【Abstract】ObjectiveTo analyse the current situation and advance in perioperative therapy of liver transplantation for primary hepatocellular carcinoma(HCC).MethodsThe published papers on current situation and advance in the perioperative therapy of liver transplantation for HCC were reviewed.ResultsThe survival rate of liver transplantation for HCC in early stage has been the same as that for benign liver diseases up to now. However, it is still a difficult problem to improve the survival rate of liver transplantation for advanced HCC. The ideal perioperative therapies of liver transplantation for HCC should be helpful to suppress the growth of tumor while the HCC patients are waiting for donated livers, to diminish or eliminate the intraoperative spread or implantation of tumor cells and to repress the micrometastasis postoperatively. The current perioperative therapies of liver transplantation for HCC include hepatic arterial chemoembolization, systemic chemotherapy, radiotherapy, percutaneous ethanol injection into HCC and radiofrequency ablation etc. ConclusionThe perioperative assistant therapy of HCC can not only save time for patients before liver transplantation but also improve the survival rate after operation.
ObjectiveTo study the clinical value of changes of serumα-fetoprotein(AFP) and soluble cell adhesion molecule-1(sICAM-1) levels before and after surgical treatment of primary hepatocellular carcinoma(PHC) as predictors of patient survival. MethodsThe clinical data and followed-up results of 86 patients with hepatocellular carcinoma received hepatectomy or radiofrequency ablation(RFA) in Xijing Hospital and the 451st Hospital of PLA were retrospectivly analyzed. The changes of peripheral blood AFP and sICAM-1 levels in patients before and in 1 month after treatment were observed and all patients were divided into different groups according to the changes in both two markers. Then survival rates of each group were analyzed. ResultsThe patients with AFP < 20μg/L or sICAM-1 < 1 000 U/L before treatment had lower tumor recurrence rate and higher survival rate than patients with elevated serum levels of the both markers(AFP:P=0.018, P < 0.001;sICAM-1:P=0.027, P < 0.001). The larger tumor, late TNM stage, and higher rate of recurrence were associated with elevated serum levels of the both markers(AFP:P=0.016, P=0.026 and P=0.025;sICAM-1:P < 0.001, P=0.024 and P=0.032). The better survival situation was closely related with these cases treated with hepatectomy and their levels of both markers were lower than the above cutoff values both before and after treatment, or leves of both markers above the cut-off values returned to within the normal range after treatment (AFP:P=0.006, P=0.001;sICAM-1:P=0.001, P=0.002). The patients who had simultaneous increase of AFP and sICAM-1 after operation showed the worst tumor-free and overall survivals(P=0.007, P < 0.001). ConclusionTo test the changes of serum AFP and sICAM-1 levels in early stage after treatment for patients who received radical resection of hepatocellular carcinoma has good clinical value for monitoring of tumor recurrence and predict prognosis.
We have devised a highly sensitive, specific, and quantitative assay for multidrug resistance (mdr1) mRNA expression based on the reverse transcription-polymerase chain reaction (RT-PCR). mdr1 mRNA levels were detected in 30 human primary hepatocellular carcinoma (PHC) tissue and adjacent liver tissue. Five of the patients had received chemotherapy before hepatectomy. The results show that the level of expression of mdr1 gene is higher in tumor tissue than in adjacent liver tissue. mdr1 gene is overexpressed in PHC after chemotherapy. Furthermore, mdr1 gene expression in the treated tumor adjacent liver tissue is higher than that in untreated tumor adjacent liver tissue. Our results indicated that overexpression of mdr1 gene may be responsible for the intrinsic and acquired drug resistance of PHC.
【Abstract】Objective To investigate the influence of hepatectomy combined with splenectomy on curative effect of primary hepatocellular carcinoma patients associated with hypersplenism.Methods Twenty three cases of primary hepatocellular carcinoma associated with hypersplenism were analyzed retrospectively and divided into hepatectomy combined with splenectomy group (n=10) and hepatectomy combined with ligation of splenic artery (n=13). Peripheral blood samples were collected 1 week before operation and 3 monthes after operation respectively. The levels of CD4, CD8, CD16, CD4/CD8, WBC and PLT in the blood were detected. Survival rate between the two groups was compared. Results There were not significant differences in the expressional levels of CD4, CD8, CD16, CD4/CD8,WBC and PLT before operation, bleeding quantity during the operation and rate of severe complications after operation in the two groups. The expressional levels of CD4, CD16, CD4/CD8, WBC and PLT of hepatectomy combined with splenectomy group were much higher in 3 months after operation than those in 1 week before operation and in hepatectomy combined with ligation of splenic artery group (P＜0.01) and the latter with no distinct changes of the above indexes. There was no difference of survival rate between the two groups. But in the hepatectomy combined with ligation of splenic artery group, 7 patients of 13 patients were compelled to terminate chemotherapy because of their low WBC while not a single patient was forced to do so in the hepatectomy combined with splenectomy group. Conclusion Hepatectomy combined with splenectomy is useful for patients with hepatocellular carcinoma associated with hypersplenism to restore the immunological function and the application of chemotherapy after operation.
Objective To investigate the expressions of X-linked inhibitor of apoptosis protein （XIAP） and survivin in primary hepatocellular carcinoma tissues，and to explore the relationship between them. Methods The expressions of XIAP and survivin protein in 38 primary hepatocellular carcinoma tissues and 16 paracancerous tissues were detected by using immunohistochemistry and the expressions were scored. Results The positive expression rate of XIAP and survivin in primary hepatocellular carcinoma tissues was 81.6% （31/38）and 78.9% （30/38），respctively （P＜0.001）， and in paracancerous tissues was 12.5% （2/16）and 6.3% （1/16）， respectively （P＜0.001）. The score of XIAP expression in the well， middle，and low differentiated tissues of primary hepatocellular carcinoma was （2.91±1.31），（9.27±3.25）， and （13.08±2.26） score， respectively （F=118.948，P＜0.001）， and the score of survivin expression was （4.85±1.83）， （11.08±3.72），and （13.38±1.76） score， respectively （F=72.202，P＜0.001）. They both significantly correlated with the histological grade，but not with the size of tumor（P＞0.05）. There was significantly correlation between the expression intensity of XIAP and survivin in primary hepatocellular carcinoma tissues （r=0.764， P＜0.001）. Conclusions The expression intensity of XIAP and survivin in primary hepatocellular carcinoma tissues are both related with the differentiation of primary hepatocellular carcinoma. The expression intensity of XIAP is related with the survivin， and they may play an important role in the tumor progression and chemical resistances.
Objective To compare the positive rate of zinc finger protein A20， NF-κB p65 protein， and P-glyco- protein between primary hepatocellular carcinoma （HCC） tissues and paratumor tissues， and to explore the relationship between the 3 kinds of proteins and pathological features of HCC. Methods Thirty-two HCC tissues and 26 paratumor tissues resected from patients with HCC treated in our hospital from Feb. 2009 to Aug. 2010 were enrolled. Clinical data were also collected from files. The expressions of zinc finger protein A20， NF-κB p65 protein， and P-glycoprotein were tested by immunohistochemistry. Results The positive rate of zinc finger protein A20， NF-κB p65 protein， and P-glycoprotein in HCC tissues were 87.5%（28/32）， 81.3%（26/32）， and 65.6%（21/32）， respectively， which were higher than that in paratumor tissues〔61.5%（16/26）， 34.6%（9/26）， and 30.8%（8/26）， respectively〕， P＜0.05. The three kinds of proteins were all closely related with HbsAg， and zinc finger protein A20 was related with cirrhosis in addition （P＜0.05）. Conclusions The positive rate of zinc protein A20， NF-κB p65 protein， and P-glycoprotein are much higher in primary HCC tissues than that in paratumor tissus， and they may play an important role in preoperative determination of hepatic tumors.
ObjectiveTo evaluate therapeutical effects of Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection of primary hepatocellular carcinoma with microvascular invasion. MethodsThe clinical data of 45 cases of primary hepatocellular carcinoma with microvascular invasion underwent Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection from June 2010 to June 2013 in Liaoning Cancer Hospital were retrospectively analyzed. These patients were divided into Huaier granule plus TACE treatment group (20 cases) and simple TACE treatment group (25 cases) according to the postoperative treatment of the patients. The immune function (CD4+/CD8+ ratio and IL-2 level), 1and 3-year tumor recurrence rates and 3-year cumulative survival rate were compared between two groups after operation. Result① The CD4+/CD8+ ratio and IL-2 level had no significant differences between the 2 groups before operation (P > 0.05), which in the Huaier granule plus TACE treatment group were significantly higher than those in the simple TACE treatment group (P < 0.05) on month 3, 6, and 12 after operation.② 1and 3-year tumor recurrence rates in the Huaier granule plus TACE treatment group were significantly lower than those in the simple TACE treatment group[15% (3/20) versus 48% (12/25), P < 0.05; 45% (9/20) versus 80% (20/25), P < 0.05]. ③ The 3-year cumulative survival rate was 75% and 68% in the Huaier granule plus TACE treatment group and the simple TACE treatment group, respectively. The survival curve analysis showed that the 3-year survival rate had a decreased trend, which in the Huaier granule plus TACE treatment group was slightly higher than that in the simple TACE treatment group, but the difference had no statistical significance between the 2 groups (P > 0.05). ConclusionsAlthough the results of this study fails to confirm that Huaier granule plus TACE treatment for primary hepatocellular carcinoma with microvascular invasion following radical resection could significantly improve the 3-year cumulative survival rate, it could effectively decrease the recurrence rate. It is needed larger sample size to further explore in future research.
Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating primary hepatocellular carcinoma (HCC). Methods From March 2004 to March 2006, 137 patients with primary HCC underwent TACE alone (n=87) and TACE+RFA (n=50), respectively, after the interventional treatment, all patients periodically received CT reexaminations and alpha fetoprotein (AFP) measurement. The therapeutic efficacy, AFP level and survival rate between two groups were compared with each other. Results In TACE group the effective rate (CR+PR) was 34.5%, AFP decreasing amplitude was 54.2%, and 2 years survival rate was 43.7%. While in TACE+RFA group, the effective rate (CR+PR) was 70.0%, AFP decreasing amplitude was 78.0%, and 2 years survival rate was 62.0%, there were significant differences between two groups (P＜0.05). Conclusion Combined application of TACE and RFA is significantly superior to TACE alone in treatment of primary HCC.
Objective To assess the survival of patients receiving high intensity focused ultrasound (HIFU) and investigate the prognostic factors for primary hepatocellular carcinoma (PHCC) victims with HIFU application. Methods One hundred and eighty-seven patients with PHCC undergoing HIFU treatment in our department were enrolled into this study from June 2004 to June 2007. Among them, 101 patients were males and 86 were females (mean age: 47.7 years old, range: 19-79 years old). The average tumor size was 5.7 cm (range: 0.5-18.0 cm). Of these 187 patients, numbers according to Child-Pugh grade of A, B and C were 104, 52 and 31, respectively. According to TNM system, 45, 111 and 31 patients were in stage Ⅱb, Ⅲa and Ⅲb respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Results Survival period was (17.3±2.5) months after HIFU treatment of PHCC. The overall survival rate of 3-month, 6-month, 1-year and 2-year were 79.1%, 60.1%, 35.7%, and 29.3%， respectively. It was significant that tumor number (P=0.02), size (P=0.04)， AFP (P=0.04)， Child-Pugh grade (P=0.00)， TNM stage (P=0.01)， tumor metastasis (P=0.03) before HIFU， and tumor recurrence after HIFU (P=0.02) and standard treatment (P=0.02) were prognostic factors by single factor analysis. The following factors were identified as independent prognostic factors for overall survival by multivariate model: standard treatment protocol (P=0.000), and TNM stage (P=0.004) and Child-Pugh grade (P=0.009) before HIFU. Conclusion It is used for improving overall survival rate to found PHCC early, protect liver function, examine comprehensively before HIFU treatment, focus on standard treatment and auxiliary treatment.
ObjectiveTo systematically review clinical value of des-γ-carboxy prothrombin (DCP) in the diagnostic of primary hepatocellular carcinoma (PHC).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Medline (Ovid), CNKI, VIP, WanFang Data and CBM were electronically searched to collect relevant studies on DCP in the diagnosis of PHC from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software and RevMan 5.3 software.ResultsA total of 50 studies involving 15 099 cases were included. The results of meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio and area under the curve of SROC were 0.69 (95%CI 0.67 to 0.70), 0.89 (95%CI 0.89 to 0.90), 7.35 (95%CI 6.08 to 8.90), 0.31 (95%CI 0.27 to 0.35), 26.63 (95%CI 20.42 to 34.73) and 0.909 9, respectively.ConclusionsSerum DCP has higher diagnostic efficacy for PHC, especially with higher specificity of diagnosis. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.