肝移植前等大约两月要不要先做介入？

liver_GZ

回复 hhs0755 的帖子

有个小问题和吴医生探讨：
对于>3cm的肝癌，如果不选择肝切除，越来越多文献倾向TACE+RFA；
这里就不提被撤稿的JAMA文章。

对于<3cm的小肝癌，文献似乎支持单独的RFA，无需RFA联合TACE。
Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?

Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K.

Department of Radiology, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan. [email protected]

AbstractPURPOSE: To prospectively compare combined radiofrequency ablation and transcatheter arterial chemoembolization (TACE) with radiofrequency ablation alone for the treatment of small (< or =3 cm) hepatocellular carcinomas (HCCs).
MATERIALS AND METHODS: The ethics committee of the study institution approved the study protocol. Written informed consent was obtained from all patients at enrollment. Eighty-nine patients with 93 HCC nodules 0.8-3.0 cm (mean +/- standard deviation, 1.7 cm +/- 0.5) in diameter were randomly treated with combined radiofrequency ablation and TACE (46 patients with 49 nodules) or with radiofrequency ablation alone (43 patients with 44 nodules). The patients were followed up for 9-68 months (mean +/- standard deviation, 30.4 months +/- 14.0). Rates of local tumor progression, overall survival, local progression-free survival, and event-free survival were evaluated by using the Kaplan-Meier method.
RESULTS: The 1-, 2-, 3-, and 4-year rates of local tumor progression, overall survival, local progression-free survival, and recurrence-free survival were as follows: Local tumor progression rates were 14.4%, 17.6%, 17.6%, and 17.6%, respectively, in the combined treatment group and 11.4%, 14.4%, 14.4%, and 14.4%, respectively, in the radiofrequency ablation group (P = .797). Overall survival rates were 100%, 100%, 84.8%, and 72.7%, respectively, in the combined treatment group and 100%, 88.8%, 84.5%, and 74.0%, respectively, in the radiofrequency ablation group (P = .515). Local progression-free survival rates were 84.6%, 81.1%, 69.7%, and 55.8%, respectively, in the combined treatment group and 88.4%, 74.1%, 74.1%, and 61.7%, respectively, in the radiofrequency ablation group (P = .934). Event-free survival rates were 71.3%, 59.9%, 48.8%, and 36.6%, respectively, in the combined treatment group and 74.3%, 52.4%, 29.7%, and 29.7%, respectively, in the radiofrequency ablation group (P = .365).
CONCLUSION: Combined radiofrequency ablation plus TACE and radiofrequency ablation alone have equivalent effectiveness for the treatment of small (< or =3 cm) HCCs, so the combination treatment may not be necessary.

PMID: 19567647 [PubMed - indexed for MEDLINE]

http://hbvhbv.info/forum/forum.php?mod=attachment&aid=MjAwMDgyfDJhMDcwNTc5MTdhMTRlMDBjODkzZDhmYjVkM2ZmODgyfDE3MjY4NTgxMTE%3D&request=yes&_f=.pdf

nicholasyin

liver_GZ 发表于 2011-2-7 22:07
回复 金秋晨曦 的帖子

“1月6日入院时AFP为163；1月17日AFP119.4,胆红素13，直接胆红素3，白蛋白37，谷丙 ...

版主的建议十分正确，我老爸就是这样的情况，射频赢得了宝贵的4年，然后再肝移植。肿瘤3x4cm,浙一医蒋天安主任做的。

nicholasyin

但是小肝癌直接选择肝移植也不是没有，而且国外也流行。像你爸应该符合“米兰标准”，手术成功率100%，5年生存率75%，是任何手段治疗都无法比的。目前，国内肝癌移植后复发多，只是大量不符合“米兰标准”和“杭州标准”的患者“以最后一搏”的心理实施了肝移植的结果。
“据浙一医最新统计：符合“杭州标准”的5年生存率78%左右；
据北京大学人民医院肝胆外科2010年统计：该院9年里符合米兰标准的89例中只有7例复发，复发率7.8%；超出米兰标准的112例中有78例复发，复发率69.6%。”
可见尽早选择肝移植也是一种明智的选择。

金秋晨曦

感谢版主及所有专业人士热心人士的耐心回答，在近两个月中我学到了不少，心绪也越来越趋于平稳，父亲的情况您们这样不厌其烦地加以解答，我真的是感动至深，甚至好多在医院里没法细问管床大夫及科主任的问题我也拿到这里来问。大家各自的角度和专业的知识给我很大帮助。父亲也说以后要加入论坛。我会在这段时间里不断地将他的情况上报大家，过几天我想办法还是把片子上传，这样我想版主及各位专业人士应该是更能准确地了解父亲的情况。再次谢谢大家！祝好人一生平安！

fangfanfxiaohe

看了以后很有收获，这个论坛对我的帮助太大了，到医院就不能上网了，希望我能顺利，早点做移植。

cymcmqz

无意中翻到这个就贴，收获很大！谢谢各位！！