| Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Although liver transplantation has provided an alternative option of surgical management for HCC, partial hepatic resection remains the mainstay of treatment offering a hope of cure. With advances in surgical techniques and perioperative care, immediate results of hepatic resection for HCC have greatly improved. In recent years, surgeons in experienced centers have achieved a hospital death rate close to zero. However, the long-term prognosis after resection of HCC remains unsatisfactory, and improvement of the long-term survival is the next target of surgeons. A 5-year survival rate of 40% to 50% has been reported in recent series from Eastern and Western centers, but a high incidence of postoperative recurrence is universal and continues to be the main cause of late deaths. The cumulative 5-year recurrence rate was in the range of 75% to 100% from most centers. Recurrence occurs in the liver remnant in 78% to 96% of cases, as a result of either intrahepatic metastasis from the primary tumor or multicentric occurrence.People have tried a number of approaches to prevent recurrence, post-operative TACE is one of the most adjuvant therapies to control the growth of HCC. However, the studies on post-operative TACE have yielded conflicting results. Most domestic researchers suggested that patients using TACE after hepatic resection obtained superior disease-free survival results compared with untreated patients. They think that post-operative TACE can improve disease-free survival and overall survival. Whereas, other randomized control trial performed by foreigners failed to demonstrate a beneficial effect. Their results showed that the recurrence rate and extrahepatic metastasis rate were higher in post-operative TACE group.Post-operative active or adoptive immunotherapy became a very attractive cancer treatment modality in early 1990s because of a series of successful animal experiments. However, it turned out to be not so effective as expected in a number of clinical trials. In recent years, the intriguing ability of GM-CSF to enhance antitumor immunity wasidentified through an in vivo screen of a large number of immunostimulatory molecules. Initial clinical evaluation of GM-CSF based tumor vaccines has demonstrated the consistent induction of immunity without significant toxicity. Active clinical programs are under way for patients with malignant melanoma, leukemia, multiple myeloma and carcinomas of the lung, ovary, prostate, pancreas and kidney and showed good results. There is no report of GM-CSF based tumor vaccine using in hepatocellular carcinoma.In this study, the data of our consecutive 823 patients who underwent liver resection for HCC from Oct. 1996 to Sep. 2001 was retrospectively analyzed for evaluation of prognostic factors that might affect recurrence rates, the effect of postoperative TACE and the best opportunity and number of times of TACE. The disease-free survival of patients with different risk factor for recurrence was also compared for clarifying the appropriate indication for such adjuvant treatment. Moreover, we reported a phase I clinical trial of cancer personalized immunotherapy of sino-gene and prospectively observed its clinical effect of inhibiting in HCC recurrence.1. High risk factors for recurrence after hepatic resection Aims To evaluate prognostic factors that could affect disease-free survival and recurrence after liver resection for hepatocellular carcinoma (HCC). Methods A total of consecutive 823 patients with hepatocellular carcinoma from Oct. 1996 to Sep. 2001 were included in this study. All patients underwent hepatic resection. Variables might related with recurrence including sex, age, preoperative AFP level, vascular invasion, resection margin, tumor rupture, tumor size, number of nodule, tumor capsule and post-operative TACE were used in the multivariate analysis using the Cox proportional hazard model to analyze factors affecting intrahepatic recurrence. All analyses were carried out using SAS6.12 and SPSS. Results On multivariate analysis by Cox proportional hazard model, younger HCC patients, presence of vascular invasion, presence of tumor rupture, larger in tumor diameter, presence of multiple nodules were significantly related to a higher incidence of tumor recurrence. Wider clearance resection margin and post-operative TACE were significantly related to a lower incidence of tumor recurrence Conclusion Appropriate measures adopted pre-, during and post-operative may improve disease-free survival and overall survivalespecially in patients who possess high risk factors for recurrence.2. The role of post-operative TACE for patients with resectable hepatocellular carcinoma in disease-free survival and overall survival Aims To evaluate the effect of post-operative TACE in inhibiting recurrence and prolong survival for patients with resectable HCC postoperatively. Methods A total of consecutive 823 patients with hepatocellular carcinoma from Oct. 1996 to Sep. 2001 were included in this study. All patients underwent hepatic resection. Among them 126 patients received postoperative transcatheter arterial chemoembolization. The disease-free survival rate of the patients who was treated with or without postoperative TACE was observed. All analyses were carried out using SAS6.12 and SPSS. Results On multivariate analysis by Cox proportional hazard model, the result showed that postTACE improved disease-free survival and overall survival. The significant difference only occurred in one and two years disease-free survival rates when it was compared for the patients who received of did not received postoperative TACE. Conclusion Post-operative TACE might be effective for the patients who had HCC expressing early recurrence characteristic. Our results which'indicated the post-operative TACE play significant role in anti-recurrence within two years after hepatic tumor resection suggested that it be effective for the micro-metastasis foci from uni-centric HCC or successive lesions from multi-centric origin with relative shorter lags.3. The role of post-operative TACE in patients with different pathological characteristics Aims The purpose of this study was to evaluate the effectiveness of transcatheter arterial chemoembolization on postoperative recurrence of hepatocellular carcinoma with different risk factor for recurrence. Methods A total of consecutive 823 patients with hepatocellular carcinoma from Oct. 1996 to Sep. 2001 were included in this study. All patients underwent curative liver resection. The 126 patients (15.3%) received postoperative transcatheter arterial chemoembolization and the 697 patients (84.7%) did not receive this treatment. The effect of postoperative TACE on the recurrence of hepatocellular carcinoma with different pathological characteristics such as tumor size, tumor capsule, number of nodules, vascular invasion and surgical margin was analyzed in this study. Results Postoperative TACE can not decrease recurrence rate for the patientswith tumor diameter less than 3cm. Postoperative TACE can increase the disease-free survival for patients with tumor diameter between 3-1 Ocm, positive in AFP, present vascular invation or patients with tumor diameter larger than 10cm, positive in AFP, mutl-nodular, present vascular invation, resection margin less than lcm. Conclusion Postoperative adjuvant TACE can decrease recurrence and prolong the survival of patients with high risk factors for recurrence, but can not benefit the patients without risk factors for recurrence.4. The best opportunity and number of times of post-operative TACE Aims To evaluate the opportunity and number of times of post-operative TACE in inhibiting recurrence for patients with resectable HCC postoperatively. Methods A total of 126 patients with hepatocellular carcinoma from Oct. 1996 to Sep. 2001 were included in this study. All patients underwent hepatic resection and received postoperative TACE. A total of 823 patients with hepatocellular carcinoma from Oct. 1996 to Sep. 2001 were included in this study. All patients underwent hepatic resection. Variables might related with recurrence including sex, age, preoperative AFP level, vascular invasion, resection margin, tumor rupture, tumor size, number of nodule, tumor capsule and number of times of post-operative TACE were used in the multivariate analysis using the Cox proportional hazard model to analyze factors affecting intrahepatic recurrence. The disease-free survival rates were analyzed between groups which accepted different number of times of post-operative TACE. Results The less number of times of postTACE improved disease-free survival for patients with resectable HCC postoperatively compared with more number of times. Conclusion More times of post-operative TACE might excess restrain the immunological function of patients. Thus will lead small metastatic cells or precancerous lesion developed into an entity tumor. More times of TACE will cause occlusion of artery which would decrease the effect of TACE. Post-operative TACE should be performed as early as liver function recovered, at that time TACE can block the tumor blood supply and kill tumor cells timely.5. Clinical research of cancer personalized immunotherapy of sino-gene in recurrence as individual immunotherapy postoperatively Aims We conducted a phase I...
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