Tang Z Y, Yu Y Q, Zhou X D, Ma Z C, Yang B H, Lin Z Y, Lu J Z, Liu K D, Fan Z, Zeng Z C
Liver Cancer Institute, Shanghai Medical University, People's Republic of China.
World J Surg. 1995 Jan-Feb;19(1):47-52. doi: 10.1007/BF00316979.
Unquestionably, progress has been made in the early detection and early treatment of primary liver cancers (PLCs), although most remain unresectable, mainly because the cancer is advanced and coexists with liver cirrhosis, particularly in Oriental patients. Thanks to the progress of regional cancer therapy, a multidisciplinary approach, and changing concepts about surgical oncology, it has been proved that some unresectable but not far advanced PLCs are potentially convertible to being resectable, particularly those cancers confined to the right lobe of a cirrhotic liver. A retrospective analysis of 571 unresectable PLCs revealed the following: (1) There was an increase in 5-year survivals in the series, from 0% during the 1960s (n = 61), to 4.8% during the 1970s (n = 163), to 21.2% during the 1980s (n = 347). It might be a result of the increase in double- or triple-modality treatments in these series (from 9.8%, to 19.6%, to 70.3%, respectively) and in the sequential resection rate after cytoreduction (from 0%, to 2.5%, to 14.7%). (2) The combination of hepatic artery ligation, hepatic artery cannulation and infusion, and intrahepatic arterial radioimmunotherapy has resulted in better shrinkage of the tumor, a higher sequential resection rate, and a higher 5-year survival (28.2%). (3) Of the 55 patients who had initially unresectable PLCs and yielded "cytoreduction and sequential resection," the 5-year survival was 58.5%. It is concluded that cytoreduction and sequential resection might be an important approach to improving the prognosis of patients with unresectable PLCs.
毫无疑问，原发性肝癌（PLC）的早期检测和早期治疗已取得进展，尽管大多数病例仍无法切除，主要原因是癌症已进展且与肝硬化并存，尤其是在东方患者中。由于区域癌症治疗、多学科方法以及外科肿瘤学观念的转变，已证明一些无法切除但尚未进展到晚期的PLC有可能转变为可切除，特别是那些局限于肝硬化肝脏右叶的癌症。对571例无法切除的PLC进行的回顾性分析显示如下：（1）该系列患者的5年生存率有所提高，从20世纪60年代的0%（n = 61），提高到70年代的4.8%（n = 163），再到80年代的21.2%（n = 347）。这可能是由于这些系列中双模式或三模式治疗的增加（分别从9.8%，提高到19.6%，再到70.3%）以及减瘤后序贯切除率的提高（从0%，提高到2.5%，再到14.7%）。（2）肝动脉结扎、肝动脉插管和灌注以及肝内动脉放射免疫治疗的联合应用导致肿瘤缩小得更好、序贯切除率更高以及5年生存率更高（28.2%）。（3）在最初无法切除的PLC且进行了“减瘤和序贯切除”的55例患者中，5年生存率为58.5%。结论是，减瘤和序贯切除可能是改善无法切除的PLC患者预后的重要方法。
