Fisher Robert A, Maroney Timothy P, Fulcher Ann S, Maluf Daniel, Clay John A, Wolfe Luke G, Dawson Sherfield, Cotterell Adrian, Stravitz R Todd, Luketic Velimir A, Shiffman Mitchell, Sterling Richard K, Posner Marc P
Division of Transplant Surgery, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298, USA.
Clin Transplant. 2002;16 Suppl 7:52-8. doi: 10.1034/j.1399-0012.16.s7.8.x.
In December 1997, a prospective study with informed consent was initiated to test a neoadjuvant treatment of transcatheter hepatic arterial chemo-embolization (TACE) and thermal or chemical ablation followed by transcatheter hepatic arterial chemo-infusion (TACI) in patients with hepatocellular carcinoma (HCC) referred for transplantation (OLT) and for resection. Patients were staged with American Liver Tumor Study Group-modified tumour-node-metastasis (TNM) staging classification using serial 3-6 month physical exam, alphafetoprotein (AFP), abdominal enhanced MRI, chest CT and bone scan. Sixty-five patients with HCC, out of 508 patients referred for OLT, were divided into five clinical groups and an incidental HCC patient group (n = 8), diagnosed on post-transplant explant pathology. The key focus of study was safety, site of HCC recurrence and tumour free survival. One hundred and thirty three ablation, infusion procedures were performed with an overall 24.8% morbidity, including two septic deaths. There were 13 (21.6%) HCC recurrences in 60 patients having one or more ablative treatments with only 23% hepatic HCC recurrences at 43 months of study. Eighteen HCC patients were listed for OLT (Group 3), with 12 patients transplanted after 29-424 d waiting. Two patients were removed from the OLT list due to HCC metastases, waiting a mean of 145 d. Two patients, post-OLT, had their TNM score upgraded from T2, T3 to T4. No Group 3 post-OLT patient has died or had HCC recurrence at mean follow-up of 27 +/- 15 months. No incidental HCC group post-OLT patient has died or had HCC recurrence at mean follow-up of 24 +/- 14 months. This neoadjuvant protocol is safe and effective in reducing HCC recurrence prior to and after OLT and resection.
1997年12月，一项获得知情同意的前瞻性研究启动，旨在对肝细胞癌（HCC）患者进行经导管肝动脉化疗栓塞术（TACE）和热消融或化学消融，随后进行经导管肝动脉化疗灌注（TACI）的新辅助治疗，这些患者因移植（OLT）或切除而被转诊。使用连续3 - 6个月的体格检查、甲胎蛋白（AFP）、腹部增强MRI、胸部CT和骨扫描，根据美国肝脏肿瘤研究组改良的肿瘤-淋巴结-转移（TNM）分期分类对患者进行分期。在508例因OLT转诊的患者中，65例HCC患者被分为五个临床组和一个偶然发现的HCC患者组（n = 8），后者在移植后外植体病理检查中被诊断。研究的重点是安全性、HCC复发部位和无瘤生存率。共进行了133次消融、灌注手术，总体发病率为24.8%，包括两例败血症死亡。在60例接受一次或多次消融治疗的患者中，有13例（21.6%）出现HCC复发，在研究的43个月时，肝内HCC复发率仅为23%。18例HCC患者被列入OLT名单（第3组），其中12例在等待29 - 424天后接受了移植。两名患者因HCC转移被从OLT名单中剔除，平均等待145天。两名OLT术后患者的TNM评分从T2、T3升级为T4。在平均27±15个月的随访中，第3组OLT术后患者无死亡或HCC复发。在平均24±14个月的随访中，偶然发现的HCC组OLT术后患者无死亡或HCC复发。这种新辅助方案在降低OLT和切除术前及术后的HCC复发方面是安全有效的。
