Spiliotis John, Nikolaou Georgios, Kopanakis Nikolaos, Vassiliadou Dimitra, Terra Alexios, Efstathiou Elias
1st Department of Surgical Oncology, Metaxa Cancer Hospital, Greece.
Gulf J Oncolog. 2017 May;1(24):20-23.
Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation with an incidence of 2-6%. The most common cause of peritoneal deposits is a ruptured HCC that results in tumor spillage into the peritoneal cavity. The overall incidence of spontaneous ruptures of HCC ranges from 5 to 15% and carries a high mortality rate of up to 50%. Other factors influencing peritoneal dissemination are the lymph node metastasis and the direct diaphragmatic invasion and there is no significant association with past history of FNAB, or percutaneous RFA or ethanol injection and lung or adrenal metastasis. Clinical Study: We present our experience with 4 patients with localized peritoneal metastases from HCC controlled and managed with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The mean peritoneal cancer index (PCI) was 10.2. In two cases there is a history of rupture at the onset of diagnosis and in one case dissemination of peritoneal cavity after FNB procedure. All patients after CRS and HIPEC received Sorafenib.
In our study the mean time of onset of peritoneal metastasis was 13.5 months from initial operation and the mean survival was 30 months. Our results are comparable with other studies.
Peritoneal metastasis of hepatocellular carcinoma is rare and the benefit of systemic chemotherapy is poor and from Sorafenib is not well described. Surgical resection of extrahepatic HCC metastasis remains challenging. However several case reports and a few case series have provided that surgical resection of HCC peritoneal implants may benefit. We believe from our experience in well-selected patients with peritoneal metastasis from HCC, cytoreductive surgery with HIPEC and Sorafenib may prolong survival compared to systemic chemotherapy alone.
肝细胞癌（HCC）的腹膜播散是一种罕见的表现形式，发生率为2% - 6%。腹膜种植的最常见原因是HCC破裂，导致肿瘤细胞溢入腹腔。HCC自发破裂的总体发生率为5%至15%，死亡率高达50%。影响腹膜播散的其他因素是淋巴结转移和直接侵犯膈肌，与既往细针穿刺活检（FNAB）、经皮射频消融（RFA）或乙醇注射史以及肺或肾上腺转移无显著关联。临床研究：我们介绍了4例HCC局限性腹膜转移患者的治疗经验，这些患者接受了细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）。平均腹膜癌指数（PCI）为10.2。2例患者在诊断开始时有破裂史，1例在FNB操作后出现腹腔播散。所有接受CRS和HIPEC治疗的患者均接受了索拉非尼治疗。
在我们的研究中，腹膜转移的平均发病时间为初次手术后13.5个月，平均生存期为30个月。我们的结果与其他研究相当。
肝细胞癌的腹膜转移罕见，全身化疗效果不佳，索拉非尼的疗效也未得到充分描述。肝外HCC转移的手术切除仍然具有挑战性。然而，一些病例报告和少数病例系列表明，HCC腹膜种植的手术切除可能有益。我们相信，根据我们对精心挑选的HCC腹膜转移患者的经验，与单纯全身化疗相比，CRS联合HIPEC和索拉非尼可能延长生存期。
