Retrospective Study Immune function status of postoperative patients with colon cancer for predicting liver metastasis

BACKGROUND Colon cancer(CC)has a high incidence rate.Radical resection is the main treatment method for CC;however,liver metastasis(LM)often occurs post-surgery.The liver contains both innate and adaptive immune cells that monitor and remove abnormal cells and pathogens.Before LM,tumor cells secrete cytokines and exosomes to adjust the immune microenvironment of the liver,thus forming an inhibitory immune microenvironment for colonization by circulating tumor cells.This indicates that the immune state of patients with CC plays a crucial role in the occurrence and progression of LM.AIM To observe and analyze the relationship between immune status and expression of tumor factors in patients with LM of CC,and to provide a scientific interven-tion method for promoting the patient prognosis.METHODS A retrospective analysis was performed.The baseline data of 100 patients with CC and 100 patients with CC who suffered from postoperative LM and were admitted to our hospital from May 2021 to May 2023 were included in the non-occurrence and occurrence groups,respectively.The immune status of the pa-tients and the expression of tumor factor-related indicators in the two groups were compared,and the predictive value of the indicators for postoperative LM in patients with CC was analyzed.RESULTS Compared with the non-occurrence group,the expression of serum carcinoem-bryonic antigen(CEA),CA19-9,CA242,CA72-4 and CA50 in patients in the occurrence group were significantly higher,while the expression of CD3+,CD4+,CD8+,natural killer(NK)and CD4+/CD25 in patients in the occurrence group were significantly lower(P<0.05).No significant difference was observed in other baseline data between groups(P>0.05).Multivariate logistic regression model analysis revealed that the expressions of CEA,CA19-9,CA242,CA72-4,CA50,CD3+,CD4+,CD8+,NK,and CD4+/CD25 were associated with the LM in patients with CC.High expressions of serum CEA,CA19-9,CA242,CA72-4 and CA50,and low expressions of CD3+,CD4+,CD8+,NK,and CD4+/CD25 in patients with CC were risk factors for LM(OR>1,P<0.05).The receiver operating characteristic curve showed that the area under curve for CEA,CA19-9,CA242,CA72-4,CA50,CD3+,CD4+,CD8+,NK,and CD4+/CD25 in the prediction of LM in patients with CC were all>0.80,with a high predictive value.CONCLUSION The expression of tumor factors and immune state-related indices in patients with CC is closely associated with the occurrence of LM.

Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of colorectal cancer liver metastases

Colorectal cancer(CRC)is a common malignancy of the digestive system.Colorectal liver cancer metastasis(CRLM)occurs in approximately 50%of the patients and is the main cause of CRC mortality.Surgical resection is currently the most effective treatment for CRLM.However,given that the remnant liver volume after resection should be adequate,only a few patients are suitable for radical resection.Since Dr.Hans Schlitt first performed the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for CRLM in 2012,ALPPS has received considerable attention and has continually evolved in recent years.This review explains the technical origin of the ALPPS procedure for CRLM and evaluates its efficacy,pointing to its favorable postoperative outcomes.We also discuss the patient screening strategies and optimization of ALPPS to ensure long-term survival of patients with CRLM in whom surgery cannot be performed.Finally,further directions in both basic and clinical research regarding ALPPS have been proposed.Although ALPPS surgery is a difficult and high-risk technique,it is still worth exploration by experienced surgeons.

Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

AIM: To assess a protocol for treating patients with multiple synchronous colonic cancer liver metastases, which are unresectable in one stage. METHODS: Patients enrolled in the "liver first" protocol presented with colon-only(not rectal) cancer and multiple synchronous hepatic metastases(type Ⅱ or Ⅲ). All patients showed good performance status(ECOG PS 0-1) and were treated with curative intent. Complete oncologic staging including positron emission tomography-computed tomography was performed in order to rule out extrahepatic disease. If bowel obstruction was imminent, an intraluminal colonic stent was placed endoscopically. Subsequently, all patients received standardised neo-adjuvant chemotherapy, that is, FOLFOX or XELOX regimens combined with an antiangiogenic agent(bevacizumab or cetuximab). Provided that a response to chemotherapy was observed, patients underwent either one or two hepatectomies with or without portal vein embolization followed by the indicated colectomy. Further chemotherapy was administered after each procedure. Re-staging was performed after each chemotherapeutic treatment. Disease progression at any stage resulted in discontinuation of the protocol and conversion to palliative disease management.RESULTS: Prospectively recorded data from 11 consecutive patients(8 men) were analysed for this study. Their mean age at the time of their first assessment was 65.7(SD ± 15.3) years. Six(54.6%) patients presented with type Ⅲ metastatic disease. The minimum and maximum follow-up periods were 7.3 and 39.6 mo, respectively. The mean overall survival of all patients was 16.5(95%CI: 10.0-23.2) mo. A colonic stent had to be placed in 5(45.5%) patients due to the onset of an intraluminal obstruction. Four(36.4%) patients succeeded in completing all planned surgical operations. Their mean overall survival was 27.2(95%CI: 15.1-39.3) mo and the mean disease-free survival was 7.7(95%CI: 3.0-12.5) mo. Patients, who were obliged to shift to palliative treatment due to dis-ease progression, had a mean overall survival of 10.5(95%CI: 8.6-12.4) mo. None of these patients underwent palliative colectomy. No postoperative mortality was recorded.CONCLUSION: The implementation of a structured "liver first" approach protocol for the treatment of patients with extensive, liver-limited colon cancer metastatic disease may be beneficial.

Survival analysis of breast cancer liver metastasis treated by hepatectomy: A propensity score analysis for Chinese women in Hong Kong

Background: Survival of patients with breast cancer liver metastasis is very poor. This study aimed to analyze the survival outcome of hepatectomy for this patient population. Methods: From January 1995 to December 2014, 2522 patients with liver cancer received hepatectomy at our hospital. Twenty-one of them, all female, received the operation for breast cancer liver metastasis. Performance was compared with patients with colorectal liver metastasis treated with hepatectomy after propensity score analysis in a ratio of 1:3. Results: Twenty-one patients received hepatectomy for breast cancer. After propensity score matching, 63 patients who had hepatectomy for colorectal cancer were selected for comparison. There was no significant difference in immediate or short-term outcomes between the two groups of patients in terms of operative time, blood loss and surgical morbidities. All patients with breast cancer had R0 resection. No hospital death occurred. After hepatectomy, the 1-, 3- and 5-year overall survival rates were 100.0%, 58.9% and 58.9% respectively in patients with breast cancer. The 1-, 3- and 5-year overall survival rates were 95.0%, 57.2% and 39.7% respectively in patients with colorectal cancer (P = 0.572). On multivariate analysis, triple negative status was the only independent poor prognostic factor in breast cancer liver metastasis (OR = 6.411;95% CI: 1.351–30.435;P = 0.019). Conclusions: Hepatectomy is a safe and effective way of treating breast cancer liver metastasis at experienced centers where multidisciplinary adjuvant treatments are available. It can be considered more frequently as part of the multidisciplinary care for this patient population.

Surgical Treatment of Liver Metastases from Gastric Cancer

Background: Hepatectomy for gastric metastases remains controversial. We aimed at assessing the surgical results, clinicopathological features of gastric cancer liver metastases (GCLM) and prognostic factors. Methods: The outcome of 28 consecutive patients with synchronous (n = 24) or metachronous (n = 4) GCLM was retrospectively analyzed. Curatively, initial hepatectomies such as segmentectomy and hemihepatectomy or non-anatomical limited liver resection less extensive than segmentectomy followed complete primary gastric cancer (GC) resections. Results: Median survival time was 16 months (range, 5 - 66 months). The actuarial overall 12-, 36-, and 60-month survival rates after hepatectomy were 67.8% (n = 19), 39.2% (n = 11), and 28.5% (n = 8), respectively. In multivariate analysis, absent GC serosal invasion-hazard ratio (HR) 1;95% confidence interval (CI) 1.2 - 9.9;P = 0.020;solitary LM-HR 1;95% CI 1.6 - 16.0;P = 0.005, and?curative liver resection with negative resection margin (R0)-HR 1, 95% CI 2.2 - 18.0;P = 0.001 were independent prognostic factors. Conclusions: Surgery of GCLM is a good indication in well-selected patients with an absent serosal invasion of primary tumour, single GCLM and attainment of R0 liver resection. For most GCLM patients, however, there are no other therapeutic modalities. Thus systemic chemotherapy remains the best hope for a longer patient’s survival and an improved individual quality of life.

Preoperative selection of patients with colorectal cancerliver metastasis for hepatic resection

Surgical resection of colorectal liver metastases(CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin(R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis.

Pushing the limits of liver surgery for colorectal liver metastases:Current state and future directions

Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after surgery.Improvements in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.

Borderline resectable for colorectal liver metastases:Present status and future perspective

Surgical resection for colorectal liver metastases(CRLM)may offer the best opportunity to improve prognosis.However,only about 20% of CRLM cases are indicated for resection at the time of diagnosis(initially resectable),and the remaining cases are treated as unresectable(initially unresectable).Thanks to recent remarkable developments in chemotherapy,interventional radiology,and surgical techniques,the resectability of CRLM is expanding.However,some metastases are technically resectable but oncologically questionable for upfront surgery.In pancreatic cancer,such cases are categorized as"borderline resectable",and their definition and treatment strategies are explicit.However,in CRLM,although various poor prognosis factors have been identified in previous reports,no clear definition or treatment strategy for borderline resectable has yet been established.Since the efficacy of hepatectomy for CRLM was reported in the 1970 s,multidisciplinary treatment for unresectable cases has improved resectability and prognosis,and clarifying the definition and treatment strategy of borderline resectable CRLM should yield further improvement in prognosis.This review outlines the present status and the future perspective for borderline resectable CRLM,based on previous studies.

腹腔镜右半结肠切除同期行肝方叶转移癌切除1例

目的分析腹腔镜下同期治疗结肠癌及其肝转移的过程,探讨腹腔镜同期手术在治疗结肠癌肝转移中的作用。方法回顾性分析2023年3月安徽医科大学第一附属医院1例结肠癌伴肝方叶转移患者的临床资料,同期行混合入路腹腔镜右半结肠切除、Glisson蒂横断法肝方叶转移癌切除。结果RO切除右半结肠及肝转移癌,术中出血量约50 mL,第4天拔引流管,无并发症,顺利出院。病理结果:结肠溃疡型低分化腺癌,肠周(12/21)个淋巴结有癌转移,低分化肝转移癌。结论腹腔镜同期行右半结肠切除和肝转移癌切除的治疗安全可行,采用新的手术路径和操作模式可保证手术安全,值得推广。

结肠癌肝转移与肺转移关键基因集筛选及功能分析

目的挖掘结肠癌转移的关键基因及其临床意义。方法基于TCGA和GEO(GSE41258)中的结肠癌数据集,利用WGCNA包和Limma包分析结肠癌转移相关的基因集,并分析基因集对预后及肿瘤临床分其的影响。随后利用Metascape构建每一个关键基因的蛋白互作网络,并利用DAVID根据蛋白互作网络进行功能富集分析。最后,利用TIDE数据库,从免疫角度分析关键基因对细胞毒性T细胞的免疫浸润以及免疫应答的影响。结果本研究筛选出了CNN1、CXCL10、CXCL11、MGP、SPINK4和PBK 6个关键基因,不仅影响患者预后,同时与结肠癌的肿瘤分期呈现线性关系。通过KEGG与GO富集发现结肠癌肝转移关键基因网络调控细胞因子功能、中心粒细胞驱化以及单核细胞驱化等免疫过程,而在结肠癌肺转移关键基因网络调控RAS信号通路,这些结果揭示了结肠癌不同转移途径的机制差异。其中,CNN1、MGP抑制细胞毒性T细胞的免疫应答,PBK促进细胞毒性T细胞的免疫应答。结论CNN1、CXCL10、CXCL11、MGP、SPINK4和PBK 6个基因可以作为结肠癌转移的筛查分子标志物,并在结肠癌的免疫治疗中发挥作用,为潜在的结肠癌的治疗靶标。

调脾安肠方对裸鼠结肠癌肝转移灶miR-34a-5p、Notch1/NF-κB表达的影响

目的探讨调脾安肠方对裸鼠结肠癌肝转移(colorectal cancer liver metastasis,CLM)灶组织中MicroRNA-34a-5p(miR-34a-5p)及其靶基因Notch1/核转录因子-κB(nuclear factor-kappa B,NF-κB)通路表达的影响。方法选取30只雄性Balb/c裸鼠随机分为空白组、模型组、中药组,每组10只。脾脏原位注射HCT-116人结肠癌细胞(细胞数约为1×107个/mL)法构建CLM模型。中药组在CLM造模完成2周后开始调脾安肠方(2 g/mL,每日0.2 mL)灌胃2周,空白组和模型组同期予等体积0.9%生理盐水灌胃。苏木素—伊红染色观察肝转移灶病理组织形态;蛋白免疫印迹法测定肝转移灶Notch1、NF-κB p65蛋白水平;实时荧光定量PCR测定肝转移灶miR-34a-5p及Notch1、NF-κB p65 mRNA水平。结果与模型组比较,中药组裸鼠镜下病理转移灶面积明显减小,核分裂像减少,提示调脾安肠方抑制了结直肠癌细胞在肝脏的定植和迁移。与空白组比较,模型组肝转移灶中miR-34a-5p含量显著降低(P<0.01),Notch1、NF-κB p65蛋白表达升高(均P<0.05),Notch1、NF-κB p65的mRNA表达显著升高(均P<0.01)。与模型组比较,中药组Notch1蛋白及mRNA表达降低(P<0.05),NF-κB p65的mRNA表达显著降低(P<0.01)。miR-34a-5p与Notch1 mRNA在结肠癌肝转移灶组织中表达水平呈负相关(r^(2)=0.8845,P<0.05),Notch1与NF-κB p65在结肠癌肝转移灶组织中mRNA表达水平呈显著正相关(r^(2)=0.9291,P<0.01)。结论中药复方调脾安肠方能抑制裸鼠结肠癌肝转移灶形成,其机制可能与通过抑癌基因miR-34a-5p靶向负性调节Notch1/NF-κB通路表达有关。

Unexplained liver laceration after metastasis radiofrequency ablation

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the f irst. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.

原发性肝癌术后复发再次肝切除的疗效分析

目的 验证再次肝切除术在原发性肝癌(简称肝癌)术后复发患者中的有效性,并探究影响术后疗效的因素。方法 回顾性收集2008年1月至2019年6月北京大学人民医院肝胆外科因初次肝切除术后肝癌复发而再次行肝切除术的肝癌患者(再次肝切除组,n=50)的临床资料,并收集同期因肝癌术后复发行射频消融治疗(消融组,n=48)、同期行初次肝切除术治疗(初次肝切除组,n=50)且一般资料相近的肝癌患者作为对照,探究再次肝切除术的有效性及安全性;并通过Cox多因素分析探究再次肝切除术后患者预后的影响因素。结果 与初次肝切除组比较,再次肝切除组无瘤生存时间(18.5个月vs 24.1个月,χ^(2)=0.111,P=0.560)差异无统计学意义。但与消融组比较,再次肝切除组的无瘤生存时间(18.5个月vs14.2个月,χ^(2)=4.403,P=0.040)及总体生存时间(25.8个月vs 21.2个月,χ^(2)=4.487,P=0.032)均更长。单因素分析结果显示肿瘤复发时间(P=0.021)、有无卫星灶(P=0.022)、微血管侵犯(P=0.033)及肿瘤分化程度(P=0.039)是再次肝切除患者无瘤生存时间的影响因素,而Child-Pugh分级(P=0.030)、肿瘤复发时间(P=0.032)、微血管侵犯(P=0.021)是再次肝切除患者总体生存时间的影响因素。Cox多因素分析显示,肿瘤复发时间(P=0.012)、微血管侵犯(P=0.046)及卫星灶(P=0.050)是再次肝切除患者无瘤生存时间的独立危险因素,Child-Pugh分级(P=0.015)和肿瘤复发时间(P=0.015)是再次肝切除患者总体生存时间的独立危险因素。结论 肝癌术后复发再次肝切除术的有效性与首次肝切除术相仿,能够改善肝癌复发患者的预后;而肿瘤复发时间、微血管侵犯及卫星灶是再次肝切除患者无瘤生存时间的独立预测因素,ChildPugh分级和肿瘤复发时间是再次肝切除患者总体生存时间的独立预测因素。

初始可切除结直肠癌肝转移术后辅助化疗的研究进展

结直肠癌是目前全球第三大常见的恶性肿瘤,大约有50%的患者在病程中发生肝转移。结直肠癌肝转移(CRLM)分为初始可切除和不可切除。肝切除术目前被认为是治疗CRLM唯一潜在的治愈方法,患者5年生存率约为37%~40%。但肝切除术后这部分患者仍然存在较高的复发风险,因此选择合适的辅助治疗尤为重要。目前CRLM患者术后辅助化疗存在争议,以往前瞻性临床研究发现术后辅助化疗能延长无进展生存时间,但无法改善总生存时间。最近部分研究在化疗基础上联合靶向药物或肝动脉灌注化疗(HAIC)等应用于术后CRLM患者,以期获得更好的疗效。本文就可切除CRLM术后辅助化疗的应用现状及研究进展作一综述。

胃癌同时性肝转移肝切除的疗效及预后分析

背景与目的:胃癌同时性肝转移(gastric cancer with synchronous liver metastases,GCLM)患者是否接受肝切除仍存在争议。本研究通过分析GCLM患者的临床病理学特征及治疗方式,探究其与患者预后的关系,希望为该病的临床治疗及预后评价提供参考依据。方法:回顾性分析2006年3月—2018年8月复旦大学附属肿瘤医院收治的经术后病理学检查诊断为胃腺癌,影像学检查提示伴有肝转移的患者资料,包括性别、年龄、原发灶大小、部位、浸润深度、淋巴结转移、分化程度、肝转移灶大小、分布、数目、治疗方法及甲胎蛋白(alpha fetoprotein,AFP)、癌胚抗原(carcinoembryonic antigen,CEA)等肿瘤标志物水平,并进行随访。采用Kaplan-Meier生存曲线分析患者的总生存期(overallsurvival,OS),用log-rank检验进行单因素分析,COX回归模型进行多因素分析,探究影响GCLM患者生存的独立预后因素,通过亚组分析筛选最佳的肝切除对象。结果:79例纳入本研究的GCLM患者的中位发病年龄为63岁,男女比例为5.58∶1.00。中位OS为11个月,1、3和5年OS率分别为46.0%、23.3%和6.9%。单因素分析结果显示,影响OS的因素包括胃原发灶大小、分化程度、肝转移灶的分布、确诊时血清AFP水平及肝切除。多因素分析结果显示,影响OS的独立危险因素为双叶肝转移(HR=37.253,P=0.008),保护因素为肝切除(HR=0.149,P=0.044)。进一步亚组分析显示,对转移灶最大直径≤3cm、单发肝转移灶、单叶转移、确诊时血清AFP及CEA水平正常者,肝切除有可能改善其OS。结论:回顾性研究表明肝切除有可能改善部分GCLM患者的预后。

Renewed considerations on the utility(or the futility)of hepatic resections for breast cancer liver metastases

Importance:Indication for liver resection(LR)for localized hepatic metastases from breast cancer(BC)is still a matter of debate.Objective:A literature review of recent scientific papers pertaining to hepatectomies for BC liver metastases(LM).Evidence Review:We based our systematic review on case series on literature reviews,comparative studies and cost-utility analysis which have been selected based on criteria regarding surgery,possible prognostic factors and evaluation of long-term survival.Findings:There is a strong inhomogeneity in the reported data,with 5-year survivals ranging from 21%to 58%.There is no agreement in the evaluation of prognostic variables predicting good survival,with the only exception of the time of treatment of the primary BC until the diagnosis of metastases.Three out of the four comparative studies report better survivals for patients who underwent a hepatectomy in comparison to those treated with chemotherapy alone,but their strength in terms of scientific evidence is weak.The only cost-utility analysis revealed that 2 out of the 3 scenarios considered were in favor of the treatment with surgery followed by conventional chemotherapy.Conclusions:There is no definitive proof on the effectiveness of LRs for BC LM.Surgery can be proposed when it is possible to perform radical surgery,with R0 margins and saving at least 30%of the liver with its vascular and biliary connections.Stable skeletal metastases are not a contraindication.The interval between treatment of the primary location and diagnosis of hepatic metastases is the only prognosis criteria available.

脾切除法建立人结肠癌细胞肝转移模型及对肝转移的评估

目的：建立类似临床大肠癌根治术后肝转移动物模型，并建立精确评估肝转移的方法。方法：在裸鼠脾内注入人结肠癌细胞5min后切除脾脏。术后第30天对裸鼠行病理检查并测定肝转移DNA含量。结果：发现肝转移率为100％，肝外其它脏器未见转移结节,组织学证实肝转移结节为低分化腺癌。脾内注入105癌细胞、脾切除组肝转移癌DNA的含量比脾内注入106癌细胞、脾切除组肝转移癌DNA的含量低61.4％。结论：本实验方法建立的模型能很好地模拟临床上大肠癌根治术后肝转移征象，肝转移DNA含量的测定具有准确、可靠的优点。

乳腺癌肝转移的不同治疗方法比较

目的比较手术治疗、全身化疗、全身化疗联合肝动脉化疗栓塞对乳腺癌肝转移的疗效。方法回顾性分析1996年1月至2008年10月52例乳腺癌肝转移临床资料，根据治疗方法分为手术组（12例）和单纯全身化疗组（22例）和全身化疗联合肝动脉化疗栓塞组（18例），分析3组的疗效及预后，比较不同治疗方法的疗效。结果52例乳腺癌术后肝转移患者，全组治疗有效27例（51．9％），手术组有效4例（33．3％），单纯全身化疗组有效11例（50．0％），全身化疗联合肝动脉化疗栓塞组有效12例（66．6％）。1、2．3年生存率手术治疗组分别为25．0％（3例）、8．3％（11例）、0，单纯全身化疗组分别为31．8％（7例）、13．6％（3例）、9．1％（2例），全身化疗联合肝动脉化疗栓塞组分别为44．4％（8例）、33．3％（6例）、11．1％（2例），全身化疗联合肝动脉化疗栓塞组生存率明显优于手术治疗组和单纯全身化疗组（P〈0．05）。结论采用全身化疗联合肝动脉化疗栓塞治疗乳腺癌术后肝转移疗效较好，值得临床进一步推广。

分期手术联合射频消融和化疗栓塞治疗结肠癌肝转移12例

目的探讨分期手术联合射频消融、肝动脉化疗栓塞治疗结肠癌术后双叶肝转移的临床价值。方法 2004年12月—2007年12月我科选择性接收并采取分期手术治疗结肠癌术后双叶肝转移患者12例。Ⅰ期手术,结扎横断大多数结肠癌转移灶隶属肝叶的门静脉Ⅰ级分枝(左:右=1:11),射频消融残余肝叶内转移灶,并经胃十二指肠动脉植入肝动脉化疗泵;术后通过化疗泵行3个疗程化疗栓塞。Ⅱ期手术,全部化疗疗程结束后4周行半肝切除术。随访30月,记录术后并发症、化疗客观疗效和毒副作用、残余肝和肝外发现转移瘤时间以及实际生存时间。结果围术期内患者无死亡和肝功能衰竭,呼吸道感染/尿道感染/切口感染(2/2/2,例)是主要的术后早期并发症。患者化疗后无CR,PR 83.3%(10/12),主要不良反应为白细胞减少/血小板减少/贫血(6/3/3,例次)。2例患者术后10月残余肝内发现转移灶(超声引导下射频消融),4例患者术后17月发现肝外转移(肺2例,骨2例;立体定向R-刀治疗)。1、2年总体实际生存率分别为100%和75%,中位生存期26个月。结论分期手术联合射频消融、肝动脉化疗栓塞治疗部分结肠癌术后双叶肝转移患者近期疗效满意,不良反应可耐受,且能增加患者肝转移癌切除率、提高生活质量和生存期,是治疗结肠癌术后双叶肝转移的较好模式之一。

γ-干扰素基因治疗大肠癌及其肝转移的实验研究

目的:探讨利用γ鄄干扰素(IFN鄄γ)基因治疗对大肠癌及肝转移的预防和治疗作用,并初步探讨其作用机制。方法:利用BALB/C小鼠成瘤的小鼠结肠癌CT26细胞株制备小鼠结肠癌腹腔转移瘤模型,用携带鼠IFN鄄γ基因的重组缺陷型腺病毒AdIFN鄄γ进行治疗,同时利用携带LacZ基因的腺病毒AdLacZ和PBS作空白对照,检测经基因治疗后小鼠体内IFN鄄γ基因的表达情况、脾脏的细胞毒性T淋巴细胞(CTL)活性变化、肿瘤局部的淋巴细胞浸润情况、肝转移的发生及荷瘤小鼠的生存期。结果:经IFN鄄γ基因治疗后,与对照组相比,治疗组小鼠血清中IFN鄄γ表达量明显增加(P<0.01),脾脏的CTL活性明显增强(P<0.01),肿瘤生长受到抑制,肝转移的发生率明显下降,荷瘤小鼠的存活期明显延长。结论:利用IFN鄄γ基因治疗大肠癌具有明显的疗效,并对大肠癌肝转移具有一定的预防和治疗作用。