Preoperative systemic chemoimmunotherapy and sequential resection for unresectable hepatocellular carcinoma
Preoperative systemic chemoimmunotherapy and sequential resection for unresectable hepatocellular carcinoma
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DOI：
10.1097/00000658-200102000-00013
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发表时间：
2001-02-01
影响因子：
9
通讯作者：
Tang, AMY
中科院分区：
文献类型：
--
作者：
Lau, WY;Leung, TWT;Tang, AMY
目的探讨15例原发性不可切除的肝细胞癌（HCC）患者的手术和病理结果，并进行术前全身免疫化疗和序贯切除术。常规治疗在这组患者中产生了低肿瘤反应率。最近，新的全身性化学免疫治疗已被发现是有效的，并能够使以前不能切除的肝癌切除。化疗免疫治疗反应后，序贯切除，因此可以诱导完全的临床remission.Methods从1996年7月至1999年2月，150例不可切除的肝癌患者进行了治疗与顺铂，α-干扰素，多柔比星，5-氟尿嘧啶组成的系统化疗免疫治疗最多的6个周期。治疗后对残留肿瘤进行可切除性评估，以达到完全缓解。27例患者的肿瘤大小消退超过50%（2例完全缓解，25例部分缓解）。15例患者在治疗后有可切除的疾病，并且所有患者都接受了根治性的序贯切除。结果150例患者中有15例对免疫化疗有反应，并接受了序贯切除术。由于10例患者的广泛局部疾病（有或无主要血管受累）和5例患者的肝外或转移性疾病，认为他们患有不可切除的疾病。除两名患者外，所有患者均为B型肝炎携带者。所有患者均成功手术切除化疗后残留病灶，其中8例患者病理完全缓解。其余的有轻微残留病（
Objective To examine the surgical and pathologic findings of 15 patients who had initially unresectable hepatocellular carcinoma (HCC) and received preoperative systemic chemoimmunotherapy and sequential resection.Summary Background Data More than 80% of patients with HCC present for treatment at an unresectable stage. Conventional treatment has produced a low tumor response rate in this group of patients. Recently, new systemic chemoimmunotherapy has been found to be effective and able to make previously unresectable HCC resectable. Sequential resection after response to chemoimmunotherapy could therefore induce complete clinical remission.Methods From July 1996 to February 1999, 150 patients with unresectable HCC were treated with systemic chemoimmunotherapy consisting of cisplatin, alpha -interferon, doxorubicin, and 5-fluorouracil for a maximum of six cycles. The residual tumors were reassessed for resectability after treatment aiming at complete remission in the patients after combined modality treatment. Twenty-seven patients had a more than 50% regression in tumor size (2 complete remissions, 25 partial remissions). Fifteen patients had resectable disease after treat ment, and all underwent sequential resection with curative intent. Treatment outcome and the surgical and pathologic features of these 15 patients were studied.Results Fifteen of 150 patients responded to chemoimmunotherapy and underwent sequential resection. They were considered to have unresectable disease as a result of extensive local disease (with and without major vascular involvement) in 10 patients and the presence of extrahepatic or metastatic disease in 5 patients. All patients except two were hepatitis B carriers. Surgical resection of the residual lesion after chemoimmunotherapy was successful for all patients, Eight of the patients had complete pathologic remission. The rest had minimal residual disease (