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Objective To analyze the prognostic factors of survival in patients with huge hepatocel lular carcinoma (HCC) who underwent hepatectomy with a view to improve treatment efficacy.Methods A retrospective study was conducted on 124 patients with huge hepatocellular carcinoma who underwent hepatectomy for HCC from January 2004 to December 2010 in our hospital.Univariate and multivariate analyses were performed using statistical software (SPSS 19.0 for Windows) to identify independent prognostic factors.Results The cumulative 1-,3-and 5-year survival rates of the 124 patients were 65.1％,35.8％ and 25.1％ respectively.The mean survival and the median survival were 34.7 and 26.0 months respectively.In the 65 patients who underwent curative resection,the 1-,3-and 5-year disease-free survival rates were 40.2％,19.3％ and 7.1％ respectively.The mean disease-free survival and the median disease-free survival were 18.6 and 9.0 months respectively.Univariate analysis showed HBsAg,tumor capsule,liver cirrhosis,vascular invasion,tumor rupture,intrahepatic metastasis,curative resection and BCLC staging significantly affected postoperative survival(P ＜ 0.05).The Cox multivariate analysis indicated HBsAg,liver cirrhosis,curative resection and intrahepatic metastasis were independent prognostic factor (P ＜ 0.05).Conclusions Intrahepatic metastasis,liver cirrhosis and HBsAg were prognostic factors influencing survival outcome of huge HCC in patients after hepatectomy.Improving curative resection rate of huge HCC significantly extended survival for these patients.
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Objective To study the impact of two surgical techniques in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).Methods A retrospective study was conducted on 143 patients with HCC with PVTT who underwent hepatectomy from January 1995 to December 2010 at the Affiliated Tumor Hospital of Guangxi Medical University.The patients were divided into two groups:group A,115 patients who underwent resection of HCC with PVTT; group B,28 patients who underwent HCC resection but the PVTT was extracted from the cut opening of the portal vein or the transected liver parenchyma.Results The median overall survival of group A was 18.0 months and the cumulative 1-,2-,3-year survival rates were 60.6％,41.0％,25.6 ％,respectively; the median overall survival of group B was 7.0 months and the cumulative 1-,2-,3-year survival rates were 35.1％,13.6％,9.1％,respectively.The differences between the 2 groups were statistically significant (P ＜ 0.001).Univariate analysis showed tumor number,PVTT types,prophylactic transcatheter arterial chemoembolization (TACE),and surgical technique to be significant risk factor of postoperative overall survival (P ＜ 0.05).Cox multivariate analysis indicated prophylactic TACE and surgical technique to be independent prognostic factor (P ＜ 0.05).Conclusions When compared with group B patients,group A patients had significantly better overall survival.Postoperative prophylactic TACE further improved survival of these patients.
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Objective To investigate the influences in perioperative variations in serum levels of hepatitis B virus (HBV) DNA in patients with HBV-related hepatocellular carcinoma (HCC),and to observe the differences in postoperative recovery of liver function between the antiviral treatment group and the non-antiviral treatment group of patients.Methods From Feb.2012 to Nov.2012,55 patients whose preoperative serum levels of HBV DNA were below the recommended level of antiviral treatment were included into the study.The serum levels of HBV DNA,IL-6,IL-10 and IL-27 preoperatively and on postoperative day 3 were measured.Using the postoperative serum levels of HBV DNA,the patients were divided into 2 groups:the high level group and low level group.Patients in the high level group received antiviral treatment,but the low level group did not.The changes in preoperative and postoperative liver function and other data of the patients were recorded and analyzed by the SPSS 13.0 software.Results (1) The reactivation rate of serum HBV DNA in the HBsAg-positive HCC patients was 45％ (25/55).In patients with a preoperative HBV DNA level ＜ 1 × 104 IU/ml the postoperative HBV reactivation rate was up to 76％ (19/25).(2) Logistic regression analysis showed tumor diameter (P=0.037,0.006) and injecting anhydrous alcohol into the resection margin (P=0.004) were independent risk factors of postoperative HBV reactivation.(3) Postoperative serum IL-10 elevation was associated with HBV reactivation (P=0.001).On the contrary,serum IL-6 level elevation was associated with HBV reactivation (P＜0.01).(4) When compared with the low level group,postoperative serum alanine aminotransferase,total bilirubin and albumin in the high level group showed no significant difference (P＞0.05).Conclusions Hepatectomy could reactivate HBV replication during the perioperative period.A close monitoring of HBV DNA during the perioperative period was necessary,especially in patients with low HBV DNA levels.The tumor diameter and injecting anhydrous alcohol into the resection margin were independent risk factors of postoperative increase in HBV DNA.Changes in serum IL-10 and IL-6 levels after hepatic resection might be related to the elevation of HBV DNA level.In addition,reactivation of HBV did not aggravate damages in postoperative liver function.Antiviral treatment did not promote recovery of liver function in the early stage.
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Objective To evaluate the impact of different treatment strategies on patients with hepatocellular carcinoma (HCC) of less than 10 cm but with portal vein tumor thrombus (PVTT),and to investigate the prognostic factors.Methods Between 2003 and 2008,338 HCC patients with PVTT from the Affiliated Tumor Hospital,Guangxi Medical University,were retrospectively studied.These patients were divided into four groups:the conservative treatment group (n =75),the transarterial chemoembolization (TACE) group (n=86),the surgical resection group (n =90) and the surgical resection with postoperative TACE group (n=87).Survival rates were analyzed by the Kaplan-Meier method and differences among groups were compared using the log-rank analysis.The Cox' s proportional hazards model was performed to explore the risk factors of survival.Results The mean survival periods of patients in the four groups were 3.8,7,8.2,15.1 months respectively.There were significant differences in survival rate among the 4 groups.The survival rates at 1-,2-,and 3-year in the surgical resection with postoperative TACE group were 49％,37％ and 19％,which were significantly higher than the other 3 groups (P＜0.05).The 1-,2-,and 3-year survival rates in the surgical resection group were 28％,20％ and 15％ compared with 17.5％,0％ and 0％ in the TACE group.The survival rates were significantly higher after surgical resection than TACE (P＜0.05).The 1-,2-,and 3-year survival rates in the conservative treatment group were 0％.These were the lowest among the four groups (P＜0.05).Univariate analysis indicated that portal vein occlusion by tumor thrombus was a significant predictor of poor prognosis.Multivariate analysis revealed that the strategy of treatment (TACE) and the number of TACE cycles were independent survival predictors for HCC patients with PVTT.Conclusions Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and with good liver functional reserve.Postoperative TACE is necessary in preventing recurrence and prolonging survival in patients who could tolerate chemoembolization.TACE should be recommended as an effective and safe treatment for unresectable HCC patients with PVTT.The treatment provided a significantly better survival than conservative treatment.
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Objective To investigate the efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC).Methods The clinical data of 30 HCC patients who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2011 to December 2011 were retrospectively analyzed.All patients were divided into the laparoscopic hepatectomy (LH) group (10 patients) and open hepatectomy (OH) group (20 patients) according to the operation patterns and at the ratio of 1 ∶ 2.The degree of cirrhosis,size and location of tumor of the 2 groups were analyzed using the covariance analysis.The student t test was used for analysing the difference of the 2 groups.Results In the LH group,7 patients received laparoscopic nonanatomical liver resection,3 received anatomical resection of the left lateral lobe,no patient was converted to the hand assisted laparoscopic surgery or open surgery.In the OH group,14 patients received non-anatomical liver resection,and 6 received anatomical liver resection.The volume of blood loss of the LH group was (247 ± 235) ml,which was significantly lower than (408 ± 191)ml of the OH group (t =2.199,P ＜ 0.05).The mean postoperative fasting time,postoperative abdominal drainage time and duration of hospital stay of the LH group were (1.9 ±0.6) days,(3.2 ± 1.2) days and (8.9 ± 2.3) days,which were significantly shorter than (3.0 ± 1.6) days,(4.9±1.6)daysand (11.5±2.3)days of the OH group (t=2.149,2.917,2.921,P＜0.05).The levels of alanine aminotransferase (ALT) of the LH group at day 1,3,5 were (228 ± 100)U/L,(143 ± 51)U/L,(85 ±24) U/L,and the levels of aspartate aminotransferase (AST) of the LH group at day 1,3,5 were (196 ± 67)U/L,(90 ± 35) U/L,(46 ± 10) U/L.The levels of ALT of the OH group at day 1,3,5 were (557 ± 401) U/L,(414 ±397)U/L,(217 ± 199)U/L,and the levels of AST of the OH group at day 1,3,5 were (506 ±317)U/L,(178 ± 122) U/L,(71 ± 33) U/L.The time for hepatic function recovery of the LH group was significantly shorter than that of the OH group (t =3.675,3.001,2.073 ; 4.196,2.223,2.272,P ＜ 0.05).All the 30 patients were followed up for 3-15 months.The level of alpha fetoprotein of 1 patient in the LH group was increased at postoperative month 4,and the results of computed tomography showed multiple intrahepatic lesions.The patient was cured by intervention treatment.One patient of the OH group was diagnosed as with tumor recurrence at the resection margins and adjacent hepatic segments.The patient was cured by radiofrequency ablation,with no tumor recurrence.No tumor recurrence or metastasis was observed in the other patients.Conclusion Laparoscopic hepatectomy is a feasible,safe and minimally invasive approach for patients with HCC.
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Objective To compare anatomic resection (AR) and non-anatomic resection (NAR)for hepatocellular carcinoma (HCC) as a factor in preventing intra-hepatic recurrence and local recurrence after the initial surgical procedure.Methods A systematic review and Meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990to 2010 in PubMed and Medline,Coehrane Library,Embase,and Science Citation Index were searched.Intra-hepatic recurrence,including early and late recurrence,and local recurrence were primary outcomes.5-year survival and 5-year disease-free survival were secondary outcomes.Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result Eleven nonrandomized studies including 1576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group.Patients in the AR group were characterized by lower prevalence of cirrhosis,more favorable hepatic function,and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group.Anatomic resection significantly reduced the risks of local recurrence (OR,0.27; 95％ CI,-0.17～0.43; P＜0.001) and achieved a better 5-year disease-free survival (OR,2.10; 95％ CI,-1.41 ～3.12; P=0.001) in HCC patients.Also,anatomic resection was marginally effective in decreasing early intra-hepatic recurrence.However,anatomic resection was not advantageous in preventing late intra-hepatic recurrence.No significant differences were found between the AR and NAR groups with respect to postoperative morbidity,mortality,and length of hospitalization.Conclusion Anatomic resection was recommended to be superior to non-anatomic resection in reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5-year disease-free survival in HCC patients.
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Objective To identify potential serum biomarkers specific for hepatocellular carcinoma (HCC).Methods Eighty-one patients wilh hepatitis B-related HCC and 80 healthy controls were randomly divided into a training set (48 HCC,47 controls) and a testing set (33 HCC,33 controls).Serum proteomic profiles were measured using surface-enhanced laser desorption/ionization time-offlight mass spectroscopy (SELDI-TOF-MS).A classification tree was established by the Biomarker Pattern Software.Candidate biomarkcrs were separated by HPLC and identified by MA1DI-MS/MS and database searching.Forty-eight patients with HCC,54 cirrhotic patients and 42 healthy subjects were clinically validated using candidate biomarkers by SELDI-Immunoassay.Real-time reverse transcriptase-polymerase chain reaction was performed to observe GRO-1 and Thrombin in 55 HCC tissues and 13 normal hepatolage tissues.Results Two up-regulated protein peaks were automatically chosen as a classification tree in the training set.These biomarkers were identified as thrombin light chain and CXC chemokines ligand 1 (GRO-1).The sensitivity and specificity of this classification tree were 89.6％.The multivariate model using the two biomarkers and alpha-fetoprotein (AFP) resulted in a sensitivity of 91.7％ and specificity of 92.7％,which was significantly better than AFP alone.The mRNA expression of GRO-1 and Thrombin were found in all HCC tissues.There were significant associations between GRO-1 gene expression and some clinical and pathological findings such as metastasis and recurrence (P＜0.05).Significant differences of 5-year survival rates wee observed among subgroups according to the expression of GRO-1 (P＜0.05).There were significant associations between Thrombin gene expression and some clinical and pathological findings such as recurrence and AFP (P＜0.05).Significant differences of 5-year survival rates were observed among the subgroups according to the expression of THROMBIN (P＜0.05).A positive correlation was found between GRO-1 and Thrombin (r=0.73,P＜0.01).Conclusion Thrombin light chain and GRO-1 are potential biomarkers of HCC.The expression of GRO-1 in HCC tissues was a valuable indicator in estimating metastasis and recurrence in HCC patients.
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Objective To investigate the killing activity of tumor infiltrating lymphocytes (TIL) stimulated by dendritic cells (DC) on gastric carcinoma cells in vitro. Since DC is the strongest antigen presenting cell (APC) which has been known, it can present antigens to T lymphocytes, including TIL, and can induce cytotoxic T lymphocyte (CTL) responded in vivo and vitro. Methods DC were isolated from the peripheral blood of patients with gastric carcinoma and stimulated by granulocyte/macrophage colony stimulating factor (GM CSF), interleukin 4 (IL 4) and tumor antigen. Then TIL were stimulated by DC and their killing activity on autogenous gastric carcinoma cells and SGC 7901 cells in vitro were observed. Results TIL stimulated by DC had very high killing activity on autogenous gastric carcinoma cells and the killing rate was (89.39?3.05)%, which was much higher than those of TIL not stimulated by DC and T lymphocytes stimulated by DC as well as T lymphocytes not stimulated by DC on autogenous gastric carcinoma cells. The killing rates of the last three ones were (54.37?1.50)%, (53.92?1.46)% and (3.55? 0.25) % respectively. However, their killing activity on SGC 7901 cells was lower. Conclusions The results indicate that DC from patients with gastric carcinoma can induce efficient and specific anti gastric carcinoma immune responses.