Transarterial chemoembolization(TACE)is widely applied for the treatment of hepatocellular carcinoma.Repeat TACE is often required in clinical practice because a satisfactory tumor response may not be achieved with a ...Transarterial chemoembolization(TACE)is widely applied for the treatment of hepatocellular carcinoma.Repeat TACE is often required in clinical practice because a satisfactory tumor response may not be achieved with a single session.However,repeated TACE procedures can impair liver function and increase treatment-related adverse events,all of which prompted the introduction of the concept of“TACE failure/refractoriness”.Mainly based on evidence from two retrospective studies conducted in Japan,sorafenib is recommended as the first choice for subsequent treatment after TACE failure/refractoriness.Several studies have investigated the outcomes of other subsequent treatments,including locoregional,other molecular targeted,anti-programmed death-1/anti-programed death ligand-1 therapies,and combination therapies after TACE failure/refractoriness.In this review,we summarize the up-to-date information about the outcomes of several subsequent treatment modalities after TACE failure/refractoriness.展开更多
AIM： To examine the significance of branched-chain amino acid （BCAA） treatment before transcatheter arterial chemoembolization （rACE） for hepatocellular carcinoma （HCC）.METHODS： This study included 99 patients...AIM： To examine the significance of branched-chain amino acid （BCAA） treatment before transcatheter arterial chemoembolization （rACE） for hepatocellular carcinoma （HCC）.METHODS： This study included 99 patients who underwent TACE therapy for HCC at our hospital and were followed up without treatment for at least 6 mo between January 2004 and January 2010. They were divided into 2 groups： those receiving BCAA granules （/7 = 40） or regular diet （n = 59, control）. Data obtained were retrospectively analyzed （prior to TACE, and 1 wk, 1, 3, and 6 mo after TACE） in terms of nutritional condition and clinical laboratory parameters （serum albumin level and Child-Pugh score）, both of which are determinants of hepatic functional reserve.RESULTS： The BCAA group comprised 27 males and 13 females with a mean age of 69,9 ：E 8,8 years, The patients of the BCAA group were classified as follows： Child-Pugh A/B/C in 22/15/3 patients, and Stage Ⅱ/Ⅲ/ /IVA HCC in 12/23/5 patients, respectively. The controlgroup comprised 32 males and 27 females with a mean age of 73.2 ± 10.1 years. In the control group, 9 patients had chronic hepatitis, Child-Pugh A/B/C in 39/10/1 patients, and Stage Ⅰ/Ⅱ/Ⅲ/IVA HCC in 1/11/35/12 patients, respectively. Overall, both serum albumin level and Child-Pugh score improved significantly in the BCAA group as compared with the control 3 and 6 mo after TACE （P 〈 0.05）. Further analysis was performed by the following categorization： （1） child-Pugh classification; （2） liver cirrhosis subgroup with a serum albumin level 〉 3.5 g/dL; and （3） epirubicin dose. A similar trend indicating a significant improvement of all variables in the BCAA group was noted （P 〈 0.05）.CONCLUSION： Treatment with BCAA granules in patients who have undergone TACE for HCC is considered useful to maintain their hepatic functional reserve.展开更多
基金This study was supported by the National Natural Science Foundation of China(No.81901847)the Natural Science Foundation of Jiangsu Province(No.BK20190177)the Suzhou Science and Technology Youth Plan(No.KJXW2018003).
文摘Transarterial chemoembolization(TACE)is widely applied for the treatment of hepatocellular carcinoma.Repeat TACE is often required in clinical practice because a satisfactory tumor response may not be achieved with a single session.However,repeated TACE procedures can impair liver function and increase treatment-related adverse events,all of which prompted the introduction of the concept of“TACE failure/refractoriness”.Mainly based on evidence from two retrospective studies conducted in Japan,sorafenib is recommended as the first choice for subsequent treatment after TACE failure/refractoriness.Several studies have investigated the outcomes of other subsequent treatments,including locoregional,other molecular targeted,anti-programmed death-1/anti-programed death ligand-1 therapies,and combination therapies after TACE failure/refractoriness.In this review,we summarize the up-to-date information about the outcomes of several subsequent treatment modalities after TACE failure/refractoriness.
文摘AIM： To examine the significance of branched-chain amino acid （BCAA） treatment before transcatheter arterial chemoembolization （rACE） for hepatocellular carcinoma （HCC）.METHODS： This study included 99 patients who underwent TACE therapy for HCC at our hospital and were followed up without treatment for at least 6 mo between January 2004 and January 2010. They were divided into 2 groups： those receiving BCAA granules （/7 = 40） or regular diet （n = 59, control）. Data obtained were retrospectively analyzed （prior to TACE, and 1 wk, 1, 3, and 6 mo after TACE） in terms of nutritional condition and clinical laboratory parameters （serum albumin level and Child-Pugh score）, both of which are determinants of hepatic functional reserve.RESULTS： The BCAA group comprised 27 males and 13 females with a mean age of 69,9 ：E 8,8 years, The patients of the BCAA group were classified as follows： Child-Pugh A/B/C in 22/15/3 patients, and Stage Ⅱ/Ⅲ/ /IVA HCC in 12/23/5 patients, respectively. The controlgroup comprised 32 males and 27 females with a mean age of 73.2 ± 10.1 years. In the control group, 9 patients had chronic hepatitis, Child-Pugh A/B/C in 39/10/1 patients, and Stage Ⅰ/Ⅱ/Ⅲ/IVA HCC in 1/11/35/12 patients, respectively. Overall, both serum albumin level and Child-Pugh score improved significantly in the BCAA group as compared with the control 3 and 6 mo after TACE （P 〈 0.05）. Further analysis was performed by the following categorization： （1） child-Pugh classification; （2） liver cirrhosis subgroup with a serum albumin level 〉 3.5 g/dL; and （3） epirubicin dose. A similar trend indicating a significant improvement of all variables in the BCAA group was noted （P 〈 0.05）.CONCLUSION： Treatment with BCAA granules in patients who have undergone TACE for HCC is considered useful to maintain their hepatic functional reserve.
