Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Me...Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Methods 112 patients of recurrent hepatocellular carcinoma who underwent surgical treatment were studied. Survival results after recurrence and from first hepatectomy were analyzed, and prognostic factors were determined by analyzing the clinicopathological variables.Results The mean survival of 112 patients was 26 months (4 to 76 months). 30 patients with tumor free state were still living. 1 year, 3 year and 5 year survival rates were 81.0%, 43.3% and 32 0%, respectively, and the 58 patients with hepatic resection were 87%, 59% and 38%, respectively. Among the 9 patients with secondary re resection, 6 had lived for over 3 years, and two for over 5 years. There were no operative death in this series, and few complications were found.Conclusion Early detection of recurrence depends on AFP measurements and ultrasonography follow up monitoring after resection. Re resection for recurrent hepatocellular carcinoma has been proved to be the most effective treatment modality. Aggressive treatment with a multimodality strategy is an option to improve long term survival in some patients with unresectable recurrent hepatocellular carcinoma.\;展开更多
目的观察分析小肝细胞性肝癌（ small hepatocellular carcinoma，sHCC）迟发性复发病灶超声造影影像学特征及临床意义。方法以初发性小肝癌（primary small hepatocellular carcinoma，PsHCC）52例68个病灶为对照组，2年内首发的复发...目的观察分析小肝细胞性肝癌（ small hepatocellular carcinoma，sHCC）迟发性复发病灶超声造影影像学特征及临床意义。方法以初发性小肝癌（primary small hepatocellular carcinoma，PsHCC）52例68个病灶为对照组，2年内首发的复发性小肝细胞性肝癌（recurrent small hepatocellular carcinoma，RsHCC） 293例367个病灶为RsHCC 1组（R1组），2年后首发的RsHCC 46例51个病灶为RsHCC 2组（R2组），分析比较三组间超声造影强化始增时间、达峰时间、开始消退时间、低增强开始时间及各时相灌注模式等血流动力学参数。
结果R2组与对照组及R1组比较，始增时间、达峰时间、开始消退时间及低增强开始时间的差异均有统计学意义（P〈0.05）；而上述参数指标在R1组与对照组间差异均无统计学意义（P〉0.05）。R2组分别与对照组及R1组比较，动脉期和延迟期时相差异均有统计学意义（P〈0.05），门脉期三组分布差异均无统计学意义（P〉0.05）; R1组与对照组各时相分布差异均无统计学意义（P〉0.05）。结论迟发性RsHCC超声造影灌注模式虽仍以快进快退为主，但也呈现出多样化趋势，对肝癌迟发性复发灶超声造影强化模式的研究，结合其他相关资料，有可能为临床提供一个简便、有一定参考价值的方法。展开更多
目的比较射频消融(RFA)与肝动脉化疗栓塞术(TACE)治疗复发性肝癌的临床疗效和主要并发症。方法检索Pubmed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库等,对符合纳入标准的文献进行文献质量评价,提取数据后使用Co...目的比较射频消融(RFA)与肝动脉化疗栓塞术(TACE)治疗复发性肝癌的临床疗效和主要并发症。方法检索Pubmed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库等,对符合纳入标准的文献进行文献质量评价,提取数据后使用Cochrane Library提供的RevMan 5.3软件进行Meta分析。结果共10篇文献纳入研究,其中英文9篇,中文1篇,共1381例复发性肝癌患者。Meta分析结果显示:RFA组1年生存率(OR=1.78,95%CI:1.21~2.63,P=0.003)、3年生存率(OR=1.65,95%CI:1.31~2.08,P<0.001)、5年生存率(OR=3.49,95%CI:1.55~7.87,P=0.003)和完全缓解率(OR=33.75,95%CI:1.73~658.24,P=0.020)优于TACE组。两组主要并发症发生率比较差异无统计学意义(P>0.05)。结论RFA在提高复发性肝癌患者生存率与改善完全缓解率较TACE具有明显优势。展开更多
文摘Objective The aim of this study was to evaluate the long term results of treatment and prognositic factors in patients with recurrent hepatocellular carcinoma after curative resection of hepatocellular carcinoma. Methods 112 patients of recurrent hepatocellular carcinoma who underwent surgical treatment were studied. Survival results after recurrence and from first hepatectomy were analyzed, and prognostic factors were determined by analyzing the clinicopathological variables.Results The mean survival of 112 patients was 26 months (4 to 76 months). 30 patients with tumor free state were still living. 1 year, 3 year and 5 year survival rates were 81.0%, 43.3% and 32 0%, respectively, and the 58 patients with hepatic resection were 87%, 59% and 38%, respectively. Among the 9 patients with secondary re resection, 6 had lived for over 3 years, and two for over 5 years. There were no operative death in this series, and few complications were found.Conclusion Early detection of recurrence depends on AFP measurements and ultrasonography follow up monitoring after resection. Re resection for recurrent hepatocellular carcinoma has been proved to be the most effective treatment modality. Aggressive treatment with a multimodality strategy is an option to improve long term survival in some patients with unresectable recurrent hepatocellular carcinoma.\;
文摘目的探讨超声造影定量分析与血管内皮生长因子(vascular endothelial growth factor,VEGF)对甲胎蛋白(alpha fetoprotein,AFP)阴性复发性肝癌患者肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)术后疗效的预测价值。方法选取2017年1月至2019年12月于沧州市中心医院行TACE治疗的86例AFP阴性复发性肝癌患者为研究对象,根据TACE术后6个月内的随访结果将患者分为有效组和无效组。比较两组患者超声造影定量分析结果和血VEGF水平,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评价其对TACE手术疗效的预测价值。结果全部86例患者TACE术后6个月的疗效为:完全缓解26例(30.2%)、部分缓解37例(43.0%)、病情稳定18例(20.9%)、病情进展5例(5.8%),治疗有效率为73.3%。两组患者性别、年龄、肝功能Child-Pugh分级、AFP、总胆红素、凝血酶原时间(prothrombin time,PT)、血小板计数、乙型肝炎表面抗原、肿瘤数量、肿瘤最大径、组织学分级、有无微血管侵犯、包膜不完整等基线资料比较差异均无统计学意义(均P>0.05)。有效组患者的达峰时间显著长于无效组(P<0.05),两组患者始增时间、等增强开始时间、低增强开始时间、术前血VEGF水平比较差异均无统计学意义(均P>0.05)。有效组患者术后7 d血VEGF水平、手术前后VEGF的差值均显著低于无效组(均P<0.05)。达峰时间、术后7 d VEGF水平、手术前后VEGF的差值对TACE疗效具有较理想的预测价值(AUC>0.7),其中手术前后VEGF的差值的预测价值最高。多因素Logistic回归分析结果表明,达峰时间、术后7 d VEGF水平、手术前后VEGF的差值均为TACE有效的独立预测因素(均P<0.05)。结论超声造影结果的达峰时间与手术前后血VEGF水平变化对AFP阴性复发性肝癌患者TACE疗效具有重要的预测价值。
