A randomized control study on different abdominal drainage methods after right hepatectomy / 中华肝胆外科杂志

Objective To compare different drainage methods after right hepatectomy. Methods From April 2017 to February 2018, 90 patients who underwent right hepatectomy at Zhongshan Hospital of Fudan University were prospectively randomized to the latex tube group (right subphrenic drain with a latex tube connecting to a collection bag, n=30), the silicone tube group (right subphrenic drain with a silicone tube connecting to a closed-suction, n=30) or the combination group ( right subphrenic drain with a latex tub, combined with a silicone tube, n=30). The amount of fluid collection after the operation, complications after surgery, recovery of liver function, and length of hospital stay after operation were compared. Results There were no significant differences in the clinicopathological features among the 3 groups, including gender, age, cirrhosis status, extent of hepatectomy, and blood loss (P＞0. 05). There were no significant differences among the three groups on the incidences of postoperative complications [ the latex tube group, 20. 0% (6/30); the silicone tube group, 23. 3% (7/30); the combination group, 16. 7% (5/30); P＞0. 05]. Ultrasonography showed significantly lower rates of subphrenic collection in the combination group compared with the latex tube group and the silicone tube group [16. 7% (5/30) vs. 63. 3% (19/30) vs. 53. 3% (16/30); P＜0. 05]. The rates of postoperative fever, serum total bilirubin, ALT and postoperative hospital stay were similar among the three groups (P＞0. 05). Conclusions Drainage using the combina-tion of a latex tube connecting to a collection bag and a silicone tube connecting to closed-suction after right hepatectomy significantly reduced postoperatively subphrenic collection and prevented infection of the collec-tion. However, the treatment strategy did not delay liver function recovery, prolong hospital stay nor increase post-operative infection rate.

Research progress on Smad3 protein in hepatocellular carcinoma / 中华肝胆外科杂志

Smad3 is a major transporter in the transforming growth factor β (TGF-β) signaling pathway.It is in charge of the transfer of TGF-β signal from the surface of the cell membrane into the nucleus.The TGF-β signal can be bound to the target gene in the nucleus and regulate its expression.Abnormalities in Smad3 expression level and functional status will lead to abnormal signal transduction,involving cell growth,proliferation,development,differentiation,migration,apoptosis and other basic life activities.This review focused on the differential expression of Smad3 in hepatocellular carcinoma (HCC)and the adjacent tissue.The character of Smad3 in HCC is outlined in three parts:Smad3 upstream signaling source,Smad3 self-assembly maturation and Smad3 downstream effects,which may provide a summary and reference for the follow-up study on Smad3.

Multivariate analysis of risk factors of early and late recurrences after resection for primary clear cell carcinoma of liver / 中华肝胆外科杂志

Objective To investigate the risk factors influencing early and late recurrences after resection of primary clear cell carcinoma of the liver (PCCCL).Methods 214 PCCCL patients treated by curative resection from January 1996 to March 2006 were retrospectively analyzed.Recurrences were classified into early (≤1 year) and late (＞1 year) recurrences.Results 99 patients developed recurrences,with early recurrence in 28 patients and late recurrence in 71 patients.The 3-and 5-year overall survival (OS) rates for recurrent PCCCL were significantly worse than those with no recurrence (68.7％ and 46.2％ vs 72.2％ and 64.3％,P=0.003).The 1-,3-and 5-year OS rates for late recurrence were 100％,80.3％ and 54.6％,which were significantly better than those with early recurrence (85.7％,39.3％ and 25.0％,P=0.001).On multivariate analysis,aminoleucine transferase (ALT) level and vascular invasion were independent risk factors for early recurrence,while age was the only significant risk factor for late recurrence.Conclusions The time to recurrence was the main determinant for prognosis of recurrent PCCCL,Clarifying the different risk factors for early and late recurrences will help postoperative follow-up,early detection of recurrence,and hopefully will improve survival.

The role of TMPRSS4 in radiation induced metastasis of hepatocellular carcinoma / 中华肝胆外科杂志

Objective To investigate the role and mechanism of TMPRSS4 in radiation induced metastasis of hepatocellular carcinoma (HCC).Methods Metastatic model of human HCC was established by orthotopic implantation of histologically intact human HCC tissue into the liver of nude mice.Mice bearing xenografts in liver were killed after radiation and the residual tumors were resected and reimplanted into the liver of normal nude mice.At the end of sixth week,the mice were killed and the histopathological features,tumor volume,intrahepatic and lung metastasis were evaluated.Expression of epithelial-mesenchymal transition (EMT) related genes including N-cadherin,Vimentin,SIP1 and TMPRSS4 were measured by Western blotting and RT-PCR.Results The tumor volume and frequency of lung metastasis of control group was 2.25±0.52 cm3 and 66.7％,respectively.Compared to control group,tumor diameter (1.61±0.51 cm3,P＜0.05) and lung metastasis (12.5％,P＜0.05) were significantly inhibited 2 days after radiation.Whereas,30 days after radiation,tumor growth recovered (2.60±0.61 cm3,P＞0.05) and lung metastasis was enhanced (100％,P＜0.05).There were no intrahepatic metastasis in the control group and in the group of reimplantation of HCC 2 days after radiation,while the tumors from those 30 days after radiation showed enhanced intrahepatic metastasis (18 ± 8.05,P＜ 0.01 ),with overexpression of SIP1,N-cadherin,Vimentin and TMPRSS4,and reduced expression of E-cadherin.Conclusion The metastasis potential of residual HCC after radiation was first inhibited and then promoted.Overexpression of TMPRSS4 plays a critical role in radiation induced long-term metastasis of HCC by facilitating EMT.

Value of the conventional liver function tests in the assessment of hepatic reserve / 中华肝胆外科杂志

Objective To study the risk factors of post-hepatectomy hepatic decompensation (PHD) in patients with hepatocellular carcinoma.MethodWe reviewed 562 patients with Child-Pugh A classification,who underwent partial hepatectomy for hepatocellular carcinoma at Zhongshan Hospital,Fudan University between July 1st 2007 to December 31st 2007,to study the risk factors of hepatic decompensation.ResultsPreoperative high total bilirubin (TB) and low prealbumin (PA) were independent risk factors of PHD by logistic multivariate analysis ROC analysis revealed the cut-offs of preoperative PA predicting PHD were 0.14 g/L (sensitivity 41.4％; specificity 83.1％).The incidence of PHD was 16.0％ when TB≥20.4 μmol/L and PA＜0.14 g/L(OR=7.276,P=0.002).ConclusionThe Child-Pugh A patients recovered well when the preoperative liver function was as follows:TB＜20.4 μmol/L and PA≥0.14 g/L.

Screening of serum biomarkers related to the tumor recurrence following liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

Objective To appraise and compare protein expression profiles in sera of patients without or with recurrence following liver transplantation for hepatocellular carcinoma (HCC) using SELDI-TOF-MS technique,and establish the diagnostic and predictive model. Methods A total of 76 sera (41 from disease free survival patients and 35 from recurrence individuals) were collected pretransplantation and differentially expressed proteins were identified by SELDI-TOF-MS. The intensity values for each peak were analyzed by Biomarker Wizard Software to screen serum proteome biomarkers related to the recurrence post-transplantation. By using Biomarker Patterns Software, the classification trees were generate. from randomly selected samples (30 fingerprints obtained from each group). The sensitivity and specificity of best decision tree were then chosen for blind test with 16 samples (5 from recurrence individuals and 11 from recurrence-free survival patients). Results There were significant differences only in tumor size and the presence of vascular invasion between recurrence group and recurrence-free survival group (P＜0.05). According to serum protein fingerprints, a total of 368 protein peaks were identified at the mass-to-charge ratio (M/Z) value ranging from 2000 to 300 00. There were 22 significant differential proteins between two groups. Among them, 9 proteins were up-regulated and 13 proteins were down-regulated -espectively in recurrence group. The intensity values of differential proteins were input into BPS for classification tree analysis and the best performing tree could distinguish two groups successfully. As a result of blind assessment for this model,a sensitivity of 80.0 % (4/5) and specificity of 72.7 % (8/11) were obtained. Conclusion Some of differential proteins screened by SELDI-TOF-MS technique in the serum may be correlated with the prognoses of liver transplantation patients with HCC. The decision tree may be useful for the clinical application of formulating the indication for liver transplantation, detecting extrahepatic micrometastasis and setting up the diagnostic and treatment strategies.

Comparison of four staging systems in predicting outcomes and guiding option of treatment for patients with hepatocellular carcinoma / 中华消化杂志

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.

Salvage liver transplantation for postoperative tumor recurrence or liver dysfunction in patients of hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate salvage liver transplantation(LT)for postoperative tumor recurrence or liver dysfunction in patients of hepatocellular carcinoma(HCC).Methods From April 2001 to March 2006,97 HCC patients with the tumor within Milan Criteria underwent LT as the primary treatment(71 cases)and salvage LT because of after resection tumor recurrence(n=20)or postoperative liver dysfunction(n=6).Perioperative and postoperative parameters and long-term survival were compared between the groups of primary LT and salvage LT.Results The mean age(50.0 years vs.49.7 years),gender,and etiology of liver disease(hepatitis B/C/nonviral)were comparable between the two groups.In the salvage LT group.the mean time between liver resection and LT was 2.50 years.Clinical characteristics such as tumor number(1.37 vs.1.50),operative time(7.92 hours vs.8.56 hours),blood loss (1981.69 ml vs.2626.92 ml)and transfusion(1981.69 ml vs.2626.92 ml)were not statistically different (P＞0.05)between the two groups.The size of largest tumor was significantly different between salvage LT group and the primary LT group(2.81 cm vs.2.05 cm)(t=2.298,P=0.028).By a median follow up of 14.63 months,overall survival after liver transplantation was not different between the 2 groups(X2=0.003.P=0.959).Conclusion In selected patients,liver resection prior to transplantation does not increase the morbidity or impair long.term survival following LT.Therefore.1iver resection prior to transplantation can be integrated with the treatment strategy for HCC.

Preventive chemotherapy for hepatocellular carcinoma exceeding Milan criteria after fiver transplantation / 中华消化外科杂志

Objective To investigate the effects of preventive chemotherapy for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation. Methods The clinical data of 243 patients who had undergone orthotopic liver transplantation for HCC exceeding Milan criteria from April 2001 to July 2007 were retrospectively analyzed. Of all patients, 162 received preventive chemotherapy after transplantation. Results The 1- and 3-year survival rates and disease-free survival rates were not statistically different between patients who had received chemotherapy (78.5%, 63.7% ; 76.8%, 52.5% ) and those without chemotherapy (56.6%, 39.1%; 69.3%, 64.7% ) (X2 = 3.084, 0.444, P > 0.05). Cox regression analysis demonstrated that postoperative chemotherapy was not an independent factor affecting the survival rates of HCC patients without vascular invasion, but an independent factor affecting the survival rates of HCC patients with vascular invasion. Conclusions Early preventive chemotherapy could obviously increase the survival rate and delay the tumor recurrence of patients with HCC exceeding Milan criteria, especially for HCC patients with vascular invasion.

Dianosis and treatment of hepatic metastasis from gastrointestinal stromal tumor / 中华消化外科杂志

Objective To investigate the diagnosis and treatment of hepatic metastasis from gastrointestinal stromal turnor(GIST).Methods The clinical data of 16 patients with GIST who had been admitted to our hospitalfrom December 1993 to May 2007 were retrospectively analyzed.Results Of all patients,14 underwent radical resection and 2 underwent palliative operation.Two patients with palliative operation and 3 with radical resection were administered with imatinib postoperatively. All patients were followed up for 3-161 months,and GIST metastasis and invasion was observed in 8 of the 14 patients who received radical resection.Of the 7 patients with hepatic metastasis.3 were treated with hepatic artery chemoembolization,1 was administered with imatinib,2 received reoperation and 1 did not receive any treatment. Reoperation was carried out on 1 patient who had abdominal wall metastasis.The 1-and 3-year survival rates of the 16 patients were 92%and 74%,respectively.Conclusions The recurrence rate of GIST after hepatectomy is high.Complete surgical resection is the best curative treatment for hepatic metastasis from GIST and GIST recurrence.The combination of surgical resection and imatinib administration may help to improve the prognosis of patients with hepatic metastasis from GIST.

Advances in the study of carcinoma-associated fibroblasts / 中国癌症杂志

The biological characteristic of carcinomas is determined both by the stromal microenvironment and the oncogene or anti-oncogene.The tumor stroma is also known as the reactive stroma which is composed of base member,immunocell,capillary,fibroblasts and ECM.Fibroblasts are the majority of tumor stromal cells.The relationship between fibroblasts and the initiation,progression of carcinoma has being in the spot light.In this review,we summarized the advance in the study of carcinoma-associated fibroblasts.

Advance in the study of CD4~+CD25~+FOXP3~+ regulatory T cell in tumor immune evasion / 中国癌症杂志

As a distinct T cell subset with acknowledged specific function and marker, CD4+CD25+FOXP3+ regulatory T cells are thought to dampen T-cell immunity and to be the main obstacle tempering antitumor immunotherapy. Accumulating evidence has confirmed an increased pool of regulatory T cells both in the peripheral blood and the tumor microenvironment of cancer patients, which are indicative of disease progression, response to therapy, invasive phenotype and prognosis. Therefore, manipulation of regulatory T cells—including depletion, blocking trafficking into tumors, or reducing their differentiation and suppressive mechanisms—and concomitant stimulation of effector T cells, systemically or locally in tumors, represent new strategies for cancer treatment.

Study on the effects of combined IL-12 and GM-CSF gene therapy for murine liver cancer / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the anti-tumor effects of combined IL-12 and granalocyte-macrophage-colong scimulating factor (GM-CSF) gene therapy on murine hepatocellular carcinoma.</p><p><b>METHODS</b>Twenty-four mice received subcutaneous inoculation of 1 x 10(6) BNL hepatoma cells were randomly divided into the following four groups with different cytokine encoding plasmids (6 mice for each group): (1)pXX-GM-CSF 12.5 microg and pXX-IL-12 12.5 microg; (2)pXX-IL-12 25 microg; (3)pXX-GM-CSF 25 microg; (4)pXX-Neo 25 microg. The plasmids were given through tail vein using a versatile hydrodynamics-based DNA delivery method on day 3 and day 6 after tumor challenge. The growth of tumor and cellular immune response were observed intensively. The changes in serum concentration of IL-12, GM-CSF, and IFN-gamma after plasmids injection were also observed.</p><p><b>RESULTS</b>Co-delivery of IL-12 and GM-CSF could mount stronger anti-tumor effects, longer term enhanced IL-12 expression and lower level of IFN-gamma than did IL-12 alone.</p><p><b>CONCLUSIONS</b>Combined IL-12 and GM-CSF can render a strong anti-tumor effect as well as a potential to lower the side effects.</p>

Focal nodular hyperplasia of the liver: a report of 60 cases / 中国普通外科杂志

Objective To evaluate the diagnosis and treatment of focal nodular!hyperplasia of the liver (FNH). Methods Retrospective analysis was made on 60 FNH cases in terms of clinical findings, images, pathologic examination and surgical treatment. Results Of the 60 FNH patients in our hospital from 1993 to 2003, 41 were male and 19 female. The average age was 37 year′s old. Fifty-five cases had single focus, the other five were of multiple lesion, with tumor diameter 10cm in one. Correct preoperative diagnosis was made in 33 cases (55%). The correct diagnostic rate of BUS, CT and MRI was 33.3%, 58.3% and 72.0%, respectively. All 60 cases underwent operation with an uneventful recovery and without recurrence at follow-up. ConclusionsCT and MRI are mandatory for the diagnosis of FNH. Definite preoperative diagnosis is usually difficult even in cases of typical type of FNH. Surgical resection is the treatment of choice when a patient becomes symptomatic or when malignancy could not be excluded.