肝癌切除术后的抗复发辅助治疗
http://www.100md.com
参见附件(83kb)。
第二军医大学东方肝胆外科医院 沈 锋 吴孟超
【 摘要 】原发性肝癌根治性切除术后的高复发率严重影响肝癌总体外科疗效。鉴于肝癌的复发涉及多个环节，因此抑制肝癌复发的措施不应单一而应具有多方面的针对性。一、肝癌根治性切除术后局部区域性化疗栓塞对肝癌术后复发的预防作用 预防性 TACE 可显著提高肝癌术后总体无瘤生存率， TACE 抑制复发的显著性作用似在术后 2 年内得以体现，而对患者的远期 (>2 年 ) 无瘤生存率无显著性差异。对肿瘤直径 ≤3cm 、有完整包膜、手术切缘距离 ≥2cm 者，预防性 TACE 对无瘤生存率的影响并不显著。分析不同分期肝癌术后 TACE 的疗效，表明该治疗可能对 TNM Ⅱ 期或中国分期 Ⅲ 期的肝癌术后无瘤生存率的提高有益，且术后单次 TACE 优于多次 TACE 。二、卡培他滨口服化疗对肝癌术后复发的抑制作用 对于肿瘤体积较小仅作局部根治性切除，术后肝功能良好代偿，虽有 HBV 感染但病毒负荷较低者，可将卡培他滨口服化疗作为预防复发的一种措施。三、免疫治疗对肝癌术后复发的预防作用 各种免疫治疗的抗复发疗效相比较依次为 CTL 、 α 干扰素和胸腺素 α 。既往本组亦报道对临床分期较晚者术后单独应用免疫治疗疗效并不显著，对有复发高危因素的患者宜首选 TACE 等作为第一线抗复发措施，围治疗期或治疗后辅以免疫治疗。四、肝癌门静脉癌栓的处理对肝癌复发的防治价值 在肝切除术的同时作癌栓的术中处理能一定程度地改善预后。我们在国内外率先建立了大体 PVTT 的经皮激光消融技术可有效清除门静脉主干或主要分支内的癌栓，且治疗后临床症状、肝功能和腹水情况得到不同程度改善。如同时辅以化疗药物和小剂量碘油 (5m1) ，可进一步提高疗效。
【 Abstract 】 The prognosis of hepatocellular carcinoma after resection is still unsatisfactory as a result of high incidence of recurrence. Because the recurrence of HCC referred to multitude link, the method for inhibiting the recurrence of HCC should aim at versatile area not single one. First, adjuvant TACE can improve patients' overall survival after hepatic resection, but the beneficial effect of adjuvant TACE was limited to the first two years after resection, and thereafter at years 3, 4 and 5, disease-free survival had no difference. Adjuvant TACE shows no effect in disease-free survival for the patients with presence of integrated tumor capsule, tumor diameter≤3 cm and resection margin≥2 cm. Adjuvant TACE may improve disease-free survival for patients grouping in TNM Ⅱ or Chinese classification Ⅲ. The times of TACE had failed to show better effectiveness in the survival. Second, oral administration of capecitabine maybe an effective method, when patient with small tumor received regional radical resection, well recovery of liver function and low density of HBV. Third, the anti-recurrence effect of immunotherapy from powerful to weak in sequence was CTL, a-IFN and thymosin-a. We have reported that there had no significant effect with immunotherapy alone when patients were in late stage, for the patients with high risk of recurrence TACE would be the first and effective choice postoperatively and may have more effect plus with immunotherapy. Last, at the same time of hepatic resection dealing portal thrombosis appropriately with surgical technique shows better prognosis. We have firstly established percutaneous 1aser ablation in world, which can eliminate the portal thrombosis located in main trunk or branch of portal vein. Such therapy can palliate clinical symptom ， improve liver function and decrease ascites, and its therapeutic effect can be enhanced apply with portal vein injection of chemotherapeutics and low dosage of lipiodol (5ml).
原发性肝癌 ( 下称肝癌 ) 根治性切除术后的高复发率严重影响肝癌总体外科疗效。国内外较大系列的临床资料 [1,2] 。表明肝癌术后的 3 年复发率为 40 %～ 50 %左右， 5 年复发率为 60 %～ 70% 乃至更高。高复发率也见于局部微创治疗和肝移植后。探索肝癌术后复发的治疗措施是有效延长患者生存时间的重要课题，这种探索目前主要集中于两个方面，其一是研究肝癌复发转移的分子机制，至今虽屡有重要发现，但据此形成广泛应用的临床靶向治疗还有甚多困难，其二是研究已存在或新的辅助治疗( adjuvant therapy )措施预防肝癌复发中的作用 ......
第二军医大学东方肝胆外科医院 沈 锋 吴孟超
【 摘要 】原发性肝癌根治性切除术后的高复发率严重影响肝癌总体外科疗效。鉴于肝癌的复发涉及多个环节，因此抑制肝癌复发的措施不应单一而应具有多方面的针对性。一、肝癌根治性切除术后局部区域性化疗栓塞对肝癌术后复发的预防作用 预防性 TACE 可显著提高肝癌术后总体无瘤生存率， TACE 抑制复发的显著性作用似在术后 2 年内得以体现，而对患者的远期 (>2 年 ) 无瘤生存率无显著性差异。对肿瘤直径 ≤3cm 、有完整包膜、手术切缘距离 ≥2cm 者，预防性 TACE 对无瘤生存率的影响并不显著。分析不同分期肝癌术后 TACE 的疗效，表明该治疗可能对 TNM Ⅱ 期或中国分期 Ⅲ 期的肝癌术后无瘤生存率的提高有益，且术后单次 TACE 优于多次 TACE 。二、卡培他滨口服化疗对肝癌术后复发的抑制作用 对于肿瘤体积较小仅作局部根治性切除，术后肝功能良好代偿，虽有 HBV 感染但病毒负荷较低者，可将卡培他滨口服化疗作为预防复发的一种措施。三、免疫治疗对肝癌术后复发的预防作用 各种免疫治疗的抗复发疗效相比较依次为 CTL 、 α 干扰素和胸腺素 α 。既往本组亦报道对临床分期较晚者术后单独应用免疫治疗疗效并不显著，对有复发高危因素的患者宜首选 TACE 等作为第一线抗复发措施，围治疗期或治疗后辅以免疫治疗。四、肝癌门静脉癌栓的处理对肝癌复发的防治价值 在肝切除术的同时作癌栓的术中处理能一定程度地改善预后。我们在国内外率先建立了大体 PVTT 的经皮激光消融技术可有效清除门静脉主干或主要分支内的癌栓，且治疗后临床症状、肝功能和腹水情况得到不同程度改善。如同时辅以化疗药物和小剂量碘油 (5m1) ，可进一步提高疗效。
【 Abstract 】 The prognosis of hepatocellular carcinoma after resection is still unsatisfactory as a result of high incidence of recurrence. Because the recurrence of HCC referred to multitude link, the method for inhibiting the recurrence of HCC should aim at versatile area not single one. First, adjuvant TACE can improve patients' overall survival after hepatic resection, but the beneficial effect of adjuvant TACE was limited to the first two years after resection, and thereafter at years 3, 4 and 5, disease-free survival had no difference. Adjuvant TACE shows no effect in disease-free survival for the patients with presence of integrated tumor capsule, tumor diameter≤3 cm and resection margin≥2 cm. Adjuvant TACE may improve disease-free survival for patients grouping in TNM Ⅱ or Chinese classification Ⅲ. The times of TACE had failed to show better effectiveness in the survival. Second, oral administration of capecitabine maybe an effective method, when patient with small tumor received regional radical resection, well recovery of liver function and low density of HBV. Third, the anti-recurrence effect of immunotherapy from powerful to weak in sequence was CTL, a-IFN and thymosin-a. We have reported that there had no significant effect with immunotherapy alone when patients were in late stage, for the patients with high risk of recurrence TACE would be the first and effective choice postoperatively and may have more effect plus with immunotherapy. Last, at the same time of hepatic resection dealing portal thrombosis appropriately with surgical technique shows better prognosis. We have firstly established percutaneous 1aser ablation in world, which can eliminate the portal thrombosis located in main trunk or branch of portal vein. Such therapy can palliate clinical symptom ， improve liver function and decrease ascites, and its therapeutic effect can be enhanced apply with portal vein injection of chemotherapeutics and low dosage of lipiodol (5ml).
原发性肝癌 ( 下称肝癌 ) 根治性切除术后的高复发率严重影响肝癌总体外科疗效。国内外较大系列的临床资料 [1,2] 。表明肝癌术后的 3 年复发率为 40 %～ 50 %左右， 5 年复发率为 60 %～ 70% 乃至更高。高复发率也见于局部微创治疗和肝移植后。探索肝癌术后复发的治疗措施是有效延长患者生存时间的重要课题，这种探索目前主要集中于两个方面，其一是研究肝癌复发转移的分子机制，至今虽屡有重要发现，但据此形成广泛应用的临床靶向治疗还有甚多困难，其二是研究已存在或新的辅助治疗( adjuvant therapy )措施预防肝癌复发中的作用 ......
您现在查看是摘要介绍页，详见DOC附件(83kb)。