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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.
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Liver transplantation is one of the main treatments of early hepatocellular carcinoma (HCC). The recurrence of HCC after liver transplantation severely affects the long-term survival rate of the recipients. Targeted therapy and immunotherapy play a critical role in HCC downstaging, preventing disease progression, reducing recurrence rate, prolonging the survival and improving the quality of life. However, no consensus has been reached on the application of targeted therapy and immunotherapy in recipients undergoing liver transplantation for HCC, including indications, timing and dosage. In this article, clinical research progresses on the indications and timing of targeted therapy and immunotherapy before and after liver transplantation for HCC were reviewed, aiming to provide reference for prolonging the survival of recipients after liver transplantation for HCC.
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Objective:To systematically evaluate the efficacy of oral Chinese herbal prescriptions combined with transcatheter arterial chemoembolization （TACE） against primary hepatic carcinoma （PHC） and screen the basic Chinese herbs，in order to provide certain reference for clinical medication. Method:The randomized controlled trials concerning the treatment of PHC with oral Chinese herbal prescriptions plus TACE were retrieved from CBM，China National Knowledge Infrastructure （CNKI），Chongqing Weipu Database for Chinese Technical Periodicals （VIP），and Wanfang Data Knowledge Service Platform.The quality of the included trials was evaluated by Cochrane handbook，and the Meta-analysis was performed using RevMan 5.3.The enumeration data were expressed by odds ratio （OR），the measurement data by mean difference （MD） or standardized mean difference （SMD），and the effect size by 95% confidence interval （CI）.The data of oral Chinese herbal prescriptions involved in trials were sorted out and subjected to association rule analysis and frequency analysis based on the Traditional Chinese Medicine Inheritance Support System （TCMISS），for exploring the basic Chinese herbs and their dosages against PHC. Result:A total of 75 randomized controlled trials were included，involving 7 406 cases. As revealed by the Meta-analysis，oral Chinese herbal prescriptions combined with TACE was significantly better than TACE alone in improving the short-term curative effect ［OR=2.05，95%CI（1.83，2.29）］，decreasing alpha fetoprotein （AFP） ［MD=-59.02，95%CI（-79.03，-39.01）］，ameliorating liver function ［SMD=-1.23，95%CI（-1.58，-0.88）］，boosting immunity ［SMD=1.08，95%CI（0.84，1.32）］，adjusting Karnofsky Performance Status （KPS） scale score ［OR=2.7，95%CI（1.11，11.02）］，elevating survival rate ［OR=2.31，95%CI（1.96，2.71）］，and reducing adverse reactions ［OR=0.38，95%CI（0.34，0.43）］.Data mining results showed that the basic Chinese herbs against PHC were Bupleuri Radix，Paeoniae Alba Radix，Atractylodis Macrocephalae Rhizoma，Poria，and Glycyrrhizae Radix et Rhizoma，with their clinical dosages listed as follows：6-15 g for Bupleuri Radix，10-15 g for Paeoniae Alba Radix，9-15 g for Atractylodis Macrocephalae Rhizoma，10-15 g for Poria，and 3-10 g for Glycyrrhizae Radix et Rhizoma. Conclusion:The oral Chinese herbal prescriptions combined with TACE produce better effects in treatment of PHC as compared with TACE alone.These five basic Chinese herbs have anti-cancer effect，and their dosages are within the ranges stipulated in 2020 edition of <italic>Chinese Pharmacopoeia.</italic>This Meta-analysis has provided certain reference for clinical medication.
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Objective: To investigate the value of the Child-Pugh (CTP), ALBI, MELD, and MELD-Na scores in predicting acute-on-chronic liver failure (ACLF) in patients with hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization (TACE). Methods: Seven hundred and eleven patients with HCC who received their first TACE treatment at Guangxi Medical University Cancer Hospital between October 2013 and October 2015 were retrospectively analyzed. A Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy of the four scoring models in predicting ACLF. Results: The results of the univariate and multivariate analysis showed that the four scoring models could independently predict the occurrence of ACLF after TACE. The ROC curve analysis showed that the area under the ROC curve (AUC) of ALBI was significantly higher than the other three scores (P5.5, ALBI >-2.29, MELD >8.08 and MELD-Na >8.08 was higher than those with scores lower than the cut-off values (P0.001). Conclusions: The child-Pugh, ALBI, MELD, and MELD-Na scores have certain predictive value for ACLF after TACE treatment, with ALBI having the best predictive value.
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Objective: To investigate the efficacy of antiangiogenesis, mechanism and timing of transcatheter arterial chemoembolization (TACE) combined with sorafenib in treatment of liver cancer in new Zealand rabbits with VX2 liver cancer model. Methods: Thirty New Zealand rabbits with VX2 liver cancer were randomly divided into normal saline control group, single TACE group, single sorafenib group, pre-TACE + sorafenib group and post-TACE + sorafenib group (n=6 in each). Serum VEGF was measured by ELISA 7 days before TACE, 1 day before TACE, 3 days after TACE, 7 days after TACE, and 14 days after TACE. All the rabbits were sacrificed 14 days after operation for MVD immunohistochemical staining, and the tumor growth rate of each group was compared. Results: Compared with that in normal saline control group, serum VEGF in TACE + sorafenib group, TACE + sorafenib group and TACE + sorafenib group increased significantly (P<0.05), but the peak value of VEGF in TACE + sorafenib group was lower than that in TACE group and TACE + sorafenib group(P<0.05). Fourteen days after TACE, the VEGF level in the group + sorafenib was the lowest and that in the group of one drug alone was the highest (P<0.05). In 14 days after TACE + sorafenib group, MVD value was higher than that in saline control group and sorafenib group, but significantly lower than that of single TACE group(P<0.05). The 14 days after TACE + sorafenib group had the smallest tumor growth(P<0.05). Conclusion: TACE combined with sorafenib can significantly inhibit the growth of VX2 liver cancer in rabbits. The effect of TACE combined with sorafenib is better than that of TACE alone or sorafenib alone. However, after TACE the level of VEGF is increased and the level of serum VEGF is decreased by combining sorafenib, which decreases the microvessel density. Moreover, the effect of TACE combined with sorafenib on anti-tumor and anti-angiogenesis is better than that after TACE.
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Objective To study the impact of preoperative nutritional support on the clinical outcomes in patients with malnutrition who underwent transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma.Methods 46 patients with malnutrition underwent TACE after operation for primary liver cancer were randomly divided into the experimental group (n =23) and the control group (n =23).The patients in the experimental group received preoperative nutritional support,but patients in the control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidences of postoperative complication,the liver function,the lengths of hospital stay,the costs of nutrition support and the costs of hospitalization were compared between the two groups.Results On the day before the operation,on postoperative day 1,day 7,and one month,the levels of serum albumin,and on the postoperative day 7 and one month,the levels of pre-albumin were significantly higher in the experimental group than in the control group,and the differences were significantly different [(38.4 ± 1.5) g/L vs.(32.8±0.8) g/L,(37.6±1.3) g/Lvs.(31.4±0.9) g/L,(39.0±1.6) g/L vs.(32.0±0.7) g/L,(39.8±2.2) g/L vs.(33.0±2.0) g/L,respectively,P＜0.05],[(160.0±14.6) mg/L vs.(131.0 ± 16.5) mg/L,(163.0 ± 17.7) mg/L vs.(135.0 ± 17.1) mg/L,respectively,P ＜0.05].The incidences of complication were significantly lower in the experimental group than that of the control group (52.2％ vs.91.3％,P ＜0.05).The length of hospital stay in the experimental group was shorter than that of the control group [(19.9 ± 2.0) d vs.(24.8 ± 2.7) d,P ＜ 0.05].The cost in the experimental group was significantly lower than that in the control group [(20 108.9 ± 1 142.4) yuan vs.(23 174.1 ± 1 128.5) yuan,P ＜ 0.05].The cost in nutrition support in the experimental group was similar to that of the control group (P ＞ 0.05).Conclusions Preoperative nutritional support was helpful in reducing the incidence of postoperative complications,in shortening the length of hospital stay and in reducing medical costs.Nutritional support improved the nutritional status of the patients with primary hepatocellular carcinoma after surgery and TACE.
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Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence.Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled.These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n =32),the treatment group or the no adjuvant treatment group (n =21,the control group).The recurrence-free survival (RFS) and overall survival (OS) were analyzed.Results There was no significant difference between the two groups in clinical characteristics (P＞0.05).The recurrence-free survival (RFS) (mean±S.D.) was (20.1 ± 1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752).The 1-,2-and 3-year RFS rates of the treatment group and the control group were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％,respectively (P＞0.05).The overall survival (OS) (mean±S.D.) was (26.8± 1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037).The 1-,2-and 3-year RFS rates were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％ in the treatment group and the control group,respectively.The 1-,2-,and 3-year OS rates were 87.5％ vs.66.7％,59.4％ vs.38.1％ and 43.8％ vs.19.0％ in the treatment group and the control group,respectively.Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate,but it improved the OS rate in HCC patients with high risks of recurrence.
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Large hepatocellular carcinoma,of which diameter is considered to be ≥ 5 cm,has mostly invaded vascular system or been liver function reserve loss when found,resulting in opportunities to surgical therapy are lost.Combined interventional therapy based on transcatheter arterial chemoembolization (TACE) has become one of the main treatments for the surgically unresectable large hepatocellular carcinoma.In particular,TACE combined local ablation has gradually replaced the interventional therapy model of TACE alone.The current combination therapy is mainly sequential combination.With the development of imaging equipment,real-time synchronization is becoming increasingly important and has become one of the current research hotspots.This article focuses on the research status and perspectives of image guidance,local ablation methods,the order of the joint,the number of times and the timing of the joint situation of TACE combined local ablation in treatment of large hepatocellular carcinoma.
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Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.
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Objective To investigate the treatment efficacy of capecitabine combined with TACE for hepatic metastases after colorectal carcinoma resection.Methods The clinical data of 94 patients who were treated for hepatic metastases after colorectal carcinoma resection from June 2012 to December 2014 were retrospectively analyzed.The patients were divided into the combined group (48 patients) who underwent combined treatment of transcatheter arterial chemoembolization (TACE) and capecitabine,and the control group (46 patients) who were treated with TACE alone.The drug toxicities induced by chemotherapy in patients of the two groups were noted.The short-term outcomes and serum tumor markers were compared at 3-months after completion of TACE.All the patients were followed up and their overall survival was recorded.Results There was no significant difference in the frequency of TACE between the two groups (P ＞ 0.05).There were significant differences in the short-term outcomes at 3-month after completion of TACE (Z =2.000,P ＜ 0.05).The RR (complete response + partial response) and CBR (complete response + partial response + stable disease) were higher in the combined group than those in the control group [(52.1％ vs.32.0％) and (95.8％ vs.87.0％),respectively],although the differences were not statistically significant (both P ＞0.05).There were greater declines in CEA and CA19-9 levels at 3-month after completion of TACE in the combined group than the control group [(47.1 ± 10.3 vs.35.1 ±8.4) μg/L,(78.7 ± 19.6 vs.65.3 ± 17.0) kU/L],but the differences were not significant (t1 =5.776,t2 =7.849,both P ＜ 0.05).Toxic reactions were more common in the combined group than those in the control group,which included bone marrow suppression (39.6％ vs.30.4％) and peripheral neuritis (47.9％ vs.34.8％).Again,the differences were not significant (P ＞ 0.05).The median survivals were 17.3 months and 13.5 months,and 1-year survival rates were 72.9％ and 52.1％ in the combined group and the control group,respectively (x2 =4.325,P ＜ 0.05).There were significant differences in the survival between the two groups (x2 =4.097,P ＜ 0.05).Conclusions Capecitabine combined with TACE produced better treatment results for hepatic metastases after colorectal carcinoma resection.The short-term outcomes of the combined treatment was suDerior to TACE alone,and the treatment toxicities could be tolerated.
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Objective To investigate the treatment efficacy of capecitabine combined with TACE for hepatic metastases after colorectal carcinoma resection.Methods The clinical data of 94 patients who were treated for hepatic metastases after colorectal carcinoma resection from June 2012 to December 2014 were retrospectively analyzed.The patients were divided into the combined group (48 patients) who underwent combined treatment of transcatheter arterial chemoembolization (TACE) and capecitabine,and the control group (46 patients) who were treated with TACE alone.The drug toxicities induced by chemotherapy in patients of the two groups were noted.The short-term outcomes and serum tumor markers were compared at 3-months after completion of TACE.All the patients were followed up and their overall survival was recorded.Results There was no significant difference in the frequency of TACE between the two groups (P ＞ 0.05).There were significant differences in the short-term outcomes at 3-month after completion of TACE (Z =2.000,P ＜ 0.05).The RR (complete response + partial response) and CBR (complete response + partial response + stable disease) were higher in the combined group than those in the control group [(52.1％ vs.32.0％) and (95.8％ vs.87.0％),respectively],although the differences were not statistically significant (both P ＞0.05).There were greater declines in CEA and CA19-9 levels at 3-month after completion of TACE in the combined group than the control group [(47.1 ± 10.3 vs.35.1 ±8.4) μg/L,(78.7 ± 19.6 vs.65.3 ± 17.0) kU/L],but the differences were not significant (t1 =5.776,t2 =7.849,both P ＜ 0.05).Toxic reactions were more common in the combined group than those in the control group,which included bone marrow suppression (39.6％ vs.30.4％) and peripheral neuritis (47.9％ vs.34.8％).Again,the differences were not significant (P ＞ 0.05).The median survivals were 17.3 months and 13.5 months,and 1-year survival rates were 72.9％ and 52.1％ in the combined group and the control group,respectively (x2 =4.325,P ＜ 0.05).There were significant differences in the survival between the two groups (x2 =4.097,P ＜ 0.05).Conclusions Capecitabine combined with TACE produced better treatment results for hepatic metastases after colorectal carcinoma resection.The short-term outcomes of the combined treatment was suDerior to TACE alone,and the treatment toxicities could be tolerated.
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Transcatheter arterial chemoembolization (TACE) has been widely applied in palliative treatment of unresectable primary and metastatic liver cancer,and its efficiency and safety also have been widely acknowledged.However,there is a wide range of related complications,such as upper gastrointestinal hemorrhage,liver failure,pulmonary embolism,embolic cholecystitis and so on.As a serious complication of TACE,bile duct injury has been reported intermittently since the introduction of hepatic arterial embolization therapy.However,the exact pathogenesis,predisposing factors and clinical implications of the injuries remain to be clarified.As we find,by far there is no literature review about the bile duct injury after TACE for liver malignant tumors both at home and abroad.Thus the purpose of our study was to discuss such current issue of bile duct injury,and 26 articles have been included and analyzed.
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Introduction: The inferior phrenic arteries are major source of collateral arterial supply to hepatocellular carcinoma second only to the hepatic artery. The right inferior phrenic artery is one of the chief postoperative bleeding sources in liver transplant recipients. The aim of the present study was to identify the variations in origin of inferior phrenic arteries. Methods: We dissected inferior phrenic arteries in 100 human adult cadavers (75 males and 25 females) for the origin of both inferior phrenic arteries. Results: We found variant origin of left inferior phrenic artery in 22 male cadavers and in 7 female cadavers. The variant origin of right inferior phrenic artery was found in 27 male cadavers and in 8 female cadavers. Conclusion: The higher incidences of variant origin of inferior phrenic arteries have major clinical implications in the transcatheter arterial chemoembolization in hepatocellular carcinoma patients.
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Objective To discuss the clinical efficiency of transcatheter arterial chemoperfusion or chemoembolization (TACP / TACE) for treatment of liver metastasis from malignant insulinoma. Methods 9 cases of liver metastasis from malignant insulinoma were performed with TACP protocol of 5-fluorouracil,epirubicin,mitomycin C and interleukin-2,including 2 patients also received TACE with total 2-8 courses of treatment. Results All patients finished the interventional therapy uneventfully with no serious complication. After treatment,clinical symptoms disappeared or improved significantly,with obvious response in 2 cases and partial response in 7 cases. Efficacy in imaging revealed obvious response in 1 case,partial response in 7 and no response in 1 case. Conclusion TACP / TACE for treatment of liver metastasis from malignant insulinoma is safe and effective.
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Objective To study the change of liver micro-circulation in liver cancer patients after interventional therapy by using CT perfusion imaging.MethodThe patients were dividecl into two groups: therapy group and control group.Each group had 30 patients.CT perfusion imaging scanning was done for the patients by using the Light speed 16 CT with the MSCT "Toggling-table" technology.The data was analyzed by single variance.The interested area of liver tissue was chosen as area without iodine after interventional therapy.The parameters of perfusion imaging were MTT,BF,BV,PS and HAF.ResultsSignificance of BF and BV existed in the liver tissue between therapy group and control group.The relatively normal liver tissue and the tissue in the same side had significance of BF,BV,MTT,PS in the two groups.In the therapy group,significance of BF,BV existed in the liver tissue of both side.ConclusionThe interventional therapy combined with Chinese traditional medicine can raise life quality of the patients,relieve the clinical symptom and improve the physical sign.The perfusion imaging of liver cancer,as a simple,rapid,no trauma methed,can supply the blood perfusion information of various positions as well as displaying anatomic details,which has provided a new kind of method for evaluating the effect of chemoembolization and traditional Chinese medicine.
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Nonfunctioning islet cell tumor of the pancreas is mostly malignant and has a poor prognosis. But, even in case of hepatic metastasis, the multimodality treatment including surgical resection, transhepatic arterial chemoembolization(TACE), radiofrequency interstitial tissue ablation(RITA), and systemic chemotherapy provides a better prognosis. We report a case of the multimodality treatment for malignant nonfunctioning islet cell tumor of the pancreas. The patient was 38-year old male whose diagnosis was made by routine health check-up. Abdominal computed tomography revealed about 20cm sized hypervascular mass in the tail of the pancreas. After preoperative selective arterial embolization for the purpose of reducing surgical bleeding, we explored his abdomen and found the mass originating from the tail of the pancreas and expanding to the spleen and transverse colon. We performed distal pancreatectomy combined with total gastrectomy, splenectomy, and transverse colectomy. Also, we found multiple bilobar hepatic metastatic nodules and performed the wedge resection for the lesion of the left lateral segment. Postoperatively, we underwent the TACE and the RITA for the remaining right hepatic metastatic nodules, then performed the systemic chemotherapy with interferon-alpha. At postoperative 22 months, the patient was alive with regular follow up of viable right hepatic metastatic nodules.
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Adult , Humans , Male , Abdomen , Adenoma, Islet Cell , Colectomy , Colon, Transverse , Diagnosis , Drug Therapy , Follow-Up Studies , Gastrectomy , Hemorrhage , Interferon-alpha , Islets of Langerhans , Neoplasm Metastasis , Pancreas , Pancreatectomy , Prognosis , Spleen , SplenectomyABSTRACT
Purpose: To evaluate the antiemetic effect of azasetron hydrochloride in patients with liver neoplasm after transcatheter arterial chemoembolization. Methods: 62 patients (33 with primary hepatocellular carcinoma and 29 with hepatic metastasis), who underwent transcatheter arterial chemoembolization( TACE) therapy 78 times in all, were allocated into the azasetron group( administration of azasetron hydrochloride) and the control group( administration of metoclopramide) randomly. The inhibitory effects on nausea and vomiting were observed in the two groups respectively. Results: The antiemetic CR ratio and the response rate( CR + PR) in the azasetron group was 81.0% and 99. 7%, respectively. These results were statistically higher than those in the control group( P
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0.05,Chi-square test).Conclusion:Ribs removal can not improve the effects of HIFU plus TACE in the treatment of middle-late stage primary liver cancer significantly.