BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.T...BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.The optimal time for surgery is often missed for these patients,and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years.Therefore,postoperative follow-up treatments,such as transhepatic arterial chemoembolization(TACE),have become critical to improving survival and reducing recurrence rates.AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis.METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy.When the post-treatment results of the observation group and the control group were compared,it was found that the inclusion of TACE significantly improved the clinical efficacy,reduced the levels of tumour markers and did not aggravate the damage to liver function.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time.RESULTS When the baseline data were analysed,no statistical differences were found between the two groups in terms of gender,age,hepatitis B virus,cirrhosis,Child-Pugh grading,number of tumours,maximum tumour diameter and degree of tumour differentiation.The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group.In terms of changes in tumour markers,the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group.When post-treatment changes in liver function indicators were analysed,no statistical differences were found in the total bilirubin,alanine aminotransferase and aspartate aminotransferase levels between the two groups.CONCLUSION In patients with intermediate-stage HCC,post-hepatectomy TACE significantly improved clinical outcomes,reduced tumour-marker levels and may have improved the prognosis by removing residual lesions.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.展开更多
Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic ca...Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.展开更多
Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 ease...Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.展开更多
Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A pros...Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.展开更多
Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as...Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as metastasis from gastrointestinal stromal tumor （GIST） are an indication for transcatheter arterial embolization （TAE）.The purpose of this study was to evaluate the efficacy and safety of Embosphere（㊣）-TAE （Embo-TAE） in comparison with conventional TACE （cTACE） for the treatment of liver metastasis from GIST.Methods：A total of 45 patients who underwent TACE between Aug 2008 and Feb 2013 were enrolled.Patients with GIST who underwent TAE with Embosphere（㊣） （n=19） were compared with controls who received cTACE （n=26）.The primary end points were treatment response and treatment-related adverse events.The secondary end points were progression-free survival （PFS） and overall survival （OS）.Results：The treatment response of Embo-TAE group was significandy higher than that of the cTACE group （P＜0.001）.The PFS was significandy better in the Embosphere（㊣）-group than in the cTACE group （56.6 and 42.1 weeks,respectively; P=0.003）.However,there was no statistically significant difference in liver toxicity between the two groups （P＞0.05）.The median OS in the Embo-TAE group was longer than that in the cTACE group （74.0 weeks,95％ CI：68.2-79.8 vs.61.7 weeks,95％ CI：56.2-67.2 weeks） （unadjusted P=0.045）.The use of Embo-TAE significantly reduced the risk of death in patients with GIST with liver metastases according to the Cox proportonal hazards regression model [hazard ratio （HR）：0.149; 95％ CI：0.064-0.475].Conclusions：TAE with Embosphcre（㊣） showed better treatment response and delayed tumor progression compared with cTACE.There was no significant difference in treatment-related hepatic toxicities.EmboTAE thus appears to be a feasible and promising approach in the treatment of liver metastasis from GIST.展开更多
Objective:To investigate the safety,efficacy,and prognostic factors of hepatic arterial infusion chemotherapy(HAIC)with raltitrexed and oxaliplatin post-transarterial chemoembolization(TACE)for unresectable hepatocell...Objective:To investigate the safety,efficacy,and prognostic factors of hepatic arterial infusion chemotherapy(HAIC)with raltitrexed and oxaliplatin post-transarterial chemoembolization(TACE)for unresectable hepatocellular carcinoma(uHCC).Methods:Thirty-seven patients with uHCC who received HAIC with raltitrexed and oxaliplatin post-TACE between June 2014 and December 2016 at our hospital were recruited.The primary endpoint was overall survival(OS),and secondary endpoint was progression-free survival(PFS).The overall response rate(ORR)was evaluated using the modified Response Evaluation Criteria in Solid Tumors.Toxicity was assessed according to the Common Terminology Criteria for Adverse Events(v4.0).The OS and prognostic factors were analyzed using the Kaplan-Meier method,log-rank test,and Cox regression models.Results:Three(8.1%)patients achieved complete response,17(46.0%)patients achieved partial response,and the ORR was54.0%.The median OS and median PFS were 19.0 months and 12.0 months,respectively.The common toxicities included grade 3-4 increased aspartate aminotransferase levels(8/37,21.6%),grade 1-2 hyperbilirubinemia(75.7%,28/37),nonspecific abdominal pain and fever,and grade 2-3 thrombocytopenia(18.9%,7/37);no patients developed grade 3-4 neutropenia.Univariate analysis showed that the tumor diameter(≤50 mm,p=0.028),Barcelona Clinic Liver Cancer(BCLC)stage(p=0.012),hepatitis B virus DNA level(p=0.033),and derived neutrophil-to-lymphocyte ratio(dNLR;derived neutrophils/leukocytes minus neutrophils)(p=0.003)were predictive factors for prognosis.Multivariate analysis showed that patients with BCLC stage B disease(p=0.029)and dNLR<2 before therapy(p=0.004)had better prognosis.Conclusions:HAIC with raltitrexed and oxaliplatin post-TACE is a safe and efficacious therapy for patients with uHCC;in particular,those with BCLC stage B and dNLR<2 have better prognosis.展开更多
The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional c...The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.展开更多
BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC...BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.展开更多
Hepatocellular carcinoma common cause of cancer death （HCC） is the third most worldwide （1）. Most patients present with intermediate or advanced disease that is not amenable to curative treatment, and the median s...Hepatocellular carcinoma common cause of cancer death （HCC） is the third most worldwide （1）. Most patients present with intermediate or advanced disease that is not amenable to curative treatment, and the median survival in this group is 6-8 months （2）. Several studies and well- designed randomized trials have shown a positive effect of transcatheter arterial chemoembolization （TACE） on patient outcome and survival （3-8）. As nicely described in the present article from Wring et al., assessment of tumor response is of extreme importance in patients undergoing locoregional treatments of liver cancer （9）. Early assessment of the effectiveness of TACE and monitoring of tumor response are paramount to the identification of treatment failure, guidance of future therapy, and determination of the interval for repeat treatment.展开更多
Background:The aim of this study was to investigate the effects of transcatheter arterial chemoembolization(TACE)combined with sorafenib on tumor angiogenesis.Materials and methods:Thirty New Zealand rabbit VX2 liver ...Background:The aim of this study was to investigate the effects of transcatheter arterial chemoembolization(TACE)combined with sorafenib on tumor angiogenesis.Materials and methods:Thirty New Zealand rabbit VX2 liver cancer model animals were divided into five groups,which received either normal saline(A),TACE(B),sorafenib(C),sorafenib followed by TACE(D),or TACE followed by sorafenib(E).Serum vascular endothelial growth factor(VEGF)levels were measured before and after TACE via ELISA.Immunohistochemistry for CD34 was performed to evaluate microvessel density(MVD),and ultrasonography was used to access tumor volume.Results:VEGF levels declined in group C but increased significantly on the 3 rd post-operative day in groups B,D,and E.Levels decreased after the 7 th post-operative day.Peak levels were significantly lower in group D than in groups B and E.On the 14 th post-operative day,VEGF levels were the lowest in group C,followed by those in groups D and B.MVD was the lowest in group C followed by that in group D and E,and was the highest in group B.Group D had the smallest tumor volume.HE staining of tumor tissues from group C showed apoptosis in a scattered patchy pattern,whereas in groups B,D,and E,large areas of tumor cell necrosis were visible.Conclusion:TACE can up-regulate serum VEGF levels,which in turn accelerates the formation of new blood vessels.Thus,TACE combined with sorafenib inhibits VEGF and angiogenesis,and pre-operative administration of sorafenib has a more superior anti-angiogenic effect than post-operative administration.展开更多
Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma(HCC)who have undergone transcatheter arterial chemoem...Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma(HCC)who have undergone transcatheter arterial chemoembolization(TACE).Methods We conducted a retrospective analysis of the clinical data of 198 patients with HCC who were admitted to The Fifth Medical Center of PLA General Hospital from June 2014 to August 2019 and underwent TACE therapy.The patients were divided into glucocorticoid(GCC)treatment group and control group.Standard liver-protecting procedures were used in both groups.The treatment group also received intravenous injections of methylprednisolone sodium succinate for 3–5 days.Reduction in bilirubin concentration,mean duration of hospitalization,and complications were compared between the two groups to investigate the safety and efficacy of GCCs for treatment of hyperbilirubinemia after TACE treatment.Results Bilirubin concentrations were significantly lower in the treatment group than in control group on days 3 and 5 after GCC/conventional liver-protecting treatment(P<0.05).The treatment group had significantly shorter durations of total post-surgery hospitalization,and recovery time than the control group(14.5±4.6 days vs.17.5±6.6 days,P<0.001;9.2±3.3 days vs.11.8±5.4 days,P=0.001;7.0±3.3 days vs.9.3±4.6 days,P<0.001).No GCC-associated complications were detected in the treatment group.Conclusion Short-term use of GCCs to treat hyperbilirubinemia in patients with HCC who have undergone TACE is safe and associated with rapid decline in bilirubin concentration and shorter hospital stay compared with patients who did not receive GCCs.展开更多
Purpose: A series of clinical studies have established the safety and efficacy of transcatheter arterial chemoembolization(TACE) with gelatin sponge microparticles(GSMs) in treating hepatocellular carcinoma(HCC). HCC ...Purpose: A series of clinical studies have established the safety and efficacy of transcatheter arterial chemoembolization(TACE) with gelatin sponge microparticles(GSMs) in treating hepatocellular carcinoma(HCC). HCC can lead to obvious necrosis inside tumors, especially larger ones, although it is unclear whether such necrotic tumor tissue can induce favorable immune reactions against the tumor. Myeloid-derived suppressor cells(MDSCs)have immunosuppressive functions and are currently considered a very important cell type affecting tumor immunity. This study observed changes in MDSC frequency in peripheral blood before and after GSM–TACE to evaluate the effect on the immune function of HCC patients.Methods: Eight patients diagnosed with HCC underwent GSM–TACE treatment in the Hepatobiliary Interventional Department of Beijing Tsinghua Chang Gung Hospital, Beijing, China;we followed up with the patients over a period of 30 days post-surgery. We used flow cytometry(FCM) to quantify the frequency of MDSCs in peripheral blood before TACE, 10 days after surgery and 30 days after surgery.Results: MDSC frequency after GSM–TACE had a significant downward trend. Pre-TACE, it was 30.73% ? 11.93%,decreasing to 18.60% ? 11.37% at 10 days after operation. This decrease was not statistically significant(P > 0.05). MDSC frequency was even lower 30 days after TACE(7.63% ? 7.32%) than at 10 days after TACE(P < 0.05), and there was a significant difference compared with pre-TACE(P < 0.001). We evaluated tumor response at 30 days after GSM–TACE according to the Modified Response Evaluation Criteria in Solid Tumors(mRECIST), and all eight patients showed partial response(PR).Conclusion: Our results confirmed that GSM–TACE was beneficial for improving anti-tumor immunity in the treatment of HCC.展开更多
文摘BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.The optimal time for surgery is often missed for these patients,and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years.Therefore,postoperative follow-up treatments,such as transhepatic arterial chemoembolization(TACE),have become critical to improving survival and reducing recurrence rates.AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis.METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy.When the post-treatment results of the observation group and the control group were compared,it was found that the inclusion of TACE significantly improved the clinical efficacy,reduced the levels of tumour markers and did not aggravate the damage to liver function.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time.RESULTS When the baseline data were analysed,no statistical differences were found between the two groups in terms of gender,age,hepatitis B virus,cirrhosis,Child-Pugh grading,number of tumours,maximum tumour diameter and degree of tumour differentiation.The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group.In terms of changes in tumour markers,the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group.When post-treatment changes in liver function indicators were analysed,no statistical differences were found in the total bilirubin,alanine aminotransferase and aspartate aminotransferase levels between the two groups.CONCLUSION In patients with intermediate-stage HCC,post-hepatectomy TACE significantly improved clinical outcomes,reduced tumour-marker levels and may have improved the prognosis by removing residual lesions.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.
基金supported by the Scientific Research Project of Traditional Chinese Medicine Administration of Guangdong Province(No.20222174)。
文摘Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.
基金Natural Science Research Program of Education Bureau of Anhui Province (No. J2009A163)
文摘Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.
文摘Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.
文摘Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as metastasis from gastrointestinal stromal tumor （GIST） are an indication for transcatheter arterial embolization （TAE）.The purpose of this study was to evaluate the efficacy and safety of Embosphere（㊣）-TAE （Embo-TAE） in comparison with conventional TACE （cTACE） for the treatment of liver metastasis from GIST.Methods：A total of 45 patients who underwent TACE between Aug 2008 and Feb 2013 were enrolled.Patients with GIST who underwent TAE with Embosphere（㊣） （n=19） were compared with controls who received cTACE （n=26）.The primary end points were treatment response and treatment-related adverse events.The secondary end points were progression-free survival （PFS） and overall survival （OS）.Results：The treatment response of Embo-TAE group was significandy higher than that of the cTACE group （P＜0.001）.The PFS was significandy better in the Embosphere（㊣）-group than in the cTACE group （56.6 and 42.1 weeks,respectively; P=0.003）.However,there was no statistically significant difference in liver toxicity between the two groups （P＞0.05）.The median OS in the Embo-TAE group was longer than that in the cTACE group （74.0 weeks,95％ CI：68.2-79.8 vs.61.7 weeks,95％ CI：56.2-67.2 weeks） （unadjusted P=0.045）.The use of Embo-TAE significantly reduced the risk of death in patients with GIST with liver metastases according to the Cox proportonal hazards regression model [hazard ratio （HR）：0.149; 95％ CI：0.064-0.475].Conclusions：TAE with Embosphcre（㊣） showed better treatment response and delayed tumor progression compared with cTACE.There was no significant difference in treatment-related hepatic toxicities.EmboTAE thus appears to be a feasible and promising approach in the treatment of liver metastasis from GIST.
基金supported by the National Natural Science Foundation of China(81571781).
文摘Objective:To investigate the safety,efficacy,and prognostic factors of hepatic arterial infusion chemotherapy(HAIC)with raltitrexed and oxaliplatin post-transarterial chemoembolization(TACE)for unresectable hepatocellular carcinoma(uHCC).Methods:Thirty-seven patients with uHCC who received HAIC with raltitrexed and oxaliplatin post-TACE between June 2014 and December 2016 at our hospital were recruited.The primary endpoint was overall survival(OS),and secondary endpoint was progression-free survival(PFS).The overall response rate(ORR)was evaluated using the modified Response Evaluation Criteria in Solid Tumors.Toxicity was assessed according to the Common Terminology Criteria for Adverse Events(v4.0).The OS and prognostic factors were analyzed using the Kaplan-Meier method,log-rank test,and Cox regression models.Results:Three(8.1%)patients achieved complete response,17(46.0%)patients achieved partial response,and the ORR was54.0%.The median OS and median PFS were 19.0 months and 12.0 months,respectively.The common toxicities included grade 3-4 increased aspartate aminotransferase levels(8/37,21.6%),grade 1-2 hyperbilirubinemia(75.7%,28/37),nonspecific abdominal pain and fever,and grade 2-3 thrombocytopenia(18.9%,7/37);no patients developed grade 3-4 neutropenia.Univariate analysis showed that the tumor diameter(≤50 mm,p=0.028),Barcelona Clinic Liver Cancer(BCLC)stage(p=0.012),hepatitis B virus DNA level(p=0.033),and derived neutrophil-to-lymphocyte ratio(dNLR;derived neutrophils/leukocytes minus neutrophils)(p=0.003)were predictive factors for prognosis.Multivariate analysis showed that patients with BCLC stage B disease(p=0.029)and dNLR<2 before therapy(p=0.004)had better prognosis.Conclusions:HAIC with raltitrexed and oxaliplatin post-TACE is a safe and efficacious therapy for patients with uHCC;in particular,those with BCLC stage B and dNLR<2 have better prognosis.
文摘The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.
文摘BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.
文摘Hepatocellular carcinoma common cause of cancer death （HCC） is the third most worldwide （1）. Most patients present with intermediate or advanced disease that is not amenable to curative treatment, and the median survival in this group is 6-8 months （2）. Several studies and well- designed randomized trials have shown a positive effect of transcatheter arterial chemoembolization （TACE） on patient outcome and survival （3-8）. As nicely described in the present article from Wring et al., assessment of tumor response is of extreme importance in patients undergoing locoregional treatments of liver cancer （9）. Early assessment of the effectiveness of TACE and monitoring of tumor response are paramount to the identification of treatment failure, guidance of future therapy, and determination of the interval for repeat treatment.
基金supported by 2017 Key Research&Development Program of Shaanxi Province,Grant/Award Number:2017SF-095
文摘Background:The aim of this study was to investigate the effects of transcatheter arterial chemoembolization(TACE)combined with sorafenib on tumor angiogenesis.Materials and methods:Thirty New Zealand rabbit VX2 liver cancer model animals were divided into five groups,which received either normal saline(A),TACE(B),sorafenib(C),sorafenib followed by TACE(D),or TACE followed by sorafenib(E).Serum vascular endothelial growth factor(VEGF)levels were measured before and after TACE via ELISA.Immunohistochemistry for CD34 was performed to evaluate microvessel density(MVD),and ultrasonography was used to access tumor volume.Results:VEGF levels declined in group C but increased significantly on the 3 rd post-operative day in groups B,D,and E.Levels decreased after the 7 th post-operative day.Peak levels were significantly lower in group D than in groups B and E.On the 14 th post-operative day,VEGF levels were the lowest in group C,followed by those in groups D and B.MVD was the lowest in group C followed by that in group D and E,and was the highest in group B.Group D had the smallest tumor volume.HE staining of tumor tissues from group C showed apoptosis in a scattered patchy pattern,whereas in groups B,D,and E,large areas of tumor cell necrosis were visible.Conclusion:TACE can up-regulate serum VEGF levels,which in turn accelerates the formation of new blood vessels.Thus,TACE combined with sorafenib inhibits VEGF and angiogenesis,and pre-operative administration of sorafenib has a more superior anti-angiogenic effect than post-operative administration.
文摘Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma(HCC)who have undergone transcatheter arterial chemoembolization(TACE).Methods We conducted a retrospective analysis of the clinical data of 198 patients with HCC who were admitted to The Fifth Medical Center of PLA General Hospital from June 2014 to August 2019 and underwent TACE therapy.The patients were divided into glucocorticoid(GCC)treatment group and control group.Standard liver-protecting procedures were used in both groups.The treatment group also received intravenous injections of methylprednisolone sodium succinate for 3–5 days.Reduction in bilirubin concentration,mean duration of hospitalization,and complications were compared between the two groups to investigate the safety and efficacy of GCCs for treatment of hyperbilirubinemia after TACE treatment.Results Bilirubin concentrations were significantly lower in the treatment group than in control group on days 3 and 5 after GCC/conventional liver-protecting treatment(P<0.05).The treatment group had significantly shorter durations of total post-surgery hospitalization,and recovery time than the control group(14.5±4.6 days vs.17.5±6.6 days,P<0.001;9.2±3.3 days vs.11.8±5.4 days,P=0.001;7.0±3.3 days vs.9.3±4.6 days,P<0.001).No GCC-associated complications were detected in the treatment group.Conclusion Short-term use of GCCs to treat hyperbilirubinemia in patients with HCC who have undergone TACE is safe and associated with rapid decline in bilirubin concentration and shorter hospital stay compared with patients who did not receive GCCs.
基金Supported by a grant from National Natural Science Foundation of China(grant number 81571783)National Major Project for Infectious Diseases of China(2017ZX100203205005)
文摘Purpose: A series of clinical studies have established the safety and efficacy of transcatheter arterial chemoembolization(TACE) with gelatin sponge microparticles(GSMs) in treating hepatocellular carcinoma(HCC). HCC can lead to obvious necrosis inside tumors, especially larger ones, although it is unclear whether such necrotic tumor tissue can induce favorable immune reactions against the tumor. Myeloid-derived suppressor cells(MDSCs)have immunosuppressive functions and are currently considered a very important cell type affecting tumor immunity. This study observed changes in MDSC frequency in peripheral blood before and after GSM–TACE to evaluate the effect on the immune function of HCC patients.Methods: Eight patients diagnosed with HCC underwent GSM–TACE treatment in the Hepatobiliary Interventional Department of Beijing Tsinghua Chang Gung Hospital, Beijing, China;we followed up with the patients over a period of 30 days post-surgery. We used flow cytometry(FCM) to quantify the frequency of MDSCs in peripheral blood before TACE, 10 days after surgery and 30 days after surgery.Results: MDSC frequency after GSM–TACE had a significant downward trend. Pre-TACE, it was 30.73% ? 11.93%,decreasing to 18.60% ? 11.37% at 10 days after operation. This decrease was not statistically significant(P > 0.05). MDSC frequency was even lower 30 days after TACE(7.63% ? 7.32%) than at 10 days after TACE(P < 0.05), and there was a significant difference compared with pre-TACE(P < 0.001). We evaluated tumor response at 30 days after GSM–TACE according to the Modified Response Evaluation Criteria in Solid Tumors(mRECIST), and all eight patients showed partial response(PR).Conclusion: Our results confirmed that GSM–TACE was beneficial for improving anti-tumor immunity in the treatment of HCC.
