Venook A P, Ferrell L D, Roberts J P, Emond J, Frye J W, Ring E, Ascher N L, Lake J R
Department of Medicine, University of California, San Francisco, USA.
Liver Transpl Surg. 1995 Jul;1(4):242-8. doi: 10.1002/lt.500010409.
At the University of California, San Francisco, 17 patients who met the following criteria-hepatic tumor unresectable because of location or inadequate liver reserve, no metastases, HBsAg negative, no tumor larger than 5 cm in diameter, and no more than three tumors--were enrolled prospectively in a protocol employing preoperative chemoembolization to assess whether orthotopic liver transplantation (OLT) could cure a majority of highly selected patients with hepatocellular carcinoma (HCC). Thirteen patients had biopsy-proven HCC, 2 had the fibrolamellar variant, and 2 had radiological findings of HCC but no biopsy confirmation. Fourteen had underlying liver disease. All arteriographically apparent lesions were chemoembolized using a mixture including Gelfoam powder, doxorubicin, mitomycin-c, and cisplatin. Eight patients with poor hepatic reserve were chemoembolized when a donor organ became available, whereas 9 patients were chemoembolized and then placed on the waiting list. The only complication of chemoembolization was a gangrenous gallbladder in 1 patient. Thirteen patients underwent liver transplantation (2 patients without prior histological confirmation of carcinoma had no identifiable tumor at OLT); 3 patients developed metastases between the time of enrollment and donor organ availability and subsequently died; and 1 patient underwent a trisegmentectomy. Ten of the 11 patients with biopsy-proven HCC who underwent transplantation remain free of recurrent cancer at a median of 40 months; 1 patient died at 6 months of lymphoproliferative disease with no cancer found at autopsy. Although the role of chemoembolization is uncertain, these data show that the majority of carefully selected patients with HCC may achieve long-term survival with OLT.
在加利福尼亚大学旧金山分校，17名符合以下标准的患者被纳入一项前瞻性研究方案：因肿瘤位置或肝脏储备不足而无法切除的肝肿瘤、无转移、乙肝表面抗原阴性、肿瘤直径不超过5厘米且肿瘤数量不超过3个，该方案采用术前化疗栓塞来评估原位肝移植（OLT）能否治愈大多数经过高度挑选的肝细胞癌（HCC）患者。13名患者经活检证实患有HCC，2名患有纤维板层样变体，2名有HCC的影像学表现但未经活检证实。14名患者有潜在的肝脏疾病。所有动脉造影显示的病变均使用包含明胶海绵粉、阿霉素、丝裂霉素-C和顺铂的混合物进行化疗栓塞。8名肝脏储备功能差的患者在有供体器官时进行了化疗栓塞，而9名患者先进行化疗栓塞，然后被列入等待名单。化疗栓塞的唯一并发症是1名患者出现坏疽性胆囊炎。13名患者接受了肝移植（2名术前未得到癌组织学证实的患者在肝移植时未发现可识别的肿瘤）；3名患者在入组至供体器官可用期间发生转移，随后死亡；1名患者接受了三段切除术。11名经活检证实患有HCC且接受移植的患者中有10名在中位时间40个月时仍无癌症复发；1名患者在6个月时死于淋巴增殖性疾病，尸检未发现癌症。尽管化疗栓塞的作用尚不确定，但这些数据表明，大多数经过精心挑选的HCC患者通过OLT可能实现长期生存。
