Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the effi...Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the efficacy and safety of adjuvant transcatheter arterial chemoembolization(TACE)after hepatectomy versus hepatectomy alone in HCC patients with a solitary tumor≥5 cm and MVI.Methods:In this randomized,open-labeled,phase III trial,HCC patients with a solitary tumor≥5 cm and MVI were randomly assigned(1:1)to receive either 1-2 cycles of adjuvant TACE after hepatectomy(Hepatectomy-TACE)or hepatectomy alone(Hepatectomy Alone).The primary endpoint was disease-free survival(DFS);the secondary end-points included overall survival(OS)and adverse events.Results:Between June 1,2009,and December 31,2012,250 patients were enrolled and randomly assigned to the Hepatectomy-TACE group(n=125)or the Hepatectomy Alone group(n=125).Clinicopathological characteristics were balanced between the two groups.The median follow-up time from randomization was 37.5 months[interquartile range 18.3-48.2 months].The median DFS was significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[17.45 months(95%confidence interval[CI]11.99-29.14)vs.9.27 months(95%CI 6.05-13.70),hazard ratio[HR]=0.70(95%CI 0.52-0.95),P=0.020],respectively.The median OS was also significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[44.29 months(95%CI 25.99-62.58)vs.22.37 months(95%CI 10.84-33.91),HR=0.68(95%CI 0.48-0.97),P=0.029].Treatment-related adverse events were more frequently observed in the Hepatectomy-TACE group,although these were generally mild and manageable.The most common grade 3 or 4 adverse events in both groups were neutropenia and liver dysfunction.Conclusion:Hepatectomy followed by adjuvant TACE is an appropriate option after radical resection in HCC patients with solitary tumor≥5 cm and MVI,with acceptable toxicity.展开更多
Gradient cemented carbide is usually employed as the snbstrate for coated carbide insert. In this work, gradient cemented carbide with ultrafine Ti（C0.5,N0.5） was prepared and its microstructure and properties were ...Gradient cemented carbide is usually employed as the snbstrate for coated carbide insert. In this work, gradient cemented carbide with ultrafine Ti（C0.5,N0.5） was prepared and its microstructure and properties were researched. Moreover, this novel substrate was coated to investigate cutting performance. It is found that the average WC grain size in the gradient zone is larger than that in the bulk. Owing to ultrafine Ti（C0.5,N0.5） introduction, gradient cemented carbide prepared by vacuum sintering exhibits full densification. By contrast, the gradient cemented carbide with ultrafine Ti（C0.5,N0.5） shows higher transverse rupture strength （TRS） and hardness than the homogenous one. Gradient cemented carbide suffers small TRS reduction after coating, and the bonding between coatings and gradient substrate is tidy and compact. The coated gradient cemented carbide shows much better endurance and impact resistance than the coated homogenous one. It confirms the superiority of gradient cemented carbide when used as the substrate for coating inserts.展开更多
基金supported by the National Natural Science Foundation of China(No.81172037)Science and Technology Program of Guangdong Province,China(No.2013B021800159)Clinical Trials Project(308 Project)of Sun Yat-sen University Cancer Center(No.308-2015-014).
文摘Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the efficacy and safety of adjuvant transcatheter arterial chemoembolization(TACE)after hepatectomy versus hepatectomy alone in HCC patients with a solitary tumor≥5 cm and MVI.Methods:In this randomized,open-labeled,phase III trial,HCC patients with a solitary tumor≥5 cm and MVI were randomly assigned(1:1)to receive either 1-2 cycles of adjuvant TACE after hepatectomy(Hepatectomy-TACE)or hepatectomy alone(Hepatectomy Alone).The primary endpoint was disease-free survival(DFS);the secondary end-points included overall survival(OS)and adverse events.Results:Between June 1,2009,and December 31,2012,250 patients were enrolled and randomly assigned to the Hepatectomy-TACE group(n=125)or the Hepatectomy Alone group(n=125).Clinicopathological characteristics were balanced between the two groups.The median follow-up time from randomization was 37.5 months[interquartile range 18.3-48.2 months].The median DFS was significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[17.45 months(95%confidence interval[CI]11.99-29.14)vs.9.27 months(95%CI 6.05-13.70),hazard ratio[HR]=0.70(95%CI 0.52-0.95),P=0.020],respectively.The median OS was also significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[44.29 months(95%CI 25.99-62.58)vs.22.37 months(95%CI 10.84-33.91),HR=0.68(95%CI 0.48-0.97),P=0.029].Treatment-related adverse events were more frequently observed in the Hepatectomy-TACE group,although these were generally mild and manageable.The most common grade 3 or 4 adverse events in both groups were neutropenia and liver dysfunction.Conclusion:Hepatectomy followed by adjuvant TACE is an appropriate option after radical resection in HCC patients with solitary tumor≥5 cm and MVI,with acceptable toxicity.
基金financially supported by the National Natural Science Foundation of China(No.51074110)Research Funds for the Central Universities(No.2011SCU11038)the Chengdu Science and Technology Project(Nos.10GGZD080GX-268 and 11DXYB096JH-027)
文摘Gradient cemented carbide is usually employed as the snbstrate for coated carbide insert. In this work, gradient cemented carbide with ultrafine Ti（C0.5,N0.5） was prepared and its microstructure and properties were researched. Moreover, this novel substrate was coated to investigate cutting performance. It is found that the average WC grain size in the gradient zone is larger than that in the bulk. Owing to ultrafine Ti（C0.5,N0.5） introduction, gradient cemented carbide prepared by vacuum sintering exhibits full densification. By contrast, the gradient cemented carbide with ultrafine Ti（C0.5,N0.5） shows higher transverse rupture strength （TRS） and hardness than the homogenous one. Gradient cemented carbide suffers small TRS reduction after coating, and the bonding between coatings and gradient substrate is tidy and compact. The coated gradient cemented carbide shows much better endurance and impact resistance than the coated homogenous one. It confirms the superiority of gradient cemented carbide when used as the substrate for coating inserts.
