乙型肝炎病毒肝硬化相关孤立性肝细胞癌切除术后的辅助性肝化疗

Adjuvant hepatic chemotherapy after resection of solitary hepatocellular carcinoma associated with hepatitis B virus cirrhosis.

作者信息

Wen Jun, Shen Wen-Lv, Yang Shao-Hua

机构信息

Department of Surgery, Second Hospital of Shantou University of Medical College, Shantou 515041, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2006 May;5(2):224-7.

DOI:

PMID:16698580

Abstract

BACKGROUND

Although resection is the major treatment for patients with hepatocellular carcinoma (HCC), the high intrahepatic recurrence remains a cardinal cause of death. This study was undertaken to evaluate the effect of hepatic arterial infusion chemotherapy on the survival and recurrence of HCC patients with hepatitis B virus (HBV) cirrhosis after resection.

METHODS

Twenty-eight patients who had undergone placement of a hepatic arterial pump at the time of liver wedge resection for HCC from 1998 through 2004 were reviewed retrospectively. These patients aged 23-71 years had HBV cirrhosis (Child-Pugh class A or B). They were given floxuridine (FUDR)(250 mg), doxorubicin (10 mg) and mitomycin C (4 mg) alternatively every 2 or 3 days through arterial pumps for 8 cycles each year in the first two years after resection. Meanwhile, traditional Chinese herbal medicine was prescribed to the patients. When the leukocyte count was as low as 3X10(9)/L or asparate aminotransferase (AST) level was significantly increased, the regimen of chemotherapy was delayed for the normalization of leukocyte count and AST level (below 80 U/L).

RESULTS

Of the 28 patients, 23 received 8 or 16 cycles of the set regimen of chemotherapy. These patients are alive with no evidence of recurrence. Among them, 5, 7, and 11 patients are alive beyond 5 years, 3 years, and 1 year respectively. In the remaining 5 patients, 3 who had had a HCC 10 cm or more in diameter showed tumor recurrence within 1 year, in whom, 8 cycles of chemotherapy were not completed because of their low leukocyte count (<3 x 10(9)/L) and poor liver function. One patient who had received 8 cycles of chemotherapy demonstrated recurrence at 16 months after resection. One patient who had received 16 cycles of chemotherapy had intrahepatic recurrence at 58 months after surgery. No recurrence was observed in 17 patients who had received 16 cycles of chemotherapy.

CONCLUSION

Adjuvant hepatic arterial chemotherapy may be feasible to improve the survival of patients after resection of solitary HCC associated with HBV cirrhosis.

摘要

背景

虽然手术切除是肝细胞癌（HCC）患者的主要治疗方法，但肝内高复发率仍是主要的死亡原因。本研究旨在评估肝动脉灌注化疗对乙型肝炎病毒（HBV）肝硬化的HCC患者术后生存及复发的影响。

方法

回顾性分析1998年至2004年期间因HCC行肝楔形切除术时放置肝动脉泵的28例患者。这些患者年龄在23 - 71岁，患有HBV肝硬化（Child-Pugh A或B级）。术后前两年，通过动脉泵每2或3天交替给予氟尿苷（FUDR）（250mg）、阿霉素（10mg）和丝裂霉素C（4mg），每年8个周期。同时给患者开中药。当白细胞计数低至3×10⁹/L或天冬氨酸转氨酶（AST）水平显著升高时，化疗方案推迟至白细胞计数和AST水平恢复正常（低于80U/L）。

结果

28例患者中，23例接受了8或16个周期的既定化疗方案。这些患者存活且无复发迹象。其中，分别有5例、7例和11例患者存活超过5年、3年和1年。其余5例患者中，3例直径10cm或更大的HCC患者在1年内出现肿瘤复发，其中，由于白细胞计数低（<3×10⁹/L）和肝功能差，未完成8个周期的化疗。1例接受了8个周期化疗的患者在切除术后16个月出现复发。1例接受了16个周期化疗的患者在术后58个月出现肝内复发。接受16个周期化疗的17例患者未观察到复发。