Cytolysis following chemoembolization for hepatocellular carcinoma
Cytolysis following chemoembolization for hepatocellular carcinoma
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DOI：
10.1046/j.1365-2168.1999.01014.x
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发表时间：
1999-02-01
影响因子：
9.6
通讯作者：
Belghiti, J
中科院分区：
文献类型：
--
作者：
Paye, F;Farges, O;Belghiti, J
背景：肝细胞癌（HCC）的脂化化疗栓塞可诱导发烧和细胞溶解，定义为血清肝转氨酶水平升高，这通常被认为是由肿瘤坏死引起的。本研究旨在评估该综合征的原因，回顾术前资料、术中发现、肿瘤坏死和无肿瘤肝脏的状况。方法：对29例肝细胞癌术前行新辅助脂化化疗栓塞的患者进行回顾性研究。在切除的标本中评估肿瘤坏死，并分为四个阶段：没有，50%或更少，50%以上和完全。非肿瘤性肝实质分为纤维化和肝硬化。结果：16例患者化疗栓塞后出现细胞溶解，11例伴有发热。化疗栓塞后伴有或不伴有发热的细胞溶解在有轻微纤维化改变的患者中比在有肝硬化的患者中更容易发生（21例纤维化患者中有14例，4例肝硬化患者中有2例，P < 0.05）。相反，肿瘤坏死的程度与症状的发生无关。结论：HCC化疗栓塞后的发热和细胞溶解不是肿瘤坏死的指征，而是非肿瘤肝损伤的指征。
Background: Lipiodolized chemoembolization of hepatocellular carcinoma (HCC) can induce fever and cytolysis, defined as an increase in serum levels of liver transaminases, which is frequently assumed to result from tumour necrosis. This study aimed to assess the causes of this syndrome, reviewing preoperative data, intraoperative findings, tumour necrosis and the status of non-tumorous liver.Methods: A retrospective study was undertaken of 29 patients treated by neoadjuvant lipiodolized chemoembolization before surgical resection of HCC. Tumour necrosis was assessed in the resected specimen and scored in four stages: absent, 50 per cent or less, more than 50 per cent, and complete. The status of non-tumorous liver parenchyma was classified as either fibrotic or cirrhotic.Results: Cytolysis occurred following chemoembolization in 16 patients and was associated with fever in 11. Postchemoembolization cytolysis with or without fever was more likely to develop in patients with minor fibrotic changes than in those with cirrhosis (14 of 21 with fibrosis versus two of four with cirrhosis, P < 0.05). In contrast, the extent of tumour necrosis did not correlate with the occurrence of symptoms.Conclusion: These results suggest that fever and cytolysis following chemoembolization of HCC are an indication not of tumour necrosis but of injury to the non-tumorous liver.