Recurrence of liver cancer, liver cancer recurrence rate after resection is very high. According to the Shanghai Medical University, Liver Research Institute, the past of large hepatocellular carcinoma after curative resection 5-year recurrence rate was 61.5%, 43.5% of small liver cancer also. Analysis of 308 cases in recent years, preoperative fetoprotein-positive, liver resection AFP decreased to normal cases (radical resection is more reliable), the 1,3,5,10 year recurrence rates were 9.2%, 38.8% , 54.1%, 85.0%. Recurrence rate of liver cancer 3 years ago was the highest, generally after 2 years of high incidence of. Cancer recurrence after resection of advanced liver cancer mortality. Recurrence is common in the liver, a small number of lung, bone and other parts of the transfer. Recent (1_2 years) relapsed within months, mostly in the primary tumor intrahepatic metastasis, long-term (2_4) of intrahepatic recurrence occurred is a lot of those multi-center. Depending on the recurrence of the type to take a different treatment strategies, such as a single center, consider re-excision; the case of multi-center, intervention and comprehensive treatment should be taken.
Once the recurrence of cancer, the earlier the removal of the smaller the better, since most associated with cirrhosis of the liver, partial resection for the surgical resection is usually longer, and some patients can be 2 or 3 times implemented the re-excision. But then all of recurrence of liver cancer resection in the proportion of patients is still small, mainly due to late diagnosis of recurrence of the time, missed the opportunity of re-resection. At the same time, then surgery is only applicable to a good performance status, normal liver function, Yuan Huang disease, meta ascites, the limitations of single or small number of cancer nodules.
In addition, the site of recurrence of liver cancer, pathology, hepatic portal violations also affect the effect of re-excision. Resection of cancer recurrence rate was 25% _35%, the 5-year survival rate was 35% _75%. If surgery is not suitable for patients who use other non-surgical treatments such as percutaneous hepatic arterial chemoembolization (TACE), also can control tumor development and prolong survival time, create conditions for the re-operation.
How to prevent liver cancer recurrence after surgery
(1) before surgery to prevent recurrence of liver cancer:
First to perfect the routine and special inspections. Proposed line of CT, not only to understand the lesion site, size, violations, you can learn a million other metastases to avoid missing patients. AFP testing is conducive to understanding and monitoring of the Yuan residual postoperative recurrence. Percutaneous transcatheter arterial embolization (TAE) or chemoembolization (TACE) for resectable liver cancer usually do not advocate the application, but the TACE for unresectable HCC is an effective way to shrink the tumor.
(2) liver cancer prevention during the operation:
Mainly the application of methods to reduce residual cancer and the cancer spread. resection: small liver cancer 1 cm, 2 cm large hepatocellular carcinoma. thrombosis and cancer spread: the formation of liver cancer invasion to the portal vein tumor thrombus, surgical operation in the fall planting in other parts of the liver, liver cancer recurrence may be the most important reason. Therefore, we should pay attention to surgical techniques, action should be gentle, do not squeeze the tumor, so as to avoid tumor spread. surgery assistant examination, since many patients with liver cirrhosis, intraoperative touch hard to find deep in the small liver nodules, it is difficult to avoid the omission. B-detection technique can be found in small liver nodules, and facilitate the adjustment of the scope of surgery can significantly reduce the residual tumor and reduce recurrence. But it also increased the possibility of surgical infection, prolonged operative time, higher technical requirements and other shortcomings. Others: the first cut or frozen microwave coagulation of the first re-resection surgery to reduce the spread hope and kill the residual tumor margin, thereby reducing the recurrence rate, but its complicated to operate, and the present results is uncertain. There are also home surgery after tumor resection or hepatic artery hepatic artery portal vein catheterization equipment prophylactic regional chemotherapy or chemoembolization.
HCC recurrence (3) prevention of liver cancer recurrence after surgery:
Exploration after TACE, biological treatment to reduce the recurrence rate. Data and literature, supplemented by immune therapy help to reduce postoperative recurrence rate. Although in recent years for a variety of clinical exploration, also reported a certain effect, but persuasive, rigorous randomized controlled clinical rarely reported.
Early detection of recurrent cancer is important, the sooner the better. The past, because that late recurrent lesions have a larger line of re-excision ineffective. Therefore, after periodic review, the long-term follow-up is extremely important. At present, most scholars believe that liver cancer is the recurrence rate within 2 years after the most dangerous period. Therefore, patients should be regularly reviewed 5-10 consecutive years. For all patients after radical resection line every 3 months to once AFP and B-, if necessary, supplemented by CT. The earliest signs of relapse is increased AFP, but there are also negative for AFP, the imaging findings of cases. Because the location of recurrent nodules and liver resection is not a constant image of the liver, B-ultrasound in the diagnosis and the position may be difficult. On difficult cases, selective hepatic arteriography obtained good results, especially with shy of oil combined imaging and CT examination, often can be found in nodules of about 1.0 cm, and can determine the original liver cancer parts of the relationship. In addition, scholars from the pathological level, cellular level and molecular level, and in the serum specimens studied, to find a more sensitive marker for tumor recurrence and metastasis to be predicted before the occurrence of metastasis and recurrence. Preliminary findings are: some oncogenes, growth factors and other factors correlated with the invasiveness of hepatocellular carcinoma: pI6 (CDKN2) mutation, p53, p2I, H-ras, c-erbB-2, mdm2, transforming growth factor (TGF) a, epidermal growth factor (EGF) receptor, vascular endothelial growth factor (VEGF) and its receptor (KDR) mRNA, plasminogen activator inhibitor (PAl-I), thrombomodulin (thrombomodulin), etc.; some is a negative correlation: nm23-Hl gene, Kai-I gene, TlMP-2 and so on. Some of the extracellular matrix was positively correlated with the invasiveness of hepatocellular carcinoma: matrix metalloproteinase (MMR cushions 2), intercellular adhesion molecule I (IeAM-I); while others was a negative correlation: as epithelial cadherin (cadherin), integrin 5 (integrin (5) and so on. But so far, have not yet found a recurrence of liver cancer closely related to that specific and sensitive tumor marker.
Once past that liver cancer recurrence or metastasis after surgery to not further surgery. This is due to a lack of early detection and early diagnosis methods, such as patient symptoms, recurrent lesions are large, even if re-resection, its efficacy is similar with conservative treatment. At present, if found subclinical recurrence, then the rule of re-resection of small hepatocellular carcinoma after resection is similar. 5-year survival counting from the first surgery was 56%, counting from the second surgery was 35%, much higher than surgical 5-year survival rate (counting from the first surgery was 29%, from the first second operation counting for 2%). Feasible for local treatment of unresectable, and strive to reduce the post-resection.
The high liver cancer recurrence rate after resection of liver resection may be pathological and biological characteristics of tumor related, such as vascul
ar invasion, tumor number, DNA ploidy, postoperative adjuvant therapy, TNM stage, capsular invasion, satellite knot Day, liver cirrhosis, intraoperative ultrasound application, the country-operative blood transfusion, postoperative retention and many other factors related to cancer. Among them, the formation of liver cancer invasion to the portal vein tumor thrombus, surgical operation in the fall planting in other parts of the liver, liver cancer recurrence may be an important reason. Comparison of recurrence after 5 years of domestic and non-recurrent group data show that: the census found, glutamyl cool switch for a skin enzyme (-GPT) value is low, TNM staging early tumors of 5 cm, portal vein tumor thrombus Yuan, surgery supplemented after the other six indicators of immune therapy is a major factor in recurrence rate. Second Military Medical University, one of 142 patients with recurrent liver cancer study shows that primary cancer> 5 cm was 71.1%, 67.7% were incomplete or not coated capsule biopsy for visible satellites nodules 66.2%, pathological visible portal vein tumor thrombus was 85.2%. Thus, late stage cancer lesions easier to relapse. Patients are required to strictly operate closely with the patients need to reduce the impact of cancer recurrence controllable human factors.
Recurrence of liver cancer, liver cancer after surgery (AFP) AFP to determine the dynamic curve of the radical surgery or not, estimate the prognosis and prediction of recurrence of great significance. Usually about 4-8 weeks after surgery AFP became negative. Drop or fall if not more, or cut down without a net rise is undone, local recurrence or metastasis has been a sign. But the original AFP-positive hepatocellular carcinoma, recurrence can also be negative for AFP, it must meet the ultrasound, so as not to miss. Of course, AFP can also be a false positive, such as hepatitis, cirrhosis, embryonal carcinoma, gastric cancer (especially liver persons) and so on. However, some small number of scholars believe, AFP had no correlation with tumor recurrence.
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