-
[show abstract]
[hide abstract]
ABSTRACT: By 1996, 2898 patients with pathologically proven hepatocellular carcinoma (HCC) had been treated at the Liver Cancer Institute of Shanghai Medical University. The 5 year survival in the entire series was 36.2%, being increased from 4.8% in 1958–70, 12.2% in 1971–83, to 50.5% in 1984–96 and 274 patients had survived more than 5 years. The increase in the survival rate could be attributed to the decreasing mean tumour diameter (11.7, 10.5 and 9.5 cm, respectively) and multimodality treatment. In addition to small HCC resection (5 year survival 64.9%, n = 735) and large HCC resection (5 year survival 37.4%, n = 1050), the following deserves to be mentioned. First, the 5 year survival of unresectable HCC treated by palliative surgery increased from 0% to 7.2% to 20.0%, which was related to the increase in use of multimodality treatment, particularly in those followed by second-stage resection. Second, cytoreduction and sequential resection is a new field with a significant potential in the treatment of localized unresectable HCC in a cirrhotic liver. Cytoreduction can be achieved by surgery, such as hepatic artery ligation, cannulation, cryosurgery and their combination, and followed by intrahepatic arterial chemoembolization, targeting therapy or regional radiotherapy. Ninety of 647 patients with unresectable HCC so treated had marked shrinkage of tumour and received second-stage resection; the 5 year survival was 71.4%. Third, non-surgical cytoreduction was mainly achieved by transcatheter arterial chemoembolization (TACE); for 70 patients with second-stage resection following TACE, the 5 year survival was 56.0%. Finally, re-resection of subclinical recurrence of tumour after curative HCC resection was performed in 155 patients; the 5 year survival calculated from the first resection was 50.9%, which played an important role in increasing the 5 year survival in the resection group (from 13.0% to 29.5% to 56.2%). It is concluded that multimodality treatment with combined and sequential use of different modalities and repeated use of some modalities is of substantial benefit for localized unresectable HCC.
Journal of Gastroenterology and Hepatology 06/2008; 13(11‐s4):S315 - S319. · 2.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fourteen patients with clinical Stage I hepatocellular carcinoma (T1NOMO) were studied. All patients were asymptomatic, and their conditions were detected by alpha-fetoprotein (AFP) serosurvey and/or ultrasonography (US) either in the natural population in the early years of the study or in the high-risk population in the later years of the study. Cirrhosis was present in all patients. Radical resection was performed in all patients. There were no operative deaths or hospital deaths in this series. The 5-year survival rate after resection was 100%. There were seven long-term survivors in this series (14.2 years (alive), 11.3 years (alive), 8.8 years (alive), 8.8 years, 7.9 years, 7.6 years (alive), and 7.2 years after resection). The authors discuss aspects concerning early diagnosis, treatment, and prognosis of hepatocellular carcinoma (HCC).
Cancer 06/2006; 67(11):2855 - 2858. · 4.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the effect of transcatheter hepatic arterial chemoembolization (TACE) therapy on the survival and prognosis of recurrent hepatocellular carcinoma (HCC) after surgical resection.
The data of 130 surgically resected but recurrent HCC patients treated by TACE were reviewed retrospectively. The survival and influencing factors on the prognosis were analyzed.
The overall 1-, 3-, 5-year survival rates of these 130 patients were 83.0%, 45.5% and 17.6% respectively (median survival time 2.4 years). Ninty-four of the series were treated with TACE alone, which gave the 1-, 3- year survival rates of 76.4% and 37.1%, respectively (median survival time 2.1 years). Thirty-six out of 130 patients treated with TACE plus percutaneous ethanol injection (PEI), the 1-, 3-year survival rates were 100.0% and 66.5% respectively with a median survival time (MST) of 3.5 years. The survival of TACE plus PEI group was significantly better, and the mortality risk was significantly lower than that of TACE alone group (P < 0.05). The mortality risk of those with > 5 cm diameter recurrent tumor or with distant metastasis was significantly higher than those with < or = 5 cm diameter tumor or without metastasis (P < 0.05).
TACE combined with PEI may improve the survival of recurrent HCC patients.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 07/2005; 27(6):380-2.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor.
From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE.
In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%, 75.85%, 62.39% in the control group and 97.39%, 70.37%, 50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%, 61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC.
Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.
World Journal of Gastroenterology 11/2004; 10(19):2791-4. · 2.47 Impact Factor
-
Zhao-You Tang,
Sheng-Long Ye,
Yin-Kun Liu,
Lun-Xiu Qin,
Hui-Chuan Sun,
Qin-Hai Ye,
Lu Wang,
Jian Zhou,
Shuang-Jian Qiu,
Yan Li,
Xue-Ning Ji,
Hu Liu,
Jing-Ling Xia,
Zhi-Quan Wu,
Jia Fan,
Zeng-Chen Ma,
Xin-Da Zhou, Zhi-Ying Lin,
Kang-Da Liu
[show abstract]
[hide abstract]
ABSTRACT: Metastasis remains one of the major challenges before hepatocellular carcinoma (HCC) is finally conquered. This paper summarized a decade's studies on HCC metastasis at the Liver Cancer Institute of Fudan University. We have established a stepwise metastatic human HCC model system, which included a metastatic HCC model in nude mice (LCI-D20), a HCC cell line with high metastatic potential (MHCC97), a relatively low metastatic potential cell clone (MHCC97L) and several stepwise high metastatic potential cell clones (MHCC97H, HCCLM3, and HCCLM6) from their parent MHCC97 cell. Endeavors have been made for searching human HCC metastasis-related chromosomes/proteins/genes. Monogene-based studies revealed that HCC invasion/metastasis was similar to that of other solid tumors, and the biological characteristics of small HCC were only slightly better than that of large HCC. Using comparative genomic hybridization (CGH), fluorescence in situ hybridization (FISH), genotyping, cDNA microarray, and 2-dimensional gel electrophoresis, we obtained some interesting results. In particular, in collaboration with the National Institute of Health (NIH) in the United States, we generated a molecular signature that can classify metastatic HCC patients, identified osteopontin as a lead gene in the signature, and found that genes favoring metastasis progression were initiated in the primary tumors. We also found that chromosome 8p deletion, particularly in the region of 8p23, was associated with HCC metastasis. Cytokeratin 19 was identified as one of the proteins, which was found in MHCC97H, but not in MHCC97L cells. Experimental interventions using the high metastatic nude mice model have provided clues for the prevention of HCC metastasis. Translation from workbench to bedside demonstrated that serum VEGF, microvessel density, and p53 scoring may be of value for the prediction of postoperative metastatic recurrence. Interferon alpha proved effective for the prevention of recurrence both experimentally and clinically. In conclusion, HCC metastasis that probably initiated in the primary tumor is a multigene-involved, multistep, and changing process. The further elucidation of the mechanism underlying HCC metastasis will provide a more solid basis for the prediction and prevention of the metastatic recurrence of HCC.
Journal of Cancer Research and Clinical Oncology 05/2004; 130(4):187-96. · 2.56 Impact Factor
-
Zhao-You Tang,
Sheng-Long Ye,
Yin-Kun Liu,
Lun-Xiu Qin,
Hui-Chuan Sun,
Qin-Hai Ye,
Lu Wang,
Jian Zhou,
Shuang-Jian Qiu,
Yan Li,
Xue-Ning Ji,
Hu Liu,
Jing-Ling Xia,
Zhi-Quan Wu,
Jia Fan,
Zeng-Chen Ma,
Xin-Da Zhou, Zhi-Ying Lin,
Kang-Da Liu
[show abstract]
[hide abstract]
ABSTRACT: Metastasis remains one of the major challenges before hepatocellular carcinoma (HCC) is finally conquered. This paper summarized a decades studies on HCC metastasis at the Liver Cancer Institute of Fudan University. We have established a stepwise metastatic human HCC model system, which included a metastatic HCC model in nude mice (LCI-D20), a HCC cell line with high metastatic potential (MHCC97), a relatively low metastatic potential cell clone (MHCC97L) and several stepwise high metastatic potential cell clones (MHCC97H, HCCLM3, and HCCLM6) from their parent MHCC97 cell. Endeavors have been made for searching human HCC metastasis-related chromosomes/proteins/genes. Monogene-based studies revealed that HCC invasion/metastasis was similar to that of other solid tumors, and the biological characteristics of small HCC were only slightly better than that of large HCC. Using comparative genomic hybridization (CGH), fluorescence in situ hybridization (FISH), genotyping, cDNA microarray, and 2-dimensional gel electrophoresis, we obtained some interesting results. In particular, in collaboration with the National Institute of Health (NIH) in the United States, we generated a molecular signature that can classify metastatic HCC patients, identified osteopontin as a lead gene in the signature, and found that genes favoring metastasis progression were initiated in the primary tumors. We also found that chromosome 8p deletion, particularly in the region of 8p23, was associated with HCC metastasis. Cytokeratin 19 was identified as one of the proteins, which was found in MHCC97H, but not in MHCC97L cells. Experimental interventions using the high metastatic nude mice model have provided clues for the prevention of HCC metastasis. Translation from workbench to bedside demonstrated that serum VEGF, microvessel density, and p53 scoring may be of value for the prediction of postoperative metastatic recurrence. Interferon alpha proved effective for the prevention of recurrence both experimentally and clinically. In conclusion, HCC metastasis that probably initiated in the primary tumor is a multigene-involved, multistep, and changing process. The further elucidation of the mechanism underlying HCC metastasis will provide a more solid basis for the prediction and prevention of the metastatic recurrence of HCC.
Journal of Cancer Research and Clinical Oncology 03/2004; 130(4):187-196. · 2.56 Impact Factor
-
Zheng-gang Ren, Zhi-ying Lin,
Jing-lin Xia,
Bo-heng Zhang,
Sheng-long Ye,
Shi-yao Chen,
Yu-hong Gan,
Xiao-feng Wu,
Yi Chen,
Ning-ling Ge,
Zhi-quan Wu,
Zeng-chen Ma,
Xin-da Zhou,
Jia Fan,
Lun-xiu Qin,
Qing-hai Ye,
Hui-chuan Sun,
Jian Zhou,
Zhao-you Tang
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC) patients with residual tumor.
The patients were classified into intervention group (with adjuvant TACE) and control group (without adjuvant TACE) who were further stratified to those with high risk (patients with single tumor > 5 cm in diameter, or with multiple tumors, invasion to blood vessels), and low risk factors. Univariate analysis and Cox model were used to analyse prognostic factors.
In low risk patients with residual tumor, the 1-, 2-, 3-, 4-year survival rate was 97.2%, 78.0%, 66.5% and 66.5% in the intervention group, and 91.2%, 81.4%, 70.3% and 54.4% in the control group, respectively. There was no statistical difference between the two groups in survival (log-rank P = 0.7667). Comparing with the control group, the 1-, 2-, 3-, 4-year survival rate was 89.5%, 73.4%, 59.2% and 53.8% in the intervention group, and 70.5%, 61.9%, 46.8% and 46.8% in the control group, respectively. Postoperative adjuvant TACE significantly prolonged the survival in high risk patients with residual tumor (P = 0.0029). Cox model revealed that the benefit of adjuvant TACE was significantly increased by the high risk factors in HCC patients with residual tumor.
The beneficial effect of postoperative TACE was only observed in high risk patients with residual tumor but not in the low risk patients with residual tumor.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 02/2004; 26(2):116-8.
-
[show abstract]
[hide abstract]
ABSTRACT: To clarify three-grade criteria of curative resection for primary liver cancer (PLC) and evaluate their clinical significance.
Criteria of curative resection of PLC were summed up to three grades. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade II: on the basis of Grade I, there was no extrahepatic metastasis, no hilar lymph node metastasis, no tumor thrombus in the main trunks and their primary tributaries of the portal vein, common hepatic duct, hepatic vein and vena cava inferior, and the tumor was not more than two in number. Grade III: in addition to the above criteria, AFP dropped to normal level (in patients with elevated AFP before surgery) within 2 months after operation, and no residual tumor upon diagnostic imaging. A total of 354 cases with PLC who had their liver resected was reviewed. Patients in each grade were divided into two portions depending on whether the treatment was curative or palliative.
The survival of patients receiving curative treatment was better than those receiving palliative treatment (P < 0.01). This was true for patients whose treatment belonged to anyone of the three-grade criteria. The survival was improved along with the promotion of curative criteria used. The 5-year survival rate of Grade I, II and III patients undergone curative resection was 43.2%, 51.2% and 64.4%, respectively (P < 0.01).
1. The three-grade criteria may be used for judging the radicality of tumor resection for PLC. 2. The more stringent the criteria used, the better the survival would be. 3. Adopting high-grade criteria to select cases, to guide operation and postoperative follow-up would improve the results of liver resection for PLC.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2004; 26(1):33-5.
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND
Recently, the implementation of screening programs using α-fetoprotein (AFP) and ultrasonography in high risk populations has identified increasing numbers of patients with small hepatocellular carcinoma (small HCC). The aim of this study was to summarize the authors' experience in patients who underwent hepatectomy for small HCC and the factors that influence or improve long term survival.METHODS
The study included 1000 patients who underwent hepatectomy for small HCC (≤ 5 cm) and compared them with 1366 patients who underwent hepatectomy for large HCC (> 5 cm) during the same period. A Cox proportional-hazards model was used for multivariate analysis of prognostic factors.RESULTSComparison between patients with small HCC (n = 1000 patients) and patients with large HCC (n = 1366 patients) revealed that those with small HCC had a higher resection rate (93.6% [1000 of 1068 patients] vs. 55.7% [1366 of 2451 patients]; P < 0.01), a higher curative resection rate (80.5% [805 of 1000 patients] vs. 60.7% [829 of 1366 patients]; P < 0.01), a lower operative mortality rate (1.5% [15 of 1000 patients] vs. 3.7% [50 of 1366 patients]; P < 0.01), better differentiation of tumor cells (Edmondson Grade 3–4; 14.9% vs. 20.1%; P < 0.01), a higher incidence of single nodule tumors (82.6% vs. 64.4%; P < 0.01), a higher proportion of well encapsulated tumors (73.3% vs. 46.3%; P < 0.01), a lower incidence of tumor emboli in the portal vein (4.9% vs. 20.8%; P < 0.01), and higher survival rates after undergoing resection (5 years: 62.7% vs. 37.1%; P < 0.01; 10 years: 46.3% vs. 29.2%; P < 0.01). No significant difference was found between survival after undergoing minor resection (n = 949 patients) or lobectomy (n = 51 patients) in patients with small HCC (P > 0.05). Reresection for subclinical recurrence or solitary pulmonary metastasis after small HCC resection was undertaken in 84 patients.CONCLUSIONS
Resection is still the modality of first choice for the treatment of patients with small HCC. Minor resection instead of lobectomy was the key to increasing resectability and decreasing operative mortality, and reresection for subclinical recurrence or solitary pulmonary metastasis was important approach to prolonging survival further. Cancer 2001;91:1479–86. © 2001 American Cancer Society.
Cancer 04/2001; 91(8):1479 - 1486. · 4.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: During 1958–1993, 2030 patients with pathologically proven primary liver cancer (PLC) were retrospectively reviewed. Comparison between small PLC (n=514) and large PLC (>5 cm,n=1516) revealed that small PLC had a higher resection rate (92.4% versus 49.1%), lower operative mortality (1.7% versus 5.2%), a higher percentage of single tumour nodules (78.0% versus 53.4%), a higher percentage of well encapsulated tumour (74.5% versus 35.8%) and higher survival rates after resection (5-year, 63.8% versus 36.6%; 10-year, 46.8% versus 28.5%). No significant difference was found between survival following limited resection (n=440) and lobectomy (n=34) in patients with small PLC. Re-resection of any subclinical recurrence or solitary pulmonary metastasis after small PLC resection was done in 70 cases. These results indicate that resection is still the modality of choice for treatment of small PLC; limited resection instead of lobectomy was the key to increasing resectability and decreasing operative mortality; re-resection of subclinical recurrence was important to prolong survival further.
Journal of Cancer Research and Clinical Oncology 12/1995; 122(1):59-62. · 2.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Levels of expression of the nm23 gene inversely correlated with metastatic potential in several rodent tumor model systems and human breast carcinoma. In the present study, we examined nm23 mRNA levels in two murine ascites hepatoma models (H22-16A3-F and H22-A2-P) with different metastatic potentials. Metastatic H22-16A3-F (80% metastatic rate) and non-metastatic H22-A2-P clones were both derived from murine ascites hepatoma (H22). We found that a 0.8-kb nm23 transcript was expressed in both cell clones. The nm23 gene was expressed at a higher level in non-metastatic H22-A2-P: approximately 8.6-fold higher than in metastatic H22-16A3-F. The present data suggest that the expression of nm23 mRNA might be associated with metastasis of murine ascites hepatoma (H22), though heterogeneity of nm23 steady-state expression levels among the H22 clones remains to be investigated.
Journal of Cancer Research and Clinical Oncology 12/1995; 122(1):55-58. · 2.56 Impact Factor
-
Zhao-You Tang,
Ye-Qin Yu,
Xin-Da Zhou,
Zeng-Chen MA,
Ji-Zheu Lu, Zhi-Ying Lin,
Kang-Da Liu,
Sheng-Long Ye,
Bing-Hui Yang,
Hong-Wei Wang,
Hui-Chuan Sun
[show abstract]
[hide abstract]
ABSTRACT: The poor prognosis of hepatocellular carcinoma (HCC) was partly a result of the majority of unresectable HCCs in clinical patients. Fortunately, with the progress of regional cancer therapies and multimodality treatment, some of the localized unresectable HCCs were converted to resectable ones. During the period 1960–1994, 72 of the 663 patients with surgically verified unresectable HCCs have been converted to resectable. Successful cytoreduction with median diameter reduced from 10 cm to 5 cm was mainly a result of the triple or double combination treatment with hepatic artery ligation, hepatic artery cannulation with infusion, radioimmunotherapy, and fractionated regional radiotherapy. The interval between the first operation and the sequential resection was 5 months. The operative mortality was 1.4% for sequential resection, and the 5-year survival was 62.1%. Analysis of factors influencing sequential rescction rate revealed HCCs that were single nodule, well encapsulated, situated at right lobe or hepatic hilum, associated with micronodular cirrhosis, and treated with triple or double combination modalities had higher sequential resection rate as compared to their counterparts. Analysis of factors influencing survival after sequential resection revealed that HCCs with a solitary tumor confined in one lobe, without tumor embolus, and without residual cancer in specimen of sequential resection, had longer survival. It is suggested that localized unresectable, solitary, well encapsulated, right lobe or hilar HCC, associated with micronodular cirrhosis, will be good candidates for cytoreduction and sequential resection; and HCCs with unilateral involvement, without tumor embolus, and with complete necrosis of tumor after multimodality treatment favored better prognosis.El mal pronstico del carcinoma hepatocelular (CHC) se debe, por lo menos en parte, a que en la mayora de los pacientes el tumor se presenta como una lesin no resecable. Afortunadamente, con el avance en las terapias regionales del ccer y los tratamientos multimodales, algunos de los CHCs no resecables pueden ser convertidos a resecables. En el perodo 1960–1994, 72 de 663 pacientes con CHCs quirrgicamente no resecables han sido convertidos a resecables. Se logr una citorreduccin exitosa con una disminucin promedio del dimetro de 10 cm a 5 cm, fundamentalmente como resultado de un tratamiento combinado doble o triple con ligadura de la arteria heptica, canulacin e infusin de la arteria heptica, radioinmunoterapia y radioterapia regional fraccionada. El intervalo entre la primera operacin y la reseccin secuencial fue de cinco meses. La mortalidad operatoria fue 1.4% para la reseccin secuencial consobrevida a 5 aos de 62.1%. El anlisis de los factores que influyen sobre la tasa de reseccin secuencial revel que un ndulo nico, bien encapsufado, ubicados en el lbulo derecho o en el hilio heptico, asociado con cirrosis micronodular, tratado con modalidades ombinadas dobles o triples, exhibe una tasa de reseccin secuencial ms alta que la observada en el resto de los casos. El anlisis de los factores que influyen sobre la sobrevida luego de la reseccin secuencial revel que un tumor solitario confinado a un lbulo, libre de trombos tumorales, sin cncer residual en el espcimen de la reseccin secuencial, exhibe la ms larga supervivencia. Se sugiere que los CHCs localizados no resecables, solitarios, bien encapsulados, ubicados en el lbulo derecho o en la regin hiliar y asociados con cirrosis micronodular, son buenos candidatos para citorreduccin y reseccin secuencial; y la lesin unilateral, libre de tumor emblico, con necrosis completa del tumor luego de tratamiento multimodal tiende a un mejor pronstico.Le mauvais pronostic des carcinomes hpatocellulaires (CHC) est en partie d l'impossibilit de rsquer chirurgicalement la plupart de ces cancers. Il est esprer, cependant, qu'avec les progrs des thrapies locorgionales et multidisciplinaires, un certain nombre de ces cancers a priori non rscables, deviennent rscables. Pendant la priode 1960–1994, 72 des 663 patients ayant un CHC, vrifis non rscables chirurgicalement, ont t ainsi traits. On a russi ainsi diminuer le diamtre moyen de ces tumeurs de 10 5 cm, essentiellement en combinant la ligature en aval de l'artre hpatique, la perfusion directe dans cette artre en amont, une immunoradiothrapie et une radiothrapie rgionale fractionne. L'intervalle entre la premire intervention et la rsection squentielle a t de 5 mois. La mortalit opratoire a t de 1.4% pour la rsection squentielle et la survie 5 ans de 62.1% Les nodules simples, bien encapsuls, situs au lobe droit ou au hile, associs une cirrhose micronodulaire, et traits avec plusieurs de ces tactiques thrapeutiques, avaient un taux de rsecabilit plus lev par rapport aux autres tumeurs. La survie a t meilleure lorsque la rsection a intress une tumeur unique dans un seul lobe, sans embolie tumorale, et sans cancer rsiduel dans la pice de rsection. On suggre que les CHC localiss, solitaires, bien encapsuls du lobe droit ou du hile, associs une cirrhose micronodulaire mais chirurgicalement non rscables, sont susceptibles de le devenir avec une technique de cytorduction. Le pronostic des tumeurs unilatrales, sans embolie tumorale et avec une ncrose tumorale complte est meilleur aprs traitement multidisciplinaire.
World Journal of Surgery 01/1995; 19(6):784-789. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the clinicopathologic characteristics of primary liver cancer (PLC) in young adults, 77 patients aged 35 or
younger were compared with 603 patients older than 35 years during the same period. In the young patients, PLC showed: (1)
a low incidence detected at mass survey (young 15.6% vs older 28.7%,P<0.05); (2) a low level of history of hepatitis (young 36.8% vs older 66.3%,P<0.01); (3) a high incidence of positivity for hepatitis B surface antigen (HBsAg) (young 79.2% vs older 67.6%,P<0.05); (4) a relatively low incidence of associated cirrhosis (young 64.9% vs older 90.7%,P<0.01); (5) larger tumor size (PLC>5 cm; young 87.0% vs older 73.0%,P<0.01); and (6) a more advanced stage of the disease according to the TNM classification (stage III; young 29.9% vs older
18.2%,P<0.05). It is suggested that hepatitis B virus (HBV) may play an important role in the development of PLC without associated
liver cirrhosis in young patients. Close periodic surveillance of young adults who are positive for HBsAg is important to
detect PLC at an early stage.
Journal of Gastroenterology 01/1995; 30(5):632-635. · 4.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: 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.Aunque se ha logrado un incuestionable avance en la deteccin temprana y en el tratamiento precoz del cncer primario del hgado, la mayora de los pacientes sigue siendo no resecable, principalmente por lo avanzado del tumor y por la coexistente cirrosis, particularmente en pacientes orientales. En virtud del progreso logrado en la terapia regional del cncer, del enfoque multidisciplinario y de los nuevos conceptos sobre oncologa quirrgica, se ha podido comprobar que una parte de los cnceres primarios del hgado que no se encuentran en estado avanzado son potencialmente convertibles a tumores resecables, en especial en aquellos pacientes con cnceres no resecables confinados al lbulo derecho de un hgado cirrtico. Se hizo el anlisis retrospectivo de 571 cnceres primarios no resecables y los resultados son los siguientes: (a) El incremento en la sobrevida a 5 aos ascendi de 0% en los aos 1960s (n=61), a 4.8% en los 1970s (n=163) y a 21.2% en los 1980s (n=347); esto podra ser el resultado de un incremento en los tratamientos combinados dobles o triples en la serie (desde 9.8%, 19.6% hasta 70.3%, respectivamente) y al aumento en la rata secuencial de reseccin luego de citorreduccin (de 0% a 2.5% y hasta 14.7%). (b) La combinacin de ligadura de la arteria heptica con la canulacin e infusin de la arteria heptica y la radioinmunoterapia arterial intraheptica ha resultado en mayor contraccin del tumor, en ms alta rata de reseccin secuencial y en mejor sobrevida a 5 aos (28.2%). (c) De los 55 pacientes que inicialmente presentaban tumores no resecables y en quienes se logr citorreduccin y reseccin secuencial, la sobrevida a 5 aos fue 58.5%. Se concluye que la citorreduccin y la reseccin secuencial podran representar un aproche importante para mejorar el pronstico de los cnceres primarios del hgado.D'indiscutables progrs ont t faits en ce qui concerne la dtection et le traitement prcoces du cancer primitif du foie (CPF); malgr cela peu de tumeurs sont rsequables, principalement en raison du stade avanc du cancer et la coexistence d'une cirrhose, surtout chez l'oriental. Grce aux progrs du traitement rgional du cancer, une approche multidisciplinaire et aux amliorations en oncologie chirurgicale, il a t dmontr qu'une partie des CPF, autrefois estims non rsequables, peuvent le devenir, particulirement pour certaines tumeurs du foie droit cirrhotique. Une analyse rtrospective de 571 CPF estims initialement non rsequables a montr: a) une augmentation de la survie 5 ans (0% dans les annes 1960 (n=61), de 4.8% dans les annes 1970 (n=163) 21.2% dans les annes 1980 (n=347), peut-tre en rapport avec l'utilisation plus frquente d'un traitement combin qui a augment paralllement de 9.8% 19.6% et ensuite 70.3%, respectivement, et une augmentation de la rsection aprs cytorduction (de 0%, 2.5% 14.7%, respectivement). b) que la combinaison de ligature de l'artre hpatique, de la chimiothrapie directe dans l'artre hpatique et de la radio-immunothrapie intrahpatique artrielle rsulte en une meillcure rduction tumorale, un plus haut taux de rsection secondaire et une meilleur survie 5 ans et enfin c) que des 55 patients qui avaient des tumeurs initialement non rsequables et qui ont t soumis au schma cytorduction et rsection squentiele, la survie 5 ans a t de 58.5%. On conclue que la cytorduction et la rsection squentielle pourrait tre une modalit thrapeutique importante pour amliorer le pronostic des CPF initialement non rsequables.
World Journal of Surgery 12/1994; 19(1):47-52. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The long-term prognosis of surgery for hepatocellular carcinoma (HCC) is not yet satisfactory, the main reason being the high recurrence rate. The authors report the results of a long-term follow-up of 308 patients with HCC who became -fetoprotein-(AFP)-negative after resection between 1975 and 1991. By March 1992, there was recurrence in 134 patients (43.5%). The 1-, 3-, 5- and 10-year recurrence rates were 9.2%, 38.8%, 54.9% and 85.0%, respectively. The 5-year survival rate was 49.7% for patients who had undergone a second hepatic resection (n=48). Analysis of factors influencing postoperative recurrence indicated that patients subjected to mass survey, with a lower -glutamyltransferase level, at an early stage of TNM classification, with a tumour of less than 5 cm, without tumour embolus, and with postoperative immunotherapy had a lower incidence of recurrence. It is concluded that the earlier the disease is diagnosed, the less the recurrence rate; adjuvant immunotherapy may reduce postoperative recurrence, and the early detection and resection of a recurrent tumour are important to prolonging survival further after curative resection of HCC.
Journal of Cancer Research and Clinical Oncology 01/1994; 120(6):369-373. · 2.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people' Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow-up varied from 10 years and 1 month to 26 years and 7 months, with a mean followup of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 × 8 × 6 cm in size and underwent local resection. Upon follow-up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha-fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long-term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.
Cancer 05/1989; 63(11):2201 - 2206. · 4.77 Impact Factor
