Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation
Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation
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DOI：
10.1034/j.1399-0012.16.s7.8.x
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发表时间：
2002-10-01
影响因子：
2.1
通讯作者：
Posner, MP
中科院分区：
文献类型：
--
作者：
Fisher, RA;Maroney, TP;Posner, MP
1997年12月，在知情同意的情况下启动了一项前瞻性研究，以测试一种新的辅助治疗方法，即肝动脉化疗栓塞术(TACE)和热或化学消融后再经导管肝动脉化疗灌注(TACI)治疗转诊为肝移植(OLT)和切除的肝细胞癌(HCC)。采用美国肝脏肿瘤研究组改良的肿瘤-淋巴结-转移(TNM)分期方法，通过连续3~6个月的体格检查、甲胎蛋白(AFP)、腹部增强MRI、胸部CT和骨显像进行分期。根据移植后病理诊断，在508例肝移植患者中，65例肝细胞癌患者被分为5个临床组和1个偶发性肝细胞癌患者组(n=8)。研究的重点是安全性、肝癌复发的部位和无瘤生存。133例消融、输液手术的总发病率为24.8%，包括2例败血症死亡。在60例接受一种或多种消融治疗的患者中，有13例(21.6%)肝细胞癌复发，在43个月的研究中，只有23%的肝细胞癌复发。肝细胞癌患者18例(第3组)，其中12例等待29~424天后进行原位肝移植。2例患者因肝细胞癌转移而从原位肝移植名单中移除，平均等待145d。2例患者在原位肝移植后，其TNM评分从T-2、T-3升至T-4。在平均27+/-15个月的随访期内，第3组肝移植后患者无死亡或肝细胞癌复发。在平均24+/-14个月的随访期内，肝移植后无偶发性肝癌组患者死亡或出现肝癌复发。这种新辅助方案在减少肝移植和切除前后的肝细胞癌复发方面是安全和有效的。
In December 1997, a prospective study with informed consent was initiated to test a neoadjuvant treatment of transcatheter hepatic arterial chemo-embolization (TACE) and thermal or chemical ablation followed by transcatheter hepatic arterial chemo-infusion (TACI) in patients with hepatocellular carcinoma (HCC) referred for transplantation (OLT) and for resection. Patients were staged with American Liver Tumor Study Group-modified tumour-node-metastasis (TNM) staging classification using serial 3-6 month physical exam, alphafetoprotein (AFP), abdominal enhanced MRI, chest CT and bone scan. Sixty-five patients with HCC, out of 508 patients referred for OLT, were divided into five clinical groups and an incidental HCC patient group (n = 8), diagnosed on post-transplant explant pathology. The key focus of study was safety, site of HCC recurrence and tumour free survival. One hundred and thirty three ablation, infusion procedures were performed with an overall 24.8% morbidity, including two septic deaths. There were 13 (21.6%) HCC recurrences in 60 patients having one or more ablative treatments with only 23% hepatic HCC recurrences at 43 months of study. Eighteen HCC patients were listed for OLT (Group 3), with 12 patients transplanted after 29-424 d waiting. Two patients were removed from the OLT list due to HCC metastases, waiting a mean of 145 d. Two patients, post-OLT, had their TNM score upgraded from T-2, T-3 to T-4. No Group 3 post-OLT patient has died or had HCC recurrence at mean follow-up of 27 +/- 15 months. No incidental HCC group post-OLT patient has died or had HCC recurrence at mean follow-up of 24 +/- 14 months. This neoadjuvant protocol is safe and effective in reducing HCC recurrence prior to and after OLT and resection.