Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective:To evaluate vascular endothelial growth factor(VEGF)levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization(TACE)and percutaneous ethanol injection(PEI)and its relation to treatment response.Methods:A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically.Twenty patients were suitable to be treated by TACE,while other 20patients were treated with PEI.Serum VEGF levels were measured before and 1 month after each procedure by ELISA.Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound.Results:There was no significant difference between TACE and PEI groups with regard to age,sex,tumor size,response to local therapy,or VEGF and alpha-fetoprotein before and after therapy.VEGF levels after TACE were significantly higher than before TACE[(298.1±123.6)pg/m L vs.(205.8±307.3)pg/m L;P=0.001].Also,VEGF levels were significantly higher after PEI than before PEI[(333.8±365.6)pg/m L vs.(245.3±301.8)pg/m L;P=0.000].Non-responders of both groups had significantly high VEGF levels than responder's,both before[(985.0±113.2)pg/m L vs.(117.1±75.3)pg/m L;P<0.001]and after therapy[(1 330.6±495.7)pg/m L vs.(171.0±94.7)pg/m L;P=0.000)].Conclusions:Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients.Higher levels of VEGF before and after therapy were found in non-responders,suggesting that VEGF is a useful marker in predicting treatment response.

Relationship between survivin expression and recurrence,and prognosis in hepatocellular carcinoma

AIM： To study the expression of the inhibitor of apoptosis protein survivin in hepatocellular carcinoma （HCC）, and its correlation with clinicopathological factors, cell proliferation, recurrence and prognosis after hepatectomy. METHODS： Immunohistochemical staining of survivin and Ki-67 was performed by the standard streptavidin- peroxidase technique on paraffin sections of 55 cases of HCC. RESULTS： The positive rate of survivin in HCC was 52.7% （29/55）. Significant correlation was found between survivin expression with portal vein thrombi and intrahepatic matastasistic nodes （P 〈 0.05）. The recurrent rate in survivin-positive HCC was significantly higher than that in survivin-negative HCC after hepatectomy, the 1- and 3-year survival rate in patients with survivin-positive tumors was significantly lower than that in patients with survivin-negative tumors （58.62 and 10.34% vs 76.92 and 30.77%, P 〈 0.05, log-rank test）. The proliferation index （Ki-67） in survivin-positive HCC （33.83% ± 18.90%） was significantly higher than that in survivin-negative HCC （19.60% ± 19.35%） （P 〈 0.05）. CONCLUSION： Survivin may play an important role in progression of HCC by promoting cell proliferation, and may be positively correlated with high risk of disease recurrence and poor prognosis in HCC. Its expression may serve as a prognostic factor for patients with HCC after hepatectomy.

Meta-analysis on Radiofrequency Ablation in Combination with Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease （PD） rate （OR=0.15, 95% CI=0.05M3.43, P=-0.0005）. The rate of AFP reduc- ing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group （OR=4.62, 95% CI 2.56-8.34, P〈0.00001）. The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients＇ overall survival rate, tumor ne- crosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

Capability of multidetector CT to diagnose hepatocellular carcinoma-associated arterioportal shunt

AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Fortyone severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.

The Comparative Study on Ultrastructure and Immunohistochemistry in AFP Negative and Positive Hepatocellular Carcinoma

Summary: To comparatively investigate ultrastructural characteristics and expressions of AFP (alpha-fetoprotein) and Tn (Thomsen-Friedenreich-related antigen) protein in AFP negative (AFP-) and AFP positive (AFP+) primary hepatocellular carcinoma. Fourty-three cases of AFP-and AFP+ hepatocellular carcinoma (HCC) tissues and five cases of normal liver tissues were divided into three groups: control group (normal liver tissue, n=5); AFP+ HCC group (the serum AFP level was higher than 10 ng/ml, n = 22); AFP-HCC group (the serum AFP level was lower than 10 ng/ml, n=21). The ultrastructural morphology was studied by transmission electron microscopy, the expressions of AFP and Tn protein were detected by immunohistochemistry and cell image analysis. 1. The immunohistochemical study showed that (1) the expression intensity and positive rate of Tn protein in AFP-HCC group were markedly higher than that in AFP+ HCC group (P<~0.01); (2) The expression intensity of AFP in AFP-HCC group was lower than that in AFP+ HCC group (P<0.01). 2. The transmission electron microscopy demonstrated that some AFP-HCC cells linked closely with each other, others dispersed loosely just as cultured cells, the remarkable morphologic features in AFP-HCC cells were simple organelles, but they were abundant in the free polyribosomes. In AFP+ HCC group, all the HCC cells linked closely together and were rich organelles in their cytoplasm, especially the rough endoplasmic reticula. In addition, mitochondria and Golgi complex were obviously observed. (1) The AFP and Tn protein had discrepancy distribution in AFP-and AFP+ HCC tissues, Tn protein may be one of the early diagnostic indicators in AFP-HCC; (2) The synthetic locations of the AFP and Tn protein were different in hepatocarcinoma cells by ultrastructural observation.

Metastasis of hepatocellular carcinoma to the small bowel manifested by intussusception

Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.

Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma

Hepatocellular carcinoma （HCC） metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facial swelling and episodes of bleeding developed recently and biopsy revealed a metastatic HCC. Computer tomography showed a large tumor in parapharyngeal space with evident mandibular ramus destruction. Bleeding occurred from the metastatic tumor but could not be controlled by electrocauterization, SurgicelTM, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy （2400 cGy in 6 fractions） was tried and the intractable bleeding was successfully stopped after the radiotherapy. Because of the hypervascular and osteolytic nature of the solitary mandibular metastatic lesion, the bleeding was troublesome. Radiotherapy provided successful control of intractable bleeding from the metastatic tumor.

Effects of antiviral therapy on preventing liver tumorigenesis and hepatocellular carcinoma recurrence

Chronic hepatitis B virus(HBV)infection is the key driving force of liver disease progression,resulting in the development of hepatic dysfunction,cirrhosis and hepatocellular carcinoma(HCC).The primary aim of therapy is to suppress or eliminate HBV replication to reduce the activity of hepatitis,thus reducing the risk of,or slowing the progression of,liver disease.Nucleos(t)ide analogues(Nucs)may result in rapid suppression of HBV replication with normalization of serum transaminases and restore liver function,thus increasing survival in patients with hepatic decompensation.Long-term Nuc therapy may result in histological improvement or reversal of advanced fibrosis and reduction in disease progression,including the development of HCC.The long-term benefits of a finite course of interferon(IFN)-αtherapy also include a sustained and cumulative response,as well as hepatitis B surface antigen seroclearance and reduction in the development of cirrhosis and/or HCC.Pegylated IFN and newer Nucs may achieve better long-term outcomes because of improved efficacy and a low risk of drug resistance.However,treatment outcomes are still far from satisfactory.Understanding the effects of anti-HBV treatment against HCC incidence and recurrence after hepatectomy or liver transplantation is required for further improvement of outcome.

A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma

Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。

基于整合药理学和转录组学的肝细胞癌和胆管癌共同差异miRNA调控网络构建及相关中药预测分析

目的:利用整合药理学和转录组学方法,构建肝细胞癌与胆管癌共同差异微RNA(miRNA)调控网络,并对关键靶点进行中药预测分析。方法:从GEO数据库获取肝细胞癌、胆管癌芯片数据集,借助在线分析工具GEO_(2)R分析出差异表达miRNA(DEMs)并对其取交集,得到共同DEMs,分别运用FunRich和miRNet软件预测上游转录因子及下游靶基因,并利用DAVID数据库对靶基因进行基因本体(GO)功能富集分析和京都基因与基因组百科全书(KEGG)通路富集分析。借助STRING数据库和Cytoscape 3.9.1软件筛选关键基因(hubGenes)并构建miRNA-hubGenes网络。运用UALCAN、Kaplan Meier-plotter和Coremin Medical数据库对关键基因进行差异表达、总体生存率及相关中药预测分析。结果:肝细胞癌筛选出14个DEMs,胆管癌筛选出104个DEMs, miR-199a-5p为两者共同DEMs,涉及28个上调转录因子,166个下游靶基因;富集分析结果显示,这些靶基因参与肿瘤细胞凋亡、增殖、间质转变和迁移等生物过程,主要通过癌症通路、FoxO信号通路、丝裂原激活的蛋白激酶信号通路以及磷脂酰肌醇3激酶-蛋白激酶B信号通路发挥作用;核心靶点关联中药性味偏微寒,主归肝经,关联最为密切的中药为丹参。结论:miR-199a-5p是肝细胞癌与胆管癌之间重要调控miRNA,丹参干预关键基因出现频次较多,与研究报道基本相符,可为后续肝胆癌机制研究和临床应用提供依据与参考。

肝动脉化疗栓塞联合仑伐替尼治疗局部晚期肝细胞癌的临床效果

目的观察肝动脉化疗栓塞术(TACE)联合甲磺酸仑伐替尼胶囊靶向治疗局部晚期肝细胞癌(HCC)患者的临床效果和药物不良反应。方法选择2021年1月至2022年10月在河南大学第一附属医院肿瘤科确诊的78例局部晚期HCC患者,根据随机数表法分为治疗组和对照组,每组39例。给予对照组TACE治疗,给予治疗组甲磺酸仑伐替尼胶囊联合TACE治疗。观察两组客观缓解率(ORR)、疾病控制率(DCR)以及中位总生存期(OS)、中位无进展生存期(PFS),比较两组异常凝血酶原(DCP)、高尔基体蛋白73(GP73)和甲胎蛋白(AFP)表达水平。结果治疗组ORR、DCR分别为56.41%、74.36%,高于对照组的33.33%、46.15%(P<0.05)。治疗组血清DCP、GP73和AFP表达水平低于对照组(P<0.05)。治疗组高血压、疲乏、关节肌肉痛和蛋白尿发生率高于对照组(P<0.05)。治疗组中位PFS和中位OS分别为11.6、18.5个月,长于对照组的7.2、13.8个月(P<0.05)。结论TACE联合甲磺酸仑伐替尼胶囊在不可手术切除的局部晚期HCC患者中临床疗效可靠,可延长患者生存时间,不良反应可控可耐受,且可降低血清DCP、GP73和AFP表达水平,为临床治疗提供新的选择。

鳖甲煎丸对肝细胞癌中Wnt/β-catenin信号通路及抑制基因DKK-1、FrpHe表达的影响

目的通过研究鳖甲煎丸对肝细胞癌中Wnt信号通路及抑制基因DKK-1、FrpHe表达的影响,探讨其抗肝细胞癌转移侵袭的作用机制与Wnt/β-catenin信号通路的关系。方法 24只Wistar大鼠随机分为3组(8只/组),分别以临床剂量的20倍、10倍的鳖甲煎丸和生理盐水灌胃3 d,3 d后采血,离心,获取血清。分别将3组血清加入DMEM培养液中培养肝癌细胞HepG2,48 h后采用流式细胞术检测细胞中的β-catenin蛋白含量,qRT-PCR法检测DKK-1、FrpHe基因的表达情况,以进一步阐明药物的作用机制与Wnt/β-catenin信号通路的关系。结果流式细胞术结果:高剂量组和中剂量组含药血清均可显著降低细胞中β-catenin蛋白表达,且该作用与药物浓度有关。RT-PCR结果:高剂量组和中剂量组含药血清均可显著下调DKK-1基因的表达,且该作用与药物浓度有关。而高剂量组和中剂量组含药血清对FrpHe基因的表达影响不明显。结论鳖甲煎丸能显著抑制肝细胞癌的生长、粘附和转移,且这种抑制作用与显著降低肝癌细胞中β-catenin蛋白表达、显著下调DKK-1基因的表达,从而阻断Wnt/β-catenin信号通路有关。

原发性肝癌伴动静脉瘘介入栓塞治疗62例回顾性分析

目的：回顾性分析原发性肝癌合并动静脉瘘（AVS）的介入栓塞治疗疗效。分析影响其疗效的相关因素。方法回顾性分析62例原发性肝癌合并动静脉瘘的介入栓塞治疗的临床资料，根据血管造影明确AVS的类型、程度后，按不同方式进行堵瘘及肿瘤化疗栓塞治疗。再次造影评价瘘口封堵的疗效，单因素和多因素分析影响栓塞疗效的相关因素。结果62例患者中肝动脉-门静脉瘘44例，肝动-静脉瘘11例，肝动脉-门脉瘘合并肝动-静脉瘘4例，肝动脉-肺动脉瘘3例。53例患者1-2个月后DSA复查发现动静脉瘘消失18例，分流量明显减轻19例，稳定9例，进展7例。单因素分析发现栓塞材料和门静脉癌栓可影响肝动脉-门脉瘘介入栓塞的疗效，而多因素回归分析显示门静脉癌栓是独立危险因素。采用PVA颗粒和碘油无水乙醇混悬液栓塞疗效优于明胶海绵。结论肝癌合并肝动-静脉瘘的介入栓塞治疗应根据动静脉瘘的类型、程度等采用个体化治疗策略，栓塞材料亦在一定程度上影响瘘的再通。

碘[^(131)I]-美妥昔单抗注射液的人体药代动力学研究

研究碘[131I]-美妥昔单抗注射液的人体药代动力学特征,为临床给药方案及临床应用提供依据。将按纳入标准、排除标准和剔除标准选择的患原发性肝细胞肝癌受试者24例平均分为低、中、高剂量组,各组每位受试者经插管注入相应的注射液,分别在不同时刻采集静脉血及收集尿液,测定样品的放射性计数率(min-1);采用纸层析确定各血样血清中药物的比例,依此校正各血样中药物的放射性计数率;用DASver1.0(Drug And Statistics for Windows)药代动力学程序拟合、计算血液药代动力学参数;鉴定尿液中放射性物质的组成,计算各时间段尿液放射性占注入剂量的百分率(%ID),以分析注射液在尿液的清除动力学特点。研究表明:该注射液血液药代动力学符合动力学二室模型,其在人体内分解代谢产物主要以游离131I的形式通过肾脏排泄,注入后120h内排出尿液的放射性占注入剂量的47.70%~51.16%。因此,该注射液的药代动力学特征满足临床要求,推荐临床的给药剂量为每kg人体27.75MBq注射液。

TACE联合分子靶向药索拉菲尼治疗晚期肝癌远期疗效观察

目的评价经肝动脉灌注化疗栓塞术(TACE)联合分子靶向药物甲磺酸索拉菲尼治疗晚期肝细胞肝癌(HCC)的临床疗效和不良反应。方法 2007年6月至2009年5月,江苏省肿瘤医院介入科收治的30例晚期HCC患者,采用经TACE或单纯动脉灌注化疗,术中用药为氟脲苷1.0 g,羟基喜树碱20 mg,吡柔比星30 mg,碘油栓塞肿瘤供血动脉。口服甲磺酸索拉菲尼,起始剂量400 mg,每日2次,治疗过程中根据不良反应情况调整用量。每6～8周复查1次,评价肝功能,治疗效果(CT复查、术中DSA等)和不良反应。用SPSS13.0软件统计计算中位生存时间,平均生存时间和无疾病进展时间。结果至2009年12月,30例患者均达到临床评价要求,无中途停药。口服索拉菲尼相关不良反应发生率83.3%。主要不良反应为手足皮肤反应、腹泻和高血压。无疾病进展期内DSA术中造影可见肿瘤血管较服药前稀疏,纤细。经统计学分析,中位生存期38周,平均生存期41周,无疾病进展时间18周。结论晚期肝癌,经TACE术联合索拉菲尼口服治疗无严重不良反应发生。

肝癌放疗前后血浆VEGF表达的临床意义

目的观察肝癌患者放疗前后血浆血管内皮生长因子(VEGF)水平与疗效之间的关系。方法用ELISA法检测42例非手术肝癌患者放疗前1d、放疗开始后7d及1个月时血浆VEGF含量。按近期疗效分为有效组与无效组,按治疗前VEGF含量分为高水平组与低水平组,分析近期疗效、无疾病进展时间及1年生存率与VEGF之间的关系。结果近期有效率(CR+PR)为71.4%,无效率(NC+PD)为28.6%。有效组放疗前后血浆VEGF水平均低于无效组,差异有统计学意义(P=0.000)。治疗前高、低水平组无疾病进展时间分别为3.1、6.9个月,差异有统计学意义(P=0.000),1年生存率分别为42.9%、76.2%,差异有统计学意义(P=0.000)。结论肝癌患者血浆VEGF水平可作为放疗效果预测指标。

动脉灌注p53基因治疗晚期肝癌的初步临床应用

目的初步观察动脉灌注p53基因治疗晚期肝癌的疗效。方法晚期肝癌30例,治疗组14例,对照组16例。根据造影表现决定灌注药物的靶动脉,治疗组在靶动脉注入p53基因,每次用10^(12)VP,加羟基喜树碱20 mg,每周1次,连用3周为1疗程,14例患者分别接受1～4疗程的治疗。对照组给予羟基喜树碱20 mg肝动脉灌注。结果治疗组生存期最小14 d,最长405 d,平均238．1 d。对照组生存期最小18 d,最长167 d,平均80．7 d。两者相比较,P＜0．05,有显著差异。结论p53基因治疗晚期肝癌有效。

TACE联合索拉非尼治疗中晚期肝细胞肝癌的初步观察

目的:观察经导管肝动脉化疗栓塞(TACE)联合索拉非尼治疗中晚期肝细胞肝癌(HCC)的初步疗效和毒性反应。方法:选取病理证实或临床诊断及符合受试标准的中晚期HCC患者17例,行TACE治疗,术后口服索拉非尼,400mg/次,每日2次,每4～6周根据REC IST标准进行肿瘤应答的评价,并记录不良反应的发生情况。结果:近期疗效无部分缓解病例,进行独立评价的12例患者中,共10例获得疾病稳定。观察时间内的患者总体存活率为76.5%。17例患者中不良反应发生率为82.3%,经相应处理后绝大多数获得明显缓解。结论:TACE联合索拉非尼治疗中晚期HCC患者有可能获得较长的生存时间和疾病稳定状态,安全性好,值得扩大病例进一步观察。

高强度聚焦超声对中晚期肝癌患者机体免疫细胞及其活性的影响

目的观察高强度聚焦超声(HIFU)对中晚期肝癌患者的机体免疫细胞及其活性的影响。方法HCC患者30例,经全身麻醉、超声肿瘤定位进行HIFU治疗,采用流式细胞仪及双抗体夹心法检测治疗前、后外周血T细胞亚群(CD3+、CD4+、CD8+)、NK细胞的百分率及sIL-2R的变化。采用LDH释放法检测NK细胞的杀伤活性。结果HIFU治疗后CD3+、NK细胞的百分率明显升高(P<0.05),NK细胞杀伤活性也升高(P<0.05),而CD8+细胞的百分率及sIL-2R的水平明显降低(P<0.05)。结论HIFU具有激活机体免疫细胞活性作用,可使机体的免疫功能得到一定程度的改善。