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Primary liver cancer is the fourth most common malignancy and the second most common cause of cancer death in China, which poses a serious threat to the life and health of the Chinese people. Hepatocellular carcinoma (HCC) represents more than 90% of the pathology of primary liver cancer, among them around 60% of patients are at the intermediate-advanced stage when diagnosed. Therefore, increasing the rate of resection via conversion therapies is particularly important to improve the prognosis of these patients. Vascular interventional therapies represented by transarterial chemoembolization and hepatic arterial infusion chemotherapy are important treatment methods for HCC patients in intermediate-advanced stage, showing good rates of tumor response and surgical conversion. Combined with research data at home and abroad, the authors analyze research progress of vascular interventional therapy in the conversion therapy of HCC, review the history and the strategies of conversion therapies based on vascular interventional therapy in this article.
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Objective:To investigate the efficacy of venlafaxine combined with transcranial direct current stimulation in the treatment of postpartum depression and its effects on neurological function.Methods:A total of 135 patients with postpartum depression who were admitted to Wenzhou Seventh People's Hospital from November 2019 to October 2021 were included in this study. They were randomly divided into observation ( n = 70) and control ( n = 65) groups. The control group was treated with venlafaxine alone, and the observation group was treated with an IS200 intelligent electrical stimulator based on the treatment used in the control group. The two groups were treated for 4 weeks. Clinical efficacy and neurological function were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group (98.57% vs. 89.23%, χ2 = 7.61, P < 0.05). After treatment, the scores of Edinburgh Postnatal Depression Scale and Hamilton Depression Scale in the observation group were (8.03 ± 0.79) points and (9.03 ± 3.98) points, respectively, which were significantly lower than (11.74 ± 0.98) points and (14.68 ± 3.79) points in the control group ( t = 3.28, 4.65, both P < 0.05). Standard deviation of heart rate variability, root mean square of successive differences between adjacent NN intervals, ratio of low frequency to high frequency, activity of the autonomic nervous system in the observation group were (32.38 ± 0.93) ms, (27.86 ± 0.78) ms, 1.79 ± 0.19, (86.65 ± 1.21) points, respectively, which were significantly higher than (27.84 ± 0.88) ms, (25.79 ± 0.81) ms, 1.38 ± 0.14, (82.94 ± 1.19) points in the control group ( t = 4.09, 3.72, 2.98, 4.09, all P < 0.05). Conclusion:Venlafaxine combined with transcranial direct current stimulation for treatment of postpartum depression can enhance clinical efficacy and remarkably improve patient's neurological function.
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Currently, the definition, classification and Chinese nomenclature of intra-hepatic cholangiocarcinoma (ICC) are controversial. Whether ICC belongs to liver cancer or carcinoma of bile duct is debatable, and the two terms"intrahepatic cholangiocarcinoma"and"cholangiocellular carcinoma"are simultaneously used without distinction, bringing great confusions to clinical practice. Based on authoritative literatures at home and abroad, the authors give suggestions on the definition, classification and Chinese nomenclature of ICC, as well as the classification of carcinoma of bile duct, which recommend that the Chinese translation of "cholangiocarcinoma" should be "epithelial carcinoma of bile duct (cholangiocellular carcinoma)", the mass-forming type ICC should be classified as primary liver cancer, naming as"intrahepatic cholangiocarcinoma"and the periductal-infiltrating type and intraductal-growing type ICCs still be classified as carcinoma of bile duct, naming as"perihilar cholangiocarcinoma". The authors recommend to classify carcinoma of bile duct into: perihilar cholangiocarcinoma, hilar cholangiocarcinoma, and distal cholangiocarcinoma.
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Primary liver cancer is the fourth most common malignancy and the second most common cause of cancer death in China, posing a serious threat to the health of Chinese people. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers, among them 66% of patients are with intermediate-advanced HCC. Therefore, prevention strategies and conversion therapies to patients with intermediate-advanced HCC are particularly important. Hepatic arterial infusion chemotherapy (HAIC) is one of the important treatment methods to treat intermediate-advanced HCC. The tumor objective response rates and surgery conversion rates of HAIC-based conversion therapies are promising. The authors review the history of HAIC and the HAIC-based conversion therapies in this article.
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Hepatocellular carcinoma (HCC) accounts for approximately 75%-85% of primary liver cancer cases and is one of the most frequently diagnosed malignancies worldwide. Immunotherapy is currently considered to be the most promising treatment to prevent the progression and postoperative recurrence of HCC. At present, the treatment strategies of immunotherapy for HCC are classified as active immunotherapy and passive immunotherapy, including tumor vaccine therapy, immune checkpoint inhibitors, and adoptive cell therapy. Here we review the current clinical progression and discuss the future perspective on immune therapy for HCC.
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<p><b>OBJECTIVE</b>To perform a comparative analysis of the reactivation rate of hepatitis B virus (HBV) infection and related risk factors after treatment of HBV-related hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection.</p><p><b>METHODS</b>We retrospectively analyzed the HBV reactivation rate and related risk factors of a cohort of 218 patients treated for HBV-related HCC between August 2008 and August 2011; the study population consisted of 125 patients who received RFA and 93 patients who received hepatic resection. Comparisons were made using the unpaired Student's t-test for continuous variables and the x2-test and Fisher's exact test for categorical variables. Univariate and multivariate logistic regression analysis was used to assess risk factors.</p><p><b>RESULTS</b>Twenty patients showed HBV reactivation following treatment, but the incidence was significantly lower in the RFA group than in the hepatic resection group (5.6% vs. 14.0%, 7/125 vs. 13/93, x2 = 4.492, P = 0.034). The univariate and multivariate analysis indicated that no antiviral therapy (OR = 11.7; 95% CI: 1.52-90.8, P = 0.018) and the treatment type (i.e. RFA or hepatic resection) (OR = 3.36; 95% CI: 1.26-8.97, P = 0.016) were significant risk factors of HBV reactivation. Subgroup analysis showed that the incidence of HBV reactivation was lower in patients who received antiviral therapy than in those who did not for both the RFA group and the hepatic resection group but the difference was not significant in the former group (1/68 vs. 19/150, x2=7.039, P = 0.008 and 0/33 vs. 7/92, x2 = 2.660, P = 0.188, respectively). However, the incidence of HBV reactivation in patients who did not receive antiviral therapy was higher than in those who did receive antiviral therapy in the hepatic resection group (12/58 vs. 1/35, x2 = 5.773, P = 0.027).</p><p><b>CONCLUSION</b>The incidence of HBV reactivation was lower in patients who received RFA than in those who received hepatic resection to treat HBV-related HCC. Antiviral therapy prior to the hepatic resection treatment may be beneficial for reducing the incidence of HBV reactivation.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Hepatocellular , General Surgery , Virology , Catheter Ablation , Hepatectomy , Hepatitis B virus , Physiology , Incidence , Liver Neoplasms , General Surgery , Virology , Retrospective Studies , Virus ActivationABSTRACT
Objective To compare the efficacy of percutaneous radiofrequency ablation (PRFA) and repeat hepatectomy for solitary recurrent hepatocellular carcinoma (HCC) with the diameter≤3 cm. Methods The clinical data of 151 patients with recurrent HCC (diameter≤3 cm) who were admitted to the Cancer Center of Sun Yat-Sen University from January 1999 to December 2009 were retrospectively analyzed. Of all the patients, 79received PRFA (PRFA group) and 72 received repeat hepatectomy (repeat hepatectomy group). The survival rate, morbidity and recurrence of the tumor between the two groups were compared. All data were analyzed using t test, chi-square test or Log-rank test, and the survival of the patients were analyzed using the Kaplan-Meier method. Results The mobidities of the PRFA group and repeat hepatectomy group were 13% (10/79) and 36%(26/72), respectively, with a significant difference between the two groups (x2=11.411, P＜0.05). The cumulative 1-, 2-, 3-, 4-, 5-year survival rates were 89.7%, 75.2%, 67.1%, 61.5%, 56.6% in the PRFA group, and 86.0%, 67.6%, 53.6%, 44.1%, 40.2% in the repeat hepatectomy group, with no significant difference between the two groups (x2=1.610, P＞0.05). The cumulative 4-, 5-year survival rates of the PRFA group were significant higher than those in the repeat hepatectomy group (x2=4.682, 4. 196, P ＜ 0.05). The local tumor recurrence rate of the PRFA group was 5% (4/79), and the incisal margin recurrence rate was 3% (2/72) in the repeat hepatectomy group, with no significant difference between the two groups (x2=0.565, P＞0.05). Conclusion As a less invasive treatment method, PRFA is superior to repeat hepatectomy for solitary recurrent HCC with the diameter≤3 cm.
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Objective Partial hepatectomy, liver transplantation, and radio frequency ablation for hepatocellular carcinoma (HCC) were compared to select the most suitable method for HCC. Methods 1198 patients with HCC in 3 hospitals in Guangzhou were divided into 3 groups: group Ⅰ , small HCC; group Ⅱ > HCC without vascular invasions and group Ⅲ , HCC with vascular invasion. The patients either received partial hepatectomy, transplantation or ablation. The 1-, 2- or 3-year survival rates, the 3-year recurrent rates and Child-Pugh grades in the 3 groups were compared. Results For small HCC, there was a significant increase in the 3-year survival rate (P<0. 05) and a significant decease in the recurrent rate (P<0. 05) in patients who received transplantation, compared with those who received hepatic resection. Patients who received ablation had a higher 3-year survival rate and a lower recurrence (P<0. 05) in comparison with those who received hepatectomy. There was no significant difference(P<0. 05) between transplantation and ablation, but there were more Child A patients who received hepatectomy and ablation, and more Child B and C patients who received transplantation. For advanced HCC, there was no significant different in the 3-year survival rates for the 3 therapies, but the 3-year recurrence was lower (P<0. 05) in the transplantation group. Conclusions For small HCC, superiority of transplantation versus resection was obvious. Ablation (diameter <3 cm) was also superior to resection, whereas ablation was as effective as transplantation. There were more Child B and C patients in the transplantation group than the ablation and resection groups. Therefore, small HCC with hepatic decompensation should receive liver transplantation. Transplantation was advantageous in having less tumor recurrent but there was no difference in the 3 therapies for advanced HCC.
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Molecular-targeted therapy is a new method and tendency in the treatment of hepatocellular carcinoma (HCC). To date, sorafinib, a multi-targeted gent, is the only one proved to be effective in improving the survival of patients with advanced HCC. Sorafinib is also the first line systemic agent for advanced HCC. Other multi-targeted agents, such as sunitinib, are also proved to be effective. Erlotinib, gefitinib and eetuximab, which target epidermal growth factor receptor, show effectiveness but still need further investigation. Bevacizumab, which targets vascular endothelial growth factor and vascular endothelial growth factor receptor, shows excellent results and deserves more clinical trials. The effects of bortezomib, sirolimus and imatinib, which target other pathways, are still under investigation. The future studies of molecular-targeted therapy for HCC should be focused on the combination of different targeted medicine, and combination of molecular-targeted therapy and chemotherapy, as well as individualized therapy.
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<p><b>OBJECTIVE</b>To study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.</p><p><b>METHODS</b>Thirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.</p><p><b>RESULTS</b>72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.</p><p><b>CONCLUSION</b>(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.</p>
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Humans , Carcinoma, Hepatocellular , General Surgery , Hepatectomy , Methods , Liver Neoplasms , Pathology , General Surgery , Neoplasm Metastasis , Neoplasm Recurrence, LocalABSTRACT
Objective To explore the clinical diagnosis and management of focal nodular hyperplasia (FNH) of the liver. Methods Forty-two FNH cases treated in the past 9 years were studied retrospectively. The clinical and pathologic data were reviewed. Results Preoperative liver function test and AFP were normal. The preoperative radiography in FNH was usually not specific, with less than 50% cases were suggestive of FNH of the liver. Surgical resection resulted in a permanent cure with no significant postoperative complications. More than one year follow-up found recurrence in one case. Conclusion Clinical, laboratory and radiological findings when combined could help in establishing tentative diagnosis of FNH. Surgery is recommended in cases with equivocal diagnosis or in fear of hepatocellular carcinoma.
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Objectives To investigate the diagnostic value and safety of needle cutting biopsy for the primary and metastatic hepatic cancer during the treatment of percutaneous radiofrequency ablation and ethanol injection guided by ultrosound or CT. Methods The clinical data of 48 patients underwent the treatment of percutaneous radiofrequency ablation and ethanol injection as well as biopsy were analyzed. Results Among 48 patients,46 case(95.8%) were diagnosed by pathological examination and 2 cases (4.2%) failed to be diagnosed. There were no serious complications in all the patients. Conclusion Detachable needle cutting biopsy was safe and effective for the diagnosis of the primary and metastatic hepatic cancer during the treatment of percutaneous radiofrequency ablation and ethanol injection guided by ultrasound or CT.
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Objective To evaluate the relationship between the tumor encapsulation,lymphocytic infiltration,fibroplasia and cirrhosis and transcatheter arterial chemoembolization(TACE)methods for hepatocellular carcinoma(HCC).Methods Histopathological changes were studied in 59 cases of HCCs treated with four kinds of TACE and 58 cases of HCCs treated with surgical resection alone.Results In TACE group the encapsulation,lymphocytic infiltration,fibroplasia was more severe and extensive than that in group of surgical resection alone(Ρ＜0.01）.The TACE method and treatment time had effect on encapsulation and fibroplasia of tumor,but treatment interval was no effect.The rate of cirrhosis among TACE method had no significantly difference（Ρ＞0.05）,had relation to TACE time（Ρ＜0.05）.Conclusion The changes in the encapsulation,lymphocytic infiltration,fibroplasia are more easily find by polytimes,multimaterial chemoembolization than that by one time single material chemoembolization and chemotherapy alone.The superselective cathetering can avoid the damage of normal liver.
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Objective To investigate the feasibility,curative effect and problems of combined ultrasound-guided percutaneous radiofrequency ablation and ethanol injection(PRFA+EI) on small liver cancer located in first porta hepatis.Methods Twenty-six patients,who diagnosed as primary and metastatic liver cancer that located in first porta hepatis and was less than 5 cm in diameter by clinical evidence or pathology,were performed PRFA+EI between Jan 2001 and Oct 2004.The necrosis of the tumors was determined by MRI,Doppler ultrasound or CT after the treatment for one month and the regular examinations were tested every 3 months.The primary tumor recurrence rate and cumulative survival rate were calculated.Results The seroconversion rate of AFP was 76.9%(10/13).The complete necrosis rate of liver cancer in first porta hepatis was 84.6%(22/26) by MRI and CT.The primary tumor recurrence rate of 6 months and 1 year were 23.1%(6/26) and 26.9%(7/26),respectively.The 1-,2-,3-year cumulative survival rate were 92.3%(24/26),82.3% (14/17),75.0%(9/12),respectively.There was no occurrence of bile ducts stenosis.Conclusion The small live cancer located in first porta hepatis is not the contraindication of PRFA+EI.If the puncture point and route is selected properly,electrodes deployed exactly using ultrasound guidance and the size of heating area controlled appropriately,the PRFA+EI is an effective treatment for small liver cancer located in first porta hepatis.
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Objective To evaluate the relationship between the tumor encapsulation,lymphocytic infiltration,fibroplasia and cirrhosis and transcatheter arterial chemoembolization(TACE)methods for hepatocellular carcinoma(HCC).Methods Histopathological changes were studied in 59 cases of HCCs treated with four kinds of TACE and 58 cases of HCCs treated with surgical resection alone.Results In TACE group the encapsulation,lymphocytic infiltration,fibroplasia was more severe and extensive than that in group of surgical resection alone(?0.05),had relation to TACE time(?
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0.05); 88.6%, 60.0%, and 51.4% for those in group A2, and 59.3%, 48.1%, and 25.9% for those in group B2, respectively (P 8 cm.
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Objective To investigate the effect and safety of the application of radiofrequency ablation(RFA) and ethanol injectionunder the different guidance means for105 patients with primary and metastatic hepatic cancer.Methods Aretrospective study was accom-plished on the radiofrequency ablation and ethanol injection for105 patients with primary and metastatic hepatic cancer under the guidance ofultrasound(56 cases),CT(12 cases),laparoscope(9 cases),open surgery(26 cases) and ultrasound associated with laparoscopic(2cases).Results The operations of RFA with the shortest time were guided by ultrasound(0.8?0.3) h,while the longest operations wereguided by open surgery(3.6?2.5) h(P