE after hepatectomy for HCC,potentially improving patient outcomes.⇒Further research should validate the model with larger cohorts or those from other centres to assess its broader applicability.展开更多
In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using networ...In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.展开更多
Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We e...Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We evaluated the prognostic factors associated with survival in a real-world setting to identify those at high risk of a poor outcome.Methods:Patients with HCC who underwent initial TACE at six tertiary hospitals between 2009 to 2014 were included via an extensive search of hospital databases and electronic medical records.Overall survival(OS)was measured from the date of initial treatment to the date of death or last follow-up.Univariate and multivariate Cox regression analyses were used to assess the effects of baseline variables on post-TACE survival.Results:The majority of the 431 eligible patients were Caucasian(80%),male(87%),with a mean age of 66 years and had alcohol-related cirrhosis(43%).Most were Child-Pugh A(69%)with BCLC stage A(59%)or B(35%)disease,with a median OS of 28 months.On multivariate analysis,pre-treatment ascites(P=0.001)and larger HCC(P<0.001)were associated with worse overall survival,while higher serum albumin(P<0.001)and HBV(P=0.005)were associated with improved survival.Conclusion:Patients with advanced liver disease,including the presence of ascites and lower serum albumin,as well as those with greater tumour burden,have poorer outcomes following TACE treatment.Such findings provide a better understanding of the variation in survival after TACE and are helpful in facilitating selection and timely stage migration of patients undergoing this therapy.展开更多
AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ ...AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment.RESULTS: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.展开更多
AIM: To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extend...AIM: To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein.METHODS: From 2009 to 2013, a total of 418 HCC patients with tumor thrombus extending to the main portal vein were enrolled in this study and divided into four groups. These groups underwent different treatments as follows: TACE (n = 307), surgical intervention (n = 54), sorafenib (n = 15) and palliative treatment (n = 42). Overall survival rates were determined by Kaplan-Meier method, and differences between the groups were identified through log-rank analysis. Cox’s proportional hazard model was used to identify the risk factors for survival.RESULTS: The mean survival periods for patients in the TACE, surgical intervention, sorafenib and palliative treatment groups were 10.39, 4.13, 5.54 and 2.82 mo, respectively. For the TACE group, the 3-, 6-, 12- and 24-mo survival rates were 94.1%, 85.9%, 51.5% and 0.0%, respectively. The corresponding rates were 60.3%, 22.2%, 0.0% and 0.0% for the surgical intervention group and 50.9%, 29.5%, 0.0% and 0.0% for the sorafenib group. Evidently, the results in the TACE group were significantly higher than those in the other groups (P < 0.0001). Furthermore, no significant difference among survival rates was observed between TACE with/without sorafenib (10.22 mo vs 10.52 mo, P = 0.615). No significant difference in survival rates was also found among the surgical intervention, sorafenib and palliative treatment groups (P > 0.05). These values significantly increased after TACE with/without sorafenib compared with other treatments (P < 0.05).CONCLUSION: For HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.展开更多
Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heteroge...Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.展开更多
文摘Ziel: Evaluation der Effektivit t verschiedener Methodiken der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms. Material und Methoden: Bei mannlichen ACI Ratten erfolgte die Implantation eines soliden Morris Hepatom 3924A subkapsular in den Leberlappen. 12—14 Tage nach Implantation wurden die Tumorvolumina kernspintomographisch bestimmt. Nach Laparotomie und retrograder Katheterisierung der Arteria gastroduodenalis wurden anschlieend unterschiedliche Therapieprotokolle der TACE angewendet: Mitomycin C , Degradiere Starke Mikrospharen , Mitomycin C+DSM , Mitomycin C + Ligatur , Mitomycin C+Lipiodol , Mitomycin C+Lipiodol+Ligatur , Mitomycin C+DSM+Ligatur , Mitomycin C+Poly Laktide co Glykolide , DSM + Ligatur , Lipiodol + Ligatur , Ligatur , Lipiodol , 0,9% NaCl . Zur Effektivitatsbeurteilung der verschiedenen Methodiken erfolgte 12—14 Tage nach Therapie eine erneute kernspintomographische Volumenbestimmung der Tumoren. Ergebnisse: Im Vergleich zur Kontrollgruppe zeigten Gruppe D, E, F, G, H und J eine statistisch signifikant geringere Tumorvolumenzunahme, wahrend Gruppe A, B, C, I, K, L keine statistisch signifikanten Unterschiede hinsichtlich der Tumorvolumenzunahme zeigten. Schlufolgerung: Die Effektivitat der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms wird nur bei kombinierter Applikation von Zytostatikum und Carrier/Ligatur signifikant erhoht. Die alleinige Applikation des Zytostatikums/der Carrier/Ligatur hatte keinen signifikanten Effekt bezuglich der Effektivitat.
文摘Von Mai 1990 bis September 1993 wurden 106 Patienten mit hepatozellularem Karzinom (HCC) durch 354 repetitiv durchgefuhrte transarterielle Chemoembolisation behandelt. Die Beobachtungszeit variierte zwischen 10-50 Monaten bei allen Patienten. Je nach dem Embolisationsmaterial wurde n106 Patienten in zwei Gruppen geteilt, namlich Lipiodol-MMC mit Gelfoam als vorlaufige Embolisationsmethode (Gruppe A, n=50) und Lipiodol-MMC mit Bletilla striata-Pulver (BS; chinesisches traditionelles Medikament fur Koagulation)als permanente Embolisationsmethode (Gruppe B,n=56), Bei der Analyse zeigte sich,daβ auβer anderen wichtigen Faktoren,wie der Infiltration der Portalvene und dem klinischen Stadium der Patienten sowie dem Wachstumstyp des Tumors, die klinischen Effekte eng von den Embolisationsmethoden abhangig waren. Die Uberlebenraten betrugen bei Gruppe A 48, 9%,16,0% nach 1, 2, 3Jahren, bei Gruppe B 81,9 %, 44,9 %, 33,6 % nach 1, 2, 3 Jahren. Die Uberlebensraten zwischen der beiden Gruppen zeigten beim U-Test einen signifikanten Unterschied
基金supported by the National Natural Science Foundation of China(no.82273074)Dawn Project Foundation of Shanghai(no.21SG36)+2 种基金Adjunct Talent Fund of Zhejiang Provincial People’s Hospital(no.2021-YT)the Natural Science Foundation of Shanghai(no.22ZR1477900)Shanghai Science and Technology Committee Rising-Star Programme(no.22QA1411600).
文摘Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking.This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.Methods From a multi-institutional database,2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled,and randomly assigned to the training and validation cohorts.Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort,and subsequently used to construct a model and corresponding prediction calculator.The predictive performance of the model was validated using concordance indexes(C-indexes)and calibration curves,and compared with conventional HCC staging systems.The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.Results The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence:alpha-fetoprotein level,maximum tumour size,tumour number,macrovascular and microvascular invasion,satellite nodules,resection margin and adjuvant TACE.The model demonstrated good calibration and discrimination in the training and validation cohorts(C-indexes:0.799 and 0.778,respectively),and performed better among the whole cohort than four conventional HCC staging systems(C-indexes:0.797 vs 0.562–0.673,all p<0.001).An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.Conclusions The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Previous studies have indicated that adjuvant transarterial chemoembolisation(TACE)may im-prove long-term survival in certain subgroups of patients with hepatocellular carcinoma(HCC)after hepatectomy.⇒However,these studies did not provide personalised risk assessment or net benefit estimation for indi-vidual patients,highlighting the need for a more refined prediction model.WHAT THIS STUDY ADDS⇒This study developed a risk prediction model in-corporating eight independent factors associat-ed with early recurrence after hepatectomy for HCC,demonstrating good predictive accuracy and discrimination.⇒The model outperformed four commonly used con-ventional HCC staging systems and facilitated the development of an online calculator to estimate in-dividual patient’s reduced risk of early recurrence using adjuvant TACE.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒The study’s findings may assist clinicians in decid-ing whether to use adjuvant TACE after hepatectomy for HCC,potentially improving patient outcomes.⇒Further research should validate the model with larger cohorts or those from other centres to assess its broader applicability.
文摘In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.
基金supported by an Australian Government Research Training Program(RTP)Scholarship,Monash University,Melbourne,Australia。
文摘Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We evaluated the prognostic factors associated with survival in a real-world setting to identify those at high risk of a poor outcome.Methods:Patients with HCC who underwent initial TACE at six tertiary hospitals between 2009 to 2014 were included via an extensive search of hospital databases and electronic medical records.Overall survival(OS)was measured from the date of initial treatment to the date of death or last follow-up.Univariate and multivariate Cox regression analyses were used to assess the effects of baseline variables on post-TACE survival.Results:The majority of the 431 eligible patients were Caucasian(80%),male(87%),with a mean age of 66 years and had alcohol-related cirrhosis(43%).Most were Child-Pugh A(69%)with BCLC stage A(59%)or B(35%)disease,with a median OS of 28 months.On multivariate analysis,pre-treatment ascites(P=0.001)and larger HCC(P<0.001)were associated with worse overall survival,while higher serum albumin(P<0.001)and HBV(P=0.005)were associated with improved survival.Conclusion:Patients with advanced liver disease,including the presence of ascites and lower serum albumin,as well as those with greater tumour burden,have poorer outcomes following TACE treatment.Such findings provide a better understanding of the variation in survival after TACE and are helpful in facilitating selection and timely stage migration of patients undergoing this therapy.
文摘AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment.RESULTS: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.
基金Supported by National Major Special Science and Technology ProjectNo.2012ZX10002010001009
文摘AIM: To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein.METHODS: From 2009 to 2013, a total of 418 HCC patients with tumor thrombus extending to the main portal vein were enrolled in this study and divided into four groups. These groups underwent different treatments as follows: TACE (n = 307), surgical intervention (n = 54), sorafenib (n = 15) and palliative treatment (n = 42). Overall survival rates were determined by Kaplan-Meier method, and differences between the groups were identified through log-rank analysis. Cox’s proportional hazard model was used to identify the risk factors for survival.RESULTS: The mean survival periods for patients in the TACE, surgical intervention, sorafenib and palliative treatment groups were 10.39, 4.13, 5.54 and 2.82 mo, respectively. For the TACE group, the 3-, 6-, 12- and 24-mo survival rates were 94.1%, 85.9%, 51.5% and 0.0%, respectively. The corresponding rates were 60.3%, 22.2%, 0.0% and 0.0% for the surgical intervention group and 50.9%, 29.5%, 0.0% and 0.0% for the sorafenib group. Evidently, the results in the TACE group were significantly higher than those in the other groups (P < 0.0001). Furthermore, no significant difference among survival rates was observed between TACE with/without sorafenib (10.22 mo vs 10.52 mo, P = 0.615). No significant difference in survival rates was also found among the surgical intervention, sorafenib and palliative treatment groups (P > 0.05). These values significantly increased after TACE with/without sorafenib compared with other treatments (P < 0.05).CONCLUSION: For HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.
文摘Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.
