Interventional treatment of primary liver cancer

Primary hepatocellular carcinoma is one of the common malignant tumors worldwide, with Asia and Africa being the most common. Its incidence rate is about 10 people/100,000 of the population, and about 260,000 cases of liver cancer occur annually in the whole team community, 45% of which occur in China. Every year, 110,000 people die from liver cancer. The overall efficacy of liver cancer treatment is still unsatisfactory, and further improvement of liver cancer treatment level will depend on the continuous breakthrough of new technologies, new methods and basic research. At present, only about 20% of the liver cancer cases in China are fully suitable for surgical resection. Liver cancer is highly malignant and highly susceptible to early dissemination and metastasis: many cases with combined chronic liver disease are multicenter, with an incidence rate of 22%-48%, and the recurrence rate is high after surgery. Recurrence is an important factor limiting the surgical treatment and affecting the long-term outcome, which can reach 50%-60%. The vast majority of hepatocellular carcinoma still prefer non-surgical methods based on interventional therapy. How to utilize the existing treatment methods to improve patient survival is the primary issue facing clinicians at present. In normal liver, 25% of blood supply comes from hepatic artery and 75% from portal vein. The blood supply of hepatocellular carcinoma mainly comes from the hepatic artery. As long as the blood flow of hepatic artery is blocked, the tumor can be ischemic necrosis and achieve the therapeutic effect. A lot of angiographic clinical materials show that primary hepatocellular carcinoma with diameter >2 cm, except for a few diffuse type or sclerotic small nodule type (about 5-7%), all of them are multi-blood supply type of hepatic artery. Since Goidstein pioneered the successful treatment of hepatic artery chemoembolization (TACE) for hepatocellular carcinoma in 1996, hepatic artery embolization has been recognized as an important treatment method for inoperable mid- to late-stage hepatocellular carcinoma. After many years of treatment practice, it has been recognized in domestic and international literature that TACE can improve the quality of life and prolong the survival of patients, and it is safer and has fewer serious complications. In Japan, the survival rates of patients with primary liver cancer treated with TACE were 80.4%, 62.9% and 28% in 1 to 3 years, respectively. Tumor shrinkage and second-stage resection after TACE treatment accounted for 6.2%-11.2% of the total number of TACE cases, and the 5-year survival rate of those with second-stage resection was similar to that of those with small hepatocellular carcinoma. In a few cases, the tumor shrinks and disappears after multiple TACE and combination therapy. Some of them have survived for more than 10 to 20 years and achieved the basic curative effect.