Objective To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.
ObjectiveTo investigate the expression of gasdermin (GSDM) gene family in primary liver cancer and its clinical significance. MethodsThe Gene Expression Profile Data Dynamic Analysis (GEPIA2) database was used to analyze the expression levels of GSDM gene family in primary liver cancer and normal tissues, and survival analysis was performed to explore its relationship with prognosis; GEPIA2 database was used to explore the relationship between GSDM gene family and TNM staging of patients with primary liver cancer. We used GeneMANIA database to predict genes that may interact with GSDM gene family, and used Metascape website for functional enrichment analysis. Finally, we used TIMER database to explore the relationship of expression of GSDM gene family and immune cell infiltration in the tumor microenvironment of primary liver cancer. ResultsCompared with normal liver tissues, GSDMA, GSDMC, GSDMD, and GSDME were highly expressed in primary liver cancer (P<0.050), and GSDMB and DFNB59 were low expressed (P<0.050); results of univariate Cox proportional hazard regression model showed that the differential expressions of GSDMD, GSDME, and DFNB59 were related to the overall survival of patients (P<0.050), and the results of the multivariate Cox proportional hazard regression model showed that GSDME could be used as an independent predictor of the prognosis of liver cancer patients (P<0.050). With the increase of TNM staging in patients with liver cancer, the expressions of GSDMA and GSDMC also gradually increased (P<0.050). Further enrichment analysis showed that the GSDM gene family was involved in pyrolysis and various immune-related biological processes. ConclusionThe GSDM gene is differentially expressed in primary liver cancer, participates in immune-related biological processes, and its expression is related to clinicopathological staging and patients’ prognosis.
Based on the experience of more than 10 000 times of radiofrequency ablation treatment and the clinical and basic research results of radiofrequency ablation treatment of liver cancer obtained during the period, the author shares the experience of radiofrequency ablation indication selection, preoperative preparation, concept of radiofrequency ablation and postoperative follow-up of liver cancer. The purpose is to explore how to improve the curative effect of RFA treatment for small liver cancer, and reduce local residue, recurrence, as well as relevant complications.
Soluble interleukin-2 recepter(sIL-2R）levels, NK activity and T lymphocyte subpopulation in peripheral blood were determined in 34 cases of primary liver cancer (PLC). The results showed that the mean level of sIL-2R and CD8 in the patients with primary liver cancer were higher than that in health subjects (Plt;0.01or Plt;0.05), NK activity and T lymphocyte subpopulation (CD3,CD4,CD4/CD8) in the patients with primary liver cancer were much lower than that in health subjects (Plt;0.01), sIL-2R levels in stage II, III patients with primary liver cancer were significantly higher than that in stage I (Plt;0.01). The 6-month mortality rate in 3 groups of patients with sIL-2R level ≥1000u/ml, 500-1000u/ml, andlt;500u/ml were 80.0%, 29.4%and 0 respectively. sIL-2R levels were also decreased (Plt;0.05) in patient with primary liver cancer 4 weeks after immune therapy, but the cell-mediated immunity was increased. It suggests that sIL-2R level determination in peripheral blood is a new biological marker for the assessment of the stage, the response to medical intervention, the prognosis and cell-mediated immunity in primary liver cancer.
Objective The aim of this article is to verify the clinical effect of the near-infrared fluorescent liver cancer surgery projection navigation system without display screen. Methods Three patients who need to undergo open hepatectomy for liver cancer in the Affiliated Hospital of Southwest Medical University from March 2021 to May 2021 were included, verifying the accuracy, stability, and time delay effect of the self-developed near-infrared fluorescence projection navigation system for the location of tumor in surgeries. Results The intraoperative tumor location could be accurately displayed by the near-infrared fluorescence projection system and there was no significant difference between the location of the tumor displayed by intraoperative ultrasound. The tumor location displayed by the near-infrared fluorescence projection system was not influenced by the tumor movement and had no visual-time delay. Postoperative pathology confirmed that the projection range was consistent with the tumor range. Conclusion This near-infrared fluorescence projection technology innovates the intraoperative tumor imaging mode and can accurately navigate open hepatectomy in small sample trials, and it is expected to achieve wide clinical application through subsequent iterative optimization and verification.
【Abstract】ObjectiveTo investigate the effect of high intensity focused ultrasound (HIFU) on the immunity of patients with advanced primary liver cancer (PLC). MethodsForty cases of PLC admitted to our institution from Mar. 2003 to Dec. 2003 were included in this study. Patients were divided into 2 groups and received either HIFU or radiofrequency ablation (RFA) treatment randomly. CD3, CD4, CD8, CD4/CD8, NK, IL-2, TNF were chosen to assess the immune status before and after treatment. The results were compared statistically. ResultsThe survival rate after HIFU was 80.0%, 61.1%, 42.9%, 33.3% at 3 months, 6 months, 9 months and 1 year respectively, which was similar to that after RFA treatment. The changes of immunity parameters of CD3, CD4, CD8, CD4/CD8, NK, IL-2 and TNF were not significant after HIFU treatment. In addition, the differences of those parameters between HIFU group and RFA group were insignificant. ConclusionThere are no detrimental effects on immunity in the early period after HIFU treatment.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
Indocyanine green fluorescence imaging has been widely used in hepatobiliary surgery, which can guide accurate hepatectomy and improve the prognosis of patients. Lipiodol–indocyanine green emulsion as a pure physical way to prepare lipiodol-drug mixed solvent can be used for primary interventional embolization and subsequent fluorescence-guided hepatectomy. In this paper, the application of iodized oil-indocyanine green emulsion in hepatectomy was summarized by reviewing relevant research progress at home and abroad, and further discussion and prospect were made.
Objective To determine feasibility of texture analysis of non-enhanced CT scan for differential diagnosis of liver cancer and hepatic hemangioma. Methods Fifty-six patients with liver cancer or hepatic hemangioma confirmed by pathology were enrolled in this retrospective study. After exclusion of images of 4 patients with artifacts and lesion diameter less than 1.0 cm, images of 52 patients (57 lesions) were available to further analyze. Texture features derived from the gray-level histogram, co-occurrence and run-length matrix, absolute gradient, autoregressive model, and wavelet transform were calculated. Fisher, probability of classification error and average correlation (POE+ACC), and mutual information coefficients (MI) were used to extract 10 optimized texture features. The texture characteristics were analyzed by using linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) provided by B11 module in the Mazda software, the minimum error probability of differential diagnosis of liver cancer and hepatic hemangioma was calculated. Most discriminating features (MDF) of LDA was applied to K nearest neighbor classification (KNN); NDA to extract the data used in artificial neural network (ANN) for differential diagnosis. Results The NDA/ANN-POE+ACC was the best for identifying liver cancer and hepatic hemangioma, and the minimum error probability was the lowest as compared with the LDA/KNN-Fisher, LDA/KNN-POE+ACC, LDA/KNN-MI, NDA/ANN-Fisher, and NDA/ANN-MI respectively, the differences were statistically significant (χ2=4.56, 4.26, 3.14, 3.14, 3.33;P=0.020, 0.018, 0.026, 0.026, 0.022). Conclusions The minimum error probability is low for different texture feature selection methods and different analysis methods of Mazda texture analysis software in identifying liver cancer and hepatic hemangioma, and NDA/ANN-POE+ACC method is best. So it is feasible to use texture analysis of non-enhanced CT images to identify liver cancer and hepatic hemangioma.
Objective To study the effects of pcDNA3/AFP/TK/Angio fusion gene targeting therapy for human primary liver cancer in nude mice implanted with SMMC-7721. Methods Human liver cancer cell line SMMC-7721 was implanted subcutaneously in nude mice to establish experiment model. Animals bearing liver cancer were randomly divided into five groups: control group， vector group， GCV (ganciclovir) group， pcDNA3/TK/Angio group; pcDNA3/AFP/TK/Angio group. Different plasmids were directly injected into tumors and GCV was intraperitoneally administrated simultaneously according to different groups. The growth of tumors was observed and the pathology was examined as well. Serum AFP level was measured by radioimmunology, the ultrastructural change of tumor cells was studied by using electron microscopy, the expressions of MVD and VEGF were respectively detected with immunohistochemistry and the cell apoptosis in situ was detected by TUNEL. Results The success rate to establish subcutaneous implanted liver cancer model in nude mice was 100%. The tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/TK/Angio group and pcDNA3/AFP/TK/Angio group were lower than those in control group, vector group and GCV group (P＜0.05) and more apoptosis cells could be observed. While the tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/AFP/TK/Angio group was lower than those in pcDNA3/TK/Angio group (P＜0.05); and apoptosis index was higher than that of the latter (P＜0.05).Conclusion pcDNA3/AFP/TK/Angio fusion gene inhibits the growth of tumor remarkably and becomes a promising new biological agent to treat human primary liver cancer.