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Clonorchis sinensis is considered a class I carcinogen for cholangiocarcinoma, but an increasing number of studies have found that it is also closely associated with hepatocellular carcinoma. This paper reviews the discovery and prevalence, historical studies, key regional studies, animal models and complications of Clonorchis sinensis, and summarizes the possible molecular mechanisms of Clonorchis sinensis contributing to hepatocellular carcinoma development, in order to gain insight into the correlation between Clonorchis sinensis and hepatocellular carcinoma, and thus to provide new ideas for the study of the effects of Clonorchis sinensis infection on hepatocellular carcinoma.
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Objective:To investigate the risk factors for overall survival in operable hepatocellular carcinoma with portal vein tumor thrombus (PVTT-HCC) patients and establish a scoring system.Methods:Survival data in 253 PVTT-HCC patients were retrospectively analyzed in Guangxi Medical University Affiliated Tumor Hospital. Survival curves were analyzed using the Kaplan-Meier method and log-rank test. Cox stepwise regression analysis was used to identify independent preoperative risk factors affecting overall survival. A prognostic scoring system based on independent risk factors and their relative coefficients was established to screen patients with greater hepatic resection benefits, and the identification ability of the model was based on ROC.Results:A total of 253 patients with PVTT-HCC were enrolled in this study, there were 222 males and 31 females, with a median age 44 years. The median survival time in all patients was (13.00±2.15) months. Rate of overall survival was 51.8% at 1 year, 25.0% at 3 years and 17.7% at 5 years. Multivariable Cox regression analyses showed four risk factors including: AST≥40 U/L, ALP (≥80 U/L), tumor number (>1), and incomplete tumor capsule. A prognostic scoring system was established based on these variables. The area under curve of the scoring system was 0.780 (95% CI: 0.715-0.845). Patients were classified as low- or high-risk group for hepatic resection depending on whether their score was <3 ( n=77) or ≥3 ( n=176), respectively. High-risk patients had a median survival of 10 months, compared to 29 months in low-risk patients. Low-risk patients also had better survival rates at 1 year (75.3% vs 41.5%), 3 years (47.6% vs 15.2%), and 5 years (34.7% vs 10.5%), P<0.05. Conclusion:A prognostic scoring system for hepatic resection in PVTT-HCC patients has been developed based entirely on preoperative variables. Using this system, patients belong to the low risk group have better prognosis after surgery, which can provide a basis for surgical treatment of PVTT-HCC patients.
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Objective:To explore the effects and the mechanism of metformin combined with celecoxib on the proliferation and apoptosis of hepatoma HepG2 and Huh7 cells.Methods:Hepatoma cells HepG2 and Huh7 were divided into control group, metformin group, celecoxib group and combination medication group, CCK-8 assay was used to detect cell proliferation; Hoechst33258 staining method was used to investigate the cell apoptosis; wound healing test was used to detect cells migration ability; Transwell invasion chamber test was used to detect cell invasion ability; Western blotting was used to detect the expression of AMPK, PI3K, Akt, mTOR.Results:After metformin and celecoxib treatment, HepG2 and Huh7 cells were gradually contracted, disintegrated and more apoptotic cells were noticed, and cell proliferation was significantly inhibited. The wound healing test results showed that the cell migration was significantly decreased ( P<0.05) under metformin and celecoxib treatment. The results of the transwell invasion chamber test showed that the metformin and celecoxib treatment inhibited the invasion of HepG2 and Huh7 cells ( P<0.05). The expression levels of AKT, AMPK, and mTOR were decreased in HepG2 cells in the combinational treatment group, and the expression level of PI3K was decreased and then increased; the expression levels of AKT, AMPK, PI3K, and mTOR in Huh7 cells were decreased. Conclusions:Metformin can cooperate with celecoxib to enhance the inhibitory effect on the proliferation, migration and invasion of HepG2 and Huh7 cells. The mechanism may be related to the inhibition of the expression of mTOR signaling pathway.
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Objective To establish a preoperative nomogram model in predicting microvascular invasion (MVI) and to test its predictive effectiveness in hepatocellular carcinoma (HCC).Methods This retrospective study was conducted on 798 patients with HCC,including 690 males and 108 females,aged (49.8± 10.9) years old who underwent curative hepatectomy in the Guangxi Medical University Affiliated Tumor Hospital between January 2014 and December 2017 were retrospectively analyzed.The patients were divided into the model group (n=579) and the validation group (n=219) according to the periods of the operation time.Independent risk factors of MVI were identified by univariate and multivariate logistic regression analysis in the model group,and a nomogram model was established according to the independent risk factors.The accuracy of the nomogram model in predicting MVI was detected in the two groups by the computer consistency coefficient (C-index) and calibration graph method.The predictive value was evaluated by receiver operating characteristic curve.Results Histopathological diagnosis revealed 278 patients with MVI and no MVI in the 301 patients of HCC out of the 579 patients in the model group.In the validation group,there were 119 patients with MVI and 100 patients with no MVI out of the 219 patients.Total bilirubin ＞15 μmol/L(OR=1.519,95％ CI:1.041 ～ 2.217),alkaline phosphatase ＞60 U/L(OR =1.681,95％CI:1.059～2.670),alpha-fetoprotein ＞200 ng/L (OR=2.192,95％CI:1.531 ～3.134) and tumor maximum diameter (OR =1.120,95％CI:1.057 ～ 1.187) were the independent risk factors of MVI on multivariate analysis.After establishment of the nomogram model using the independent risk factors,the C-indexes were 0.680 and 0.773 respectively in the model group and the validation group.In the calibration graph,the standard curve properly fitted with the predicting calibration curve.The predicted value of MVI obtained was in good agreement with the observed value.The ROC curve analysis nomogram model predicted the low performance of MVI.Conclusion The nomogram model in predicting MVI in patients with HCC was successfully established.The model offered certain guiding significance in the clinical treatment of HCC.
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Objective To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).Methods The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed.Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test.The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.Results The 1,3 and 5year's OS of the recurrent group were 93％,73％,61％,respectively and 85％,75％,61％ for the primary group(x2 =0.017,P =0.896).The corresponding 1,3 and 5year's DFS were 61％,39％,21％ and 79％,64％,46％ respectively (x2 =3.899,P =0.048).The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence ≤ 12 months (HR =0.264,95％ CI =0.077-0.901,P =0.033) and the Child-Pugh grading B before RFA (HR =4.501,95％ CI =1.426-14.208,P =0.01).Conclusions The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA.The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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Objective@#To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).@*Methods@#The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed. Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test. The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.@*Results@#The 1, 3 and 5year′s OS of the recurrent group were 93%, 73%, 61%, respectively and 85%, 75%, 61% for the primary group(χ2=0.017, P=0.896). The corresponding 1, 3 and 5year′s DFS were 61%, 39%, 21% and 79%, 64%, 46% respectively (χ2=3.899, P=0.048). The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence≤12 months (HR=0.264, 95% CI=0.077-0.901, P=0.033) and the Child-Pugh grading B before RFA (HR=4.501, 95% CI=1.426-14.208, P=0.01).@*Conclusions@#The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA. The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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Objective To retrospectively study the prognostic impact of paraneoplastic erythrocytosis (PE) on patients with hepatocellular carcinoma (HCC) after liver resection.Methods 713 patients with HCC who underwent partial hepatic resection in The Affiliated Cancer Hospital of Guangxi Medical University were divided into two groups:the PE group (n =81) and the non-PE group (n =632).The overall survival between the two groups were compared after reducing confounding bias by using propensity score matching (PSM).Independent prognostic predictors were determined by the Cox proportional hazards model.Results 80 pairs of patients were matched using PSM.In the matched cohort,the PE group exhibited significantly longer overall survival (OS) compared to the NPE group of patients without erythrocytosis.The 1-,3-,and 5-year overall survival rates were 88.6％,74.2％,69.0％ in the PE group,and 91.0％,60.1％,41.6％ in the non-PE group,respectively (P ＜ 0.05).Using the log-rank test,tumor size ≥ 10cm,macrovascular invasion,Barcelona Clinic Liver Cancer (BCLC) stage C,PE and complete tumor encapsulation were significantly associated with OS in patients with HCC after liver resection.The Cox regression analysis indicated that tumor size ≥ 10 cm,and Barcelona Clinic Liver Cancer (BCLC) stage C were independent prognostic factors of poor prognosis,while complete tumor encapsulation and paraneoplastic erythrocytosis were independent predictors of good prognosis.Conclusions For patients with HCC who underwent surgical resection,patients with PE had better prognosis than those without PE under the condition of similar tumor burden.PE was an independent predictor of good prognosis.