Survival rates according to barcelona clinic liver cancer sub-staging system after transarterial embolization for intermediate hepatocellular carcinoma

AIM: To investigate the survival rates after transarterial embolization(TAE).METHODS: One hundred third six hepatocellular carcinoma(HCC) patients [90 barcelona clinic liver cancer(BCLC) B] were submitted to TAE between August 2008 and December 2013 in a single center were retrospectively studied. TAE was performed via superselective catheterization followed by embolization with polyvinyl alcohol or microspheres. The date of the first embolization until death or the last follow-up date was used for the assessment of survival. The survival rates were calculated using the Kaplan-Meier method, and the groups were compared using the log-rank test.RESULTS: The overall mean survival was 35.8 mo(95%CI: 25.1-52.0). The survival rates of the BCLC A patients(33.7%) were 98.9%, 79.0% and 58.0% at 12, 24 and 36 mo, respectively, and the mean survival was 38.1 mo(95%CI: 27.5-52.0). The survival rates of the BCLC B patients(66.2%) were 89.0%, 69.0% and 49.5% at 12, 24 and 36 mo, respectively, and the mean survival was 29.0 mo(95%CI: 17.2-34). The survival rates according to the BCLC B sub-staging showed significant differences between the groups, with mean survival rates in the B1, B2, B3 and B4 groups of 33.5 mo(95%CI: 32.8-34.3), 28.6 mo(95%CI: 27.5-29.8), 19.0 mo(95%CI: 17.2-20.9) and 13 mo, respectively(P = 0.013).CONCLUSION : The BCLC sub-stagingsystem could add additional prognosis information for postembolization survival rates in HCC patients.

Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

AIM:To study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.METHODS:Fifteen consecutive patients with hypersplenism due to cirrhosis were enrolled in this study from January 2006 to June 2010.All patients underwent total embolization of the main splenic artery.Clinical symptoms,white blood cell(WBC) and platelet(PLT) counts,splenic volume,and complications of the patients were recorded.The patients were followed up for 1 and 6 mo,and 1,2,3 years,respectively,after operation.RESULTS:Total embolization of the main splenic artery was technically successful in all patients.Minor complications occurred in 13 patients after the procedure,but no major complications were found.The WBC andPLT counts were significantly higher and the residual splenic volume was significantly lower 1 and 6 mo,and 1,2,3 years after the procedure than before the procedure(P < 0.01).Moreover,the residual splenic volume increased very slowly with the time after embolization.All patients were alive during the follow-up period.CONCLUSION:Total embolization of the main splenic artery is a safe and feasible procedure and may serve as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.

The Efficacy of Different Interventiona|Che moembolization Regiments Combined with Radiofrequency Ablation in the Treatment of Primary Liver Cancer and its Effects on Patients’Immune Function

Objective:To study and compare the clinical effects of the combination of different interventional embolization chemotherapy and radiofrequency ablation in patients with primary liver cancer.Methods:In this paper,based on the target data validation of those 60 patients with primary liver cancer treated in the hospital during the period from May 2017 to May 2018,the double-blind method was used for the comparison between groups.Patients in the reference group were treated with the combination of cisplatinum interventional chemoembolization regimen and radiofrequency ablation,while those in the experimental group were treated with the combination of lobaplatin interventional chemoembolization regimen and radiofrequency ablation.Then,the efficacy of both groups was compared.Results:After the treatment,the clinically effective total value,the calculation value of adverse reactions,and the value of IgA,IgM,IgG and AFP of the experimental group were compared with those of the reference group.In addition,the value of IgA,IgM,IgG and AFP of both groups after and before the treatment were compared.The experimental results showed that the data was statistically significant(P<0.05).Conclusion:The combination of lobaplatin and cisplatin interventional embolization chemotherapy and radiofrequency ablation has some effects in patients with primary liver cancer,but the former one showed more significant effects.

Sonographic differentiation of diffuse liver cancer from portal cirrhosis

Objective: To differentiate diffuse liver cancer from portal cirrhosis by using ultrasonography. Methods: We analyzed the sonographic images of 15 patients with diffuse liver cancer and 30 patients with portal cirrhosis. Results: The patients with diffuse liver cancer showed enlarged liver and obvious echo of nodules. The rate of portal embolism and swelling of lymph nodes a- round the porta hepatis was high. The patients with portal cirrhosis showed diminished liver and the obvi- ous echo of fiber proliferation. The rates of spleen enlargement and ascites as well as gallbladder edema were high. Conclusions: To identify sonographic characteristics inside and outside of the liver. It is helpful in diffe- rentiating diffuse liver cancer from portal cirrhosis. The sonographic characteristics inside the liver in- clude surface and size, node echo, echo of fibrous tissue hyperplasia. They are difficult to identify when diffuse liver cancer merges with considerable cirrho- sis. The acoustic image characteristics of the two di- seases overlap. Hence attention should be paid to the size of the liver, proliferation of cells of diffuse liver carcinoma. In sonographic characteristics outside the liver, embolism of the portal vein and swelling of lymph nodes in the porta hepatis are particularly use- ful to identify diffuse liver cancer or diffuse liver cancer combined with liver cirrhosis in particular.

The history of interventional therapy for liver cancer in China

In China interventional therapy of liver cancer started in the 1980s. It is well-known that Professor Lin Gui is the founding father of Interventional radiology. Under the leadership of Lin Gui and other professors, interventional therapy of liver cancer has swiftly progressed in China. Indeed, TAI, TAE, TACE and ablation therapy have witnessed great innovations in hardware facil ities, technical means, and therapeutic philosophy, while incorporating Chinese characteristics. As with the development of combined interventional therapy in China, interventional treatment of liver cancer has gradually started the process of precision and individualization. Actually, multidisciplinary, multimodal, and polymorphic treatments will be the most suitable pattern for liver cancer in the future, among which combination of interventional therapy with targeted, immunological treatments and information technology(IT) tools may bring a revolutionary breakthrough in liver cancer treatment.

Polyethylene glycol microspheres loaded with irinotecan for arterially directed embolic therapy of metastatic liver cancer

AIM To study tumor response, and tolerability of arterially directed embolic therapy(ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases(CRC-LM). Secondary objectives were to monitor quality of life, time to progression and survival of patients.METHODS Patients were included in the study if they were affected by CRC-LM, refractory to systemic chemotherapy, treated with ADET using polyethylene glycol embolics, and had liver involvement < 50%. Tumor response, performance status(PS), tumor marker antigens, and quality of life(QoL) were monitored at 1, 3 and 6 mo after ADET. QoL was assessed with the Palliative Performance Scale(PPS).RESULTS We treated 50 consecutive CRC-LM patients with ADET using polyethylene glycol embolics. Their tumor response one month after ADET was: 28% of complete response(CR), 48% of partial response(PR), 8% stable disease(SD), and 16% of progression. Tumor response 3 mo after ADET was CR 24%, PR 38%, SD 19% and progression disease(PD) 19%. Tumor response 6 mo after ADET was CR 18%, PR 44%, SD 21% and PD 18%. QoL was 90% PPS at each time point. Median time to progression for patients who progressed was 2.5 mo(range 0.8-6). Median follow-up was 14 mo(0.8-25 range). ADETs were performed with no complications. Observed side effects(mild or moderate intensity) were: Pain in 32% of patients, increase of transaminase levels in 20% and fever in 14%, whereas 30% of patients did not complain any adverse event. CONCLUSION The treatment of unresectable CRC-LM with ADET using polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.

Transcatheter Arterial Embolization Combined with Anti-vascular Agent Combretastatin A4 Phosphate Inhibits Growth and Vascularization of Liver Tumor in an Animal Model

Objective This study aimed to investigate the effect of combretastatin A4 phosphate(CA4P)on proliferation,migration,and capillary tube formation of human umbilical vein endothelial cells(HUVECs)and the efficacy of transcatheter arterial embolization combined with CA4P in the treatment of rabbit VX2 liver tumor.Methods The effects of different concentrations of CA4P on proliferation,migration and capillary tube formation of HUVECs were investigated by cell proliferation assay,wound healing assay and capillary tube formation assay,respectively.Thirty-two rabbits implanted with liver VX2 tumors were randomly divided into 4 groups.After catheterization of the left hepatic artery,the infusion was performed using normal saline(group A),CA4P aqueous solution(group B),lipiodol and polyvinyl alcohol particles(group C),and CA4P lipiodol emulsion and polyvinyl alcohol particles(group D),respectively.Half of the animals in each group were euthanized for immunohistochemical analysis to evaluate microvessel density(MVD)at 3 days post-treatment.The other half were examined by MRI and histology to evaluate tumor growth and necrosis at 7 days post-treatment.Results CA4P could inhibit the proliferation,migration,and tube formation of HUVECs in cell experiments.After interventional treatment,the level of MVD in group D was lower than that in group C(P<0.01).The tumor volume in group C or D was lower than that in group A or B(P<0.01).The tumor necrosis rate was higher in group D than in the other groups.Conclusion The study suggests that CA4P could inhibit the proliferation,migration,and capillary tube formation of HUVECs,and transcatheter arterial embolization combined with CA4P could inhibit the growth of VX2 tumor and obviously induce tumor necrosis.

Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale,techniques, outcomes and future directions

The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.

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.

Metastatic disease to the liver:Locoregional therapy strategies and outcomes

Secondary cancers of the liver are more than twenty times more common than primary tumors and are incurable in most cases.While surgical resection and systemic chemotherapy are often the first-line therapy for metastatic liver disease,a majority of patients present with bilobar disease not amenable to curative local resection.Furthermore,by the time metastasis to the liver has developed,many tumors demonstrate a degree of resistance to systemic chemotherapy.Fortunately,catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable metastatic disease.These novel techniques can be used for diverse applications ranging from curative intent for small localized tumors,downstaging of large tumors for resection,or locoregional control and palliation of advanced disease.Their use has been associated with increased tumor response,increased disease-free and overall survival,and decreased morbidity and mortality in a broad range of metastatic disease.This review explores recent advances in liver-directed therapies for metastatic liver disease from primary colorectal,neuroendocrine,breast,and lung cancer,as well as uveal melanoma,cholangiocarcinoma,and sarcoma.Therapies discussed include bland transarterial embolization,chemoembolization,radioembolization,and ablative therapies,with a focus on current treatment approaches,outcomes of locoregional therapy,and future directions in each type of metastatic disease.

Efficacy and safety analysis of transarterial chemoembolization and transarterial radioembolization in advanced hepatocellular carcinoma descending hepatectomy

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in the world,which is seriously threatening the lives of patients.Due to the rapid development of the disease,patients were in the middle and advanced stages at the time of diagnosis and missed the best time for treatment.With the development of minimally invasive medicine,interventional therapy for advanced HCC has achieved promising results.Transarterial chemoembolization(TACE)and transarterial radioembolization(TARE)are currently recognized as effective treatments.This study aimed to investigate the clinical value and safety of TACE alone and combined with TACE in the treatment of progression in patients with advanced HCC and to find a breakthrough for the early diagnosis and treatment of patients with advanced HCC.AIM To investigate the efficacy and safety of hepatic TACE and TARE in advanced descending hepatectomy.METHODS In this study,218 patients with advanced HCC who were treated in the Zhejiang Provincial People’s Hospital from May 2016 to May 2021 were collected.Of the patients,119 served as the control group and received hepatic TACE,99 served as the observation group and were treated with hepatic TACE combined with TARE.The patients in two groups were compared in terms of lesion inactivation,tumor nodule size,lipiodol deposition,serum alpha-fetoprotein(AFP)level in different periods,postoperative complications,1-year survival rate,and clinical symptoms such as liver pain,fatigue,and abdominal distension,and adverse reactions such as nausea and vomiting.RESULTS The observation group and the control group had good efficacy in treatment efficiency,reduction of tumor nodules,reduction of postoperative AFP value,reduction of postoperative complications,and relief of clinical symptoms.In addition,compared with the control group,the treatment efficiency,reduction of tumor nodules,reduction of AFP value,reduction of postoperative complications,and relief of clinical symptoms in the observation group were better than those in the TACE group alone.Patients in the TACE+TARE group had a higher 1-year survival rate after surgery,lipiodol deposition was significantly increased and the extent of tumor necrosis was expanded.The overall incidence of adverse reactions in the TACE+TARE group was lower than that in the TACE group,and the difference had statistical significance(P<0.05).CONCLUSION Compared with TACE alone,TACE combined with TARE is more effective in the treatment of patients with advanced HCC.It also improves postoperative survival rate,reduces adverse effects,and has a better safety profile.

Progress of transformational therapy in colorectal liver metastases

Colorectal cancer liver metastases （CLM） treatment is very important given the high incidence of colorectal cancer with liver metastases, which are primarily treated by surgical resection. Transformational therapy such as systemic chemotherapy, hepatic arterial infusion （HAl）, portal vein embolization （PVE）, ablation therapy, and targeted therapy, should be applied to CLM patients who are unable to undergo immediate surgery to improve patients＇ survival and quality of life.

Drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma: Current state of the art

Transarterial chemoembolization(TACE) represents the current gold standard for hepatocellular carcinoma(HCC) patients in intermediate stage. Conventional TACE(c TACE) is performed with the injection of an emulsion of a chemotherapeutic drug with lipiodol into the artery feeding the tumoral nodules, followed by embolization of the same vessel to obtain a synergistic effect of drug cytotoxic activity and ischemia. Aim of this review is to summarize the main characteristics of drug-eluting beads(DEB)-TACE and the clinical results reported so far in the literature. A literature search was conducted using Pub Med until June 2017. In order to overcome the drawbacks of c TACE, namely lack of standardization and unpredictability of outcomes, non-absorbable embolic microspheres charged with cytotoxic agents(DEBs) have been developed. DEBs are able to simultaneously exert both the therapeutic components of TACE, either drug-carrier function and embolization, unlike c TACE in which applying the embolic agent is a second moment after drug injection. This way, risk of systemic drug release is minimal due to both high-affinity carrier activity of DEBs and absence of a time interval between injection and embolization. However, despite promising results of preliminary studies, clear evidence of superiority of DEB-TACE over c TACE is still lacking. A number of novel technical devices are actually in development in the field of loco-regional treatments for HCC, but only a few of them have entered the clinical arena. In absence of well-designed randomized-controlled trials, the decision on whether use DEB-TACE or c TACE is still controversial.

鸦胆子油乳联合阿帕替尼+经肝化疗动脉栓塞术治疗肝癌对免疫功能、肝功能及血清指标的影响

目的分析鸦胆子注射液联合阿帕替尼+经肝化疗动脉栓塞术(Transarterial chemoembolization,TACE)治疗肝癌对免疫功能、肝功能及血清指标的影响。方法纳入2022年2月—2023年2月收治的122例肝癌患者为研究对象,随机数字表法将其分为两组,对照组61例采用TACE联合阿帕替尼治疗,观察组61例在对照组的基础上联合鸦胆子注射液治疗,对比两组治疗效果、肝功能、肿瘤标志物水平、免疫功能及1年生存期等。结果观察组客观缓解率为37.70%(23/61),疾病控制率为95.08%(58/61),高于对照组的19.67%(12/61)、81.97%(50/61),组间比较差异有统计学意义(P<0.05);观察组肝功能指标丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、总胆红素(Total bilirubin,TBiL)水平低于对照组(P<0.05);治疗后观察组甲胎蛋白(Alpha-feto-protein,AFP)、癌胚抗原(Carcinoembryonic antigen,CEA)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、糖类抗原125(Carbohydrate antigen 125,CA125)水平均低于对照组(P<0.05);治疗后观察组CD_(4)^(+)T细胞(Cluster of differ-entiation 4 positive T cells,CD_(4)^(+))、CD_(4)^(+)/CD_(8)^(+)水平高于对照组,CD_(8)^(+)T细胞(Cluster of differentiation 8 positive T cells,CD_(8)^(+))低于对照组(P<0.05);观察组治疗后12个月生存率为85.25%,高于对照组的73.77%,组间比较差异显著(P<0.05)。两组肝癌患者一年总体累积生存曲线图结果显示差异显著(P<0.05)。结论鸦胆子注射液联合阿帕替尼+经肝化疗动脉栓塞术治疗肝癌能有效提高近期疗效,促进患者肝功能改善,降低血清肿瘤标志物水平,对提高患者免疫功能,延长生存期起到积极作用。

MR动态增强扫描减影技术评估肝癌肝动脉栓塞化疗和射频消融术疗效价值研究

目的:探讨MR动态增强扫描减影技术评估肝癌肝动脉栓塞化疗(TACE)和射频消融术(RFA)疗效价值。方法:选取2020年12月-2023年11月于我院进行治疗的40例肝癌患者,依据治疗方式的不同分为观察组与对照组,每组各20例。对照组患者和观察组患者均进行MR检查,对照组患者行TACE治疗方法,观察组患者行RFA治疗方法,对比两组患者的临床疗效、不良反应发生情况、肿瘤灭活率、肝功能以及AFP水平。结果:观察组的总有效率为100.00%,对照组的总有效率为75.00%,经过对比,有显著性差异(P<0.05);对照组不良反应发生率为30.00%,观察组不良反应发生率为5.00%,经过对比,有显著性差异(P<0.05);观察组的肿瘤灭活率为92.86%,对照组的肿瘤灭活率为78.95%,经过对比,有显著性差异(P<0.05);治疗之后,两组患者的ALT和AST均高于治疗之前,观察组显而易见低于对照组,AFP水平低于治疗之前,并且观察组显而易见低于对照组,有显著性差异(P<0.05)。结论:对使用MR动态增强扫描减影技术来进行评估的肝癌患者运用RFA进行治疗,能够显著提高患者的临床治疗效果、降低不良反应发生率、提高肿瘤灭活的几率,以及能够明显改善患者肝功能和提高患者的生活质量与水平,值得在临床进行推广。

聚乙烯醇载药微球介入栓塞在原发性肝癌患者中的应用效果

目的探讨聚乙烯醇载药微球介入栓塞在原发性肝癌患者中的应用效果。方法将182例原发性肝癌患者按照治疗方法的不同分为对照组(n=87,传统栓塞治疗)和试验组(n=95,聚乙烯醇载药微球介入栓塞治疗),比较两组患者的临床疗效、血清学指标[甲胎蛋白(AFP)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)]、不良反应发生情况及生存情况。结果治疗后3个月,两组患者AFP、TBIL、ALT水平均低于本组治疗前,试验组患者AFP、TBIL、ALT水平均低于对照组,差异均有统计学意义(P﹤0.05)。试验组患者客观缓解率和1年生存率均高于对照组,1级无症状或轻度体征发生率高于对照组,3、4级不良反应发生率均低于对照组,差异均有统计学意义(P﹤0.05)。结论聚乙烯醇载药微球介入栓塞治疗原发性肝癌的临床疗效较好,不良反应和对肝组织的损伤较小,并且能有效降低血清AFP水平,提高患者的生存率。

吡柔比星载药微球联合洛铂在原发性肝癌介入栓塞治疗中的临床效果及不良反应分析

目的探究吡柔比星载药微球联合洛铂在原发性肝癌介入栓塞治疗中的临床效果及不良反应。方法选取2020年6月—2022年6月河北北方学院附属第一医院收治的原发性肝癌中晚期患者92例,按随机数字表法分为对照组(n=46)和观察组(n=46)。所有患者均接受介入栓塞治疗,对照组患者给予洛铂灌注治疗,观察组患者在对照组的基础上联合吡柔比星载药微球进行治疗。比较两组患者的疗效,血管内皮生长因子(VEGF)、骨桥蛋白(OPN)、肿瘤坏死因子-α(TNF-α)、总胆红素(TBil)、丙氨酸转氨酶(ALT)水平和不良反应发生情况。结果观察组患者总有效率(84.78%)显著高于对照组(65.22%)(P<0.05);治疗后两组患者VEGF、OPN、TNF-α、TBil、ALT水平均显著低于治疗前,且观察组均显著低于对照组(P<0.05);两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论吡柔比星载药微球联合洛铂在原发性肝癌介入栓塞治疗中的效果较好,可提高疾病控制率,改善患者的肝功能。

肝癌患者经导管动脉化疗栓塞后发生栓塞综合征的影响因素分析

目的探讨肝癌患者经导管动脉化疗栓塞(TACE)后发生栓塞综合征的影响因素。方法根据是否发生栓塞综合征将120例行TACE治疗的肝癌患者分为未发生组(n=63)和发生组(n=57)。比较两组患者的临床特征,采用Logistic回归模型分析肝癌患者TACE治疗后发生栓塞综合征的影响因素。结果发生组和未发生组患者的性别、心脏病病史、美国东部肿瘤协作组(ECOG)体力状况(PS)评分比较,差异均有统计学意义(P﹤0.05)。发生组和未发生组患者的年龄、体重指数、肿瘤数目、肿瘤直径、文化程度、高血压/糖尿病病史、术前疼痛情况、甲胎蛋白水平、Child-Pugh分级、巴塞罗那分期比较,差异均无统计学意义(P﹥0.05)。多因素Logistic回归分析结果显示,女性是肝癌患者TACE治疗后发生栓塞综合征的独立保护因素(P﹤0.05),有心脏病病史、ECOG PS评分为1分均是肝癌患者TACE治疗后发生栓塞综合征的独立危险因素(P﹤0.05)。结论性别、心脏病病史、ECOG PS均是肝癌患者TACE治疗后发生栓塞综合征的影响因素,临床应考虑上述因素,制订针对性的预防措施,从而改善患者预后。

基于CT放射组学列线图预测肝细胞癌TACE术后肿瘤进展:一项回顾性研究

目的开发并验证基于动态对比增强CT的放射组学列线图,用于术前无创预测肝细胞癌经动脉化疗栓塞(TACE)术后肿瘤反应。方法选择2016年1月—2022年12月在本院接受TACE治疗的肝细胞癌患者100例为研究对象,将患者分为TACE缓解组(CR和PR病人)以及非TACE缓解组(SD和PD病人),其中TACE缓解组包含49例患者,非TACE缓解组包含51例患者,按照8︰2的比例将其随机分配至训练组和验证组两组,训练组80例,验证组20例。TACE治疗前两周内进行动态对比增强CT检查,在TACE术后2个月左右按照改良的实体肿瘤反应评估标准(mRECIST)判断疗效。使用最小绝对收缩和选择算子(LASSO)算法进行放射组学标签筛选,然后使用10折交叉验证的逻辑回归(LR)、轻量级梯度提升机(LightGBM)和多层感知机(MLP)算法去构建临床、放射组学、列线图和堆叠模型。使用AUC、校准曲线和决策曲线来进行评估模型的诊断性能、校准性和临床净收益。结果在训练组中TACE缓解组与非TACE缓解组患者的最大肿瘤平均直径比较,差异有统计学意义(P<0.05);与此同时,验证组中TACE缓解组与非TACE缓解组患者非光滑肿瘤边缘比较,差异有统计学意义(P<0.05)。最大肿瘤直径和非光滑肿瘤边缘是TACE术后肿瘤复发的独立预测因子。使用临床独立预测因子(最大肿瘤直径和不光滑肿瘤边缘)和放射组学标签去构建列线图,列线图和堆叠模型的最佳模型为MLP模型,在训练组中列线图的诊断性能与堆叠模型相差不大(AUC为0.874和0.878),在验证组中列线图的诊断性能相比于堆叠模型有所改善(AUC=0.889和0.879)。校准曲线和决策曲线表明列线图具有良好的校准性和临床净收益。结论基于动态增强CT构建地放射组学列线图,能够很好地预测肝细胞癌TACE术后的肿瘤反应,可以为肝细胞癌患者的临床治疗决策做出进一步指导。

阶段性心理干预在肝癌介入栓塞术治疗中的应用效果及对患者疼痛和生活质量的影响

目的探讨阶段性心理干预在肝癌介入栓塞术治疗中的应用效果及对患者疼痛和生活质量的影响。方法选取2020年12月至2021年12月行肝癌介入栓塞术治疗的60例原发性肝癌患者作为研究对象,按随机数字表法将其分为对照组和观察组,各30例。对照组给予常规护理,观察组在对照组基础上给予阶段性心理干预。比较两组的干预效果。结果干预后,两组的焦虑自评量表(SAS)、抑郁自评量表(SDS)、视觉模拟疼痛评分(VAS)及Piper疲乏自评量表(PFS)评分均显著降低,且观察组低于对照组(P<0.05)。干预后,两组的CD4^(+)、CD4^(+)/CD8^(+)均升高,CD8^(+)均降低,且观察组优于对照组(P<0.05)。干预后,两组的生活质量综合评定问卷(GQOLI-74)各维度评分均升高,且观察组高于对照组(P<0.05)。结论肝癌介入栓塞术治疗过程中辅以阶段性心理干预,可明显提高患者的负性情绪控制效果,更好地缓解疼痛,减少癌性疲乏现象,减轻心理应激,改善免疫功能及生活质量。