肝硬化合并肝细胞癌的多模式治疗：肝移植前化疗栓塞和酒精注射的作用

Multimodal treatment for hepatocellular carcinoma on cirrhosis: the role of chemoembolization and alcoholization before liver transplantation.

作者信息

Troisi R, Defreyne L, Hesse U J, Praet M, Decruyenaere J, De Hemptinne B

机构信息

Department of General, Abdominal and Transplant Surgery, University of Gent, Belgium.

出版信息

Clin Transplant. 1998 Aug;12(4):313-9.

PMID:9686325

Abstract

The results of combined trans-arterial chemoembolization (TAE) and percutaneous ethanol injection (PEI) followed by liver transplantation for hepatocellular carcinoma (HCC) are described. Fourteen patients (G2) with tumour stages I-III received a mean of 2 times TAE and 4 times PEI prior to transplantation. Six patients (G1) received no pre-transplant therapy. Tumor size reduced from 37 +/- 16 to 28 +/- 16 mm and alpha-FP from 339 +/- 1057 to 224 +/- 711 ng/mL (p = n.s.). On histopathologic examination (G2 vs. G1) a 100% necrosis of the tumour nodules was seen in 80 vs. 0% (p = 0.001); 60-90% in 3 vs. 1 and 10-50% in 3 vs. 2. Eighty six percent of nodules in G2 and 36% in G1 had a tumour capsule (p = 0.02). After a median follow-up of 26 months (3-60), 2 patients in G1 developed a recurrence of HCC as compared to 0 in G2 (p = 0.0005). The actuarial patient disease-free survival after 48 months was 82% in G2 and 65% in G1. It is concluded that combined treatment with TAE and PEI is inducing necrosis in HCC associated with improved patient disease-free survival following liver transplantation.

摘要

本文描述了经动脉化疗栓塞术（TAE）和经皮乙醇注射术（PEI）联合治疗后行肝移植治疗肝细胞癌（HCC）的结果。14例肿瘤分期为I-III期的患者（G2组）在移植前平均接受了2次TAE和4次PEI治疗。6例患者（G1组）未接受移植前治疗。肿瘤大小从37±16mm缩小至28±16mm，甲胎蛋白从339±1057ng/mL降至224±711ng/mL（p=无统计学意义）。组织病理学检查显示（G2组与G1组相比），肿瘤结节100%坏死的比例分别为80%和0%（p=0.001）；60%-90%坏死的比例分别为3例和1例，10%-50%坏死的比例分别为3例和2例。G2组86%的结节和G1组36%的结节有肿瘤包膜（p=0.02）。中位随访26个月（3-60个月）后，G1组有2例患者出现HCC复发，而G2组无复发（p=0.0005）。48个月时，G2组患者的无病生存率为82%，G1组为65%。结论是，TAE和PEI联合治疗可诱导HCC坏死，提高肝移植后患者的无病生存率。