ABSTRACT
Objective To study the expression and significance of Glypican-3 in Budd-Chiari syndrome (BCS) complicated with hepatocellular carcinoma (HCC).Methods The data of 46 patients with BCS complicated with HCC (the BCS + HCC group) treated in The First Affiliated Hospital of Zhengzhou University from January 2007 to December 2016 were analyzed retrospectively.Another 48 patients with HBV-related HCC (the HBV + HCC group) and 43 patients with hepatic cyst (the hepatic cyst group) were randomly selected as the control groups during the same time period.The differencesin positive rates of Glypican-3 in the liver tissues among the three groups were compared.The BCS + HCC group was further divided into the Glypican-3 positive and Glypican-3 negative subgroups according to the expression of Glypican-3.The differences in gender,age,AFP,HbsAg,Child-Pugh classification,tumor number,extrahepatic metastasis,vascular invasion,Edmondson-Steiner grading and BCLC staging between the two subgroups were compared.The survival time of the two subgroups was compared using the Kaplan-Meier method.Results The expression rates of Glypican-3 in the BCS + HCC group,HBV + HCC group and Hepatic Cyst group were 76.1％,70.8％ and 0％,respectively.The levels of Glypican-3 in the BCS + HCC group and the HCC group were significantly higher than that in the hepatic cyst group.The differences were statistically significant (P ＜ 0.05).No statistically significant difference was detected between the BCS + HCC group and the HBV + HCC group (P ＞ 0.05).In the group of patients with BCS + HCC,there was no significant difference in gender,age,AFP,HbsAg,Child-Pugh classification,tumor number and extrahepatic metastasis between the Glypican-3 positive and negative subgroups (P ＞0.05).However,vascular invasion,Edmondson-Steiner grading and BCLC staging in the Glypican-3 positive subgroup were significantly higher than those in the Glypican-3 negative group,(P ＜ 0.05).The 1-year,3-year and 5-year survival rates were 77.1％,51.0％ and 22.8％ in the Glypican-3 positive subgroup,compared with 90.9％,63.6％ and 45.5％ in the Glypican-3 negative subgroup,respectively.There were statistically significant differences between the two groups (P ＜ 0.05).Conclusion Glypican-3 has a stable expression in patients with BCS complicated with HCC,and it is closely related to malignancy of the tumor and prognosis of the patients.
ABSTRACT
Objective To investigate the application value of clinical typing in the treatment of BuddChiari syndrome (BCS).Methods The retrospective corss-sectional study was adopted.The clinical data of 95 patients with BCS who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to September 2015 were collected.Based on patients' compensation and clinical symptoms,3 clinical typing and 8 subtypes of BCS were proposed,and each subtype was treated with corresponding strategies.Observation indices included (1) the clinical typing of BCS,(2) selection of treatment,(3) treatment effect,(4) follow-up situations.Follow-up using telephone interview and outpatient examination was performed once within 3 months after the first treatment and then once every 6 months up to December 2015 or death,loss to follow-up and experienced decompensation.During follow-up,color Doppler ultrasound and blood bio-chemistry test were performed regularly,and CT angiography was also conducted when necessary.Count data were presented as the case or percentage.The survival rate was calculated using Kaplan-Meier method and the survival curve was drawn.Results (1) BCS clinical typing of 95 patients:4 were detected in type Ⅰ (3 in type Ⅰ a and 1 in type Ⅰ b),7 in typeⅡ (4 in type Ⅱa and 3 in type Ⅱb),and 84 in type Ⅲ(43 in type Ⅲa,4 in type Ⅲb,32 in type Ⅲc,and 5 in type Ⅲd).(2) Selection of treatment in 95 patients:① among the 3 patients with type Ⅰ a,2 of them received inferior vena cava balloon angioplasty while 1 patient had to give up the operation due to failure in opening the occlusion.This patient underwent close observation and follow-up afterwards.② The patient with type Ⅰ b underwent cavity-antrum artificial blood vessel bypass operation due to failure in opening the occlusion.③Among the 4 patients with type Ⅱ a,one of them underwent hepatic vein balloon angioplasty.The other 3 patients underwent close observation and follow-up because of failure in intervention therapy,such as segmental occlusion of hepatic vein or difficulty in finding the hepatic vein.④ Among the 3 patients with type Ⅱ b,due to the history of upper gastrointestinal bleeding,2 patients received modified spleen-lung fixation and intestine-cavity blood vessels bypass,respectively,and 1 patient received intestine-cavity artificial blood vessels bypass due to severe peritoneal effusion.⑤ Among the 43 patients with type Ⅲ a,35 patients underwent inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (6 of them received firstly thrombolysis treatment due to combined thrombosis.Four patients received inferior vena cava and hepatic vein balloon angioplasties.Another 4 patients received close observation and follow-up due to failure in both inferior vena cava and hepatic vein intervention therapy.⑥Among the 4 patients with type Ⅲ b,2 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass.The other 2 patients only received modified spleen-lung fixation because of failure in inferior vena cava intervention therapy.⑦ Among the 32 patients with type Ⅲ c,3 underwent inferior vena cava and hepatic vein balloon angioplasties,and 27 patients underwent only inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (7 of them received balloon angioplasty following thrombolysis treatment due to combined thrombosis).On account of failure in both inferior vena cava and hepatic vein intervention therapy,2 patients underwent resection of lesion membranes and cavity-antrum artificial blood vessel bypass,respectively.⑧ Among the 5 patients with type Ⅲ d,1 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass,and 4 underwent only modified spleen-lung fixation due to failure ininferior vena cava intervention therapy.(3) Treatment efficacy:of 95 patients,8 received followup observation,and 87 patients recovered to varied extent after interventional therapies and operations,with symptomatic relief of leg edema,ulcer,peritoneal effusion and esophageal varicosity.Eighty-seven patients went through the perioperative period safely,and no death occurred.The incidence of postoperative complications was 10.3％ (9/87).The complications mainly include venous thrombosis in lower limbs during catheter-directed thrombolysis therapy,pleural effusion,pneumatosis,and peritoneal effusion after surgery,all of which were cured after symptomatic treatment.(4) Follow-up results:87 were followed up for 3-42 months with an average time of 19 months.During the follow-up,5 patients (1 in type Ⅰ a and 4 in type Ⅲa) received recanalization surgery because of the reocclusion after the inferior vena cava balloon angioplasty,and no decompensation occurred.However,decompensation was found in 11 patients (disease progression in 4 patients and symptom relapse in 7 patients).The survival rates of patients without decompensation at 0.5,1.0,2.0 and 3.0 years after the first treatment were 96.5％,95.0％,83.4％ and 80.5％,respectively.Conclusion According to patients' compensation and clinical symptoms,clinical typing of BCS and treatment strategiesis are determined,and it will provide a satisfactory clinical efficacy.