Wei Tc

Serum α-Fetoprotein in the Early Stage of Human Hepatocellular Carcinoma

The serum alpha-fetoprotein levels of 17 patients with cancers less than or equal to 3 cm in size were studied using radioimmunoassay to determine alpha-fetoprotein response in the early stage of human hepatocellular carcinoma. The levels were normal in 6 patients (35%), and elevated to 645 +/- 1140 micrograms/L (mean +/- SD) in the remaining patients. The levels were not correlated with tumor size. In 10 surgically resected patients, 5 had elevated levels of alpha-fetoprotein that returned to normal after surgery. The levels and tumor sizes were serially observed for 3-26 mo in the remaining 7 patients not surgically treated. In 1 patient alpha-fetoprotein levels were persistently normal and in the other 6 patients, the levels tended to increase with a median doubling time of 60-75 days (range 30-223 days). Despite continued tumor growth, a spontaneous fall in serum alpha-fetoprotein levels was encountered in 4 patients; in 2 patients the levels even fell within the normal range. After this fall, the levels increased drastically in 4 patients. We concluded that in the early stage of hepatocellular carcinoma, serum alpha-fetoprotein level is frequently normal, and thus determination of serum alpha-fetoprotein levels only is not a reliable indicator in the early detection of human hepatocellular carcinoma. A spontaneous fall in the level of alpha-fetoprotein is not an uncommon finding in the early stages of this cancer and cannot be used to rule out the diagnosis of hepatocellular carcinoma.

Clinicopathologic Characteristics of Helicobacter Pyloric Seropositive Gastric Adenocarcinomas

To compare and characterize retrospectively the clinicopathologic features of gastric cancers with and without previous Helicobacter pylori infection, we determined the preoperative seropositivity of H. pylori in 151 patients who had undergone gastric resection for primary gastric adenocarcinoma between 1988 and 1993. The overall seroprevalence of H. pylori was 60.9%. H. pylori-positive gastric cancers were frequently associated (p<0.05) with macroscopic localized types (Borrmann I and II) in which negative cancer associated with infiltrative types (Borrmann III and IV) and cancer invasion of the duodenum. Multivariate analysis showed that H. pylori seropositivity was not an independent prognostic factor. Pathologic tumor-node-metastases (TNM) stage remained the only prognostic indicator. Our study suggests that H. pylori has a significant impact on the clinically relevant tumor biology of gastric cancer. Investigation along this line is warranted.

The Role of Extended Lymphadenectomy and Adjuvant Immunochemotherapy for Gastric Cancer

To evaluate recent improvements in gastric cancer surgery, we performed a retrospective analysis of data from 482 patients who underwent primary gastrectomies from 1978 to 1987 (the recent group) and 264 patients who had been treated from 1965 to 1973 (the early group). Radical gastric resection with R2/3 lymphadenectomy was the standard procedure in the recent group as compared to a simple gastrectomy in the early group. In addition, postoperative long-term adjuvant immonochemotherapy with 5-fluorouracil, Mitomycin C, and PSK (Krestin) was given to 169 (35.1%) patients of the recent group. There were no significant differences in the characteristics of patients and location, stage or histological classification of gastric cancer between these two groups. Early gastric cancers accounted for 11.5% of the patients in the early group and 14.7% of the patients in the recent group. The resection rate increased from 57.8% to 686.7% and the 5-year survival rate increased from 24.7% to 37.9%. A comparison of patients with simple gastrectomies and those with radical gastrectomies showed a slight increase in the 5-year survival rate from 24.7% to 35.9% (p＜0.05). The advantage of radical resections was limited to patients at early stages and those with serosa invasion but without lymph node involvement. Patients who received adjuvant immunochemotherapy after radical gastrectomy had a 5-year survival rate of 41.5% an insignificant difference (p＞0.05) compared to 35.9% of those who received radical gastrectomy alone. However, fro patients with serosa invasion, combined adjuvant immunochemotherapy after curative resction was associated with an increased survival rate from 37.8% to 63.9% (p＜0.05). For patients with lymph node involvement, adjuvant immunochemotherapy was also associated with an increased survival rate from 10.4% to 26.4% (p＜0.01). In conclusion, the survival of gastric cancer patient after surgery appeared to have improved recently. The advantages of the radical gastrectomy seemed limited fro patients at an early stage, especially for those without lymph node involvement. For patients with advanced gastric cancer with serosa and lymph node involvement, adjuvant immunochemotherapy may be beneficial in addition to extended lymphadenectomy. Further randomized, controlled trials are warranted to clarify these issues. (Tzu Chi Med J 1994;6: 153-161)

Transcatheter Arterial Embolization Therapy for Metastatic Neoplasms of the Liver

Hepatic transcatheter arterial embolization was performed in 32 patients with metastatic neoplasms in the liver. The procedure required injection of Gelfoam suspension through the transfemorally placed angiographic catheter and aimed to achieve a whole-liver embolization. Prominent necrotic change of the metastatic foci as demonstrated by computed tomography occurred in 25 patients; 12 of 13 from colorectal cancer, 3 of 3 from breast cancer, and 3 of 5 from gastric cancer. Patients with hepatomegaly had regression of the liver size after embolization. Angiographically hypervascular metastatic lesions did not show better response to TAE than hypovascular ones. Epigastralgia, nausea, vomiting, fever, and alteration of liver function were the side effects and these side effects subsided in 1 to 2 weeks. There was no necrotic change of the non-tumorous hepatic parenchyma. We conclude that metastatic hepatic neoplasms may be treated by TAE.