Clinical and pathological features and surgical treatment of Budd-Chiari syndrome-associated hepatocellular carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Budd-Chiari syndrome (BCS) is characterized by liver sinusoidal congestion, ischemic liver cell damage, and liver portal hypertension caused by hepatic venous outflow constriction. The aim of this research was to investigate the clinicopathological features of BCS-associated hepatocellular carcinoma (HCC) and explore its surgical treatment and prognosis.</p><p><b>METHODS</b>Clinical data from 38 patients with BCS-associated HCC who were surgically treated in our hospital from July 1998 to August 2010 were retrospectively analyzed. The clinicopathological features and prognosis of patients with BCSassociated HCC and surgical treatment for BCS-associated HCC were investigated.</p><p><b>RESULTS</b>Compared to the patients with hepatitis B virus (HBV)-associated HCC, the patients with BCS-associated HCC showed a female predominance, and had significantly higher cirrhosis rate, higher incidence of solitary tumors, lower incidence of infiltrative growth, higher proportion of marginal or exogenous growth, lower rate of portal vein invasion, and higher degree of differentiation. Median survival was longer in patients with BCS-associated HCC (76 months) than in those with HBV associated HCC (38 months). Of 38 patients with BCS-associated HCC, 22 patients who received combined surgery mainly by liver resection plus cavoatrial shunts exhibited hepatic venous outflow constriction relief, while the other 16 patients only underwent liver resection. The combined surgery group had significantly longer survival and lower incidences of post-operative lethal complications (P < 0.05). Multivariate analysis showed that relief of hepatic venous outflow obstruction was a protective factor for survival of patients with BCS-associated HCC, whereas portal vein invasion was a risk factor.</p><p><b>CONCLUSIONS</b>BCS-associated HCC has a more favorable biological behavior and prognosis than HBV-associated HCC. For patients with BCS-associated HCC, tumor resection accompanied with relief of hepatic venous outflow obstruction can reduce the incidence of complications and extend survival.</p>

The prognostic significance of Omi/HtrA2 expression, and correlation between Omi/HtrA2 and hypoxia-inducible factor-1α in primary hepatocellular carcinoma cells / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the prognostic significance of Omi/HtrA2 expression, and the correlation between Omi/HtrA2 and Hypoxia-inducible factor (HIF)-1α in primary hepatocellular carcinoma cells.</p><p><b>METHODS</b>The expression of HIF-1α and Omi/HtrA2 in 43 cases of hepatic carcinoma tissues were detected immunohistochemically. Follow-up data were obtained to perform the Kaplan-Meier survival analysis. The change of Omi/HtrA2 expression in HepG2 cell was measured after HIF-1α expression of HepG2 in vitro was regulated by Tet-on expression system.</p><p><b>RESULTS</b>Omi/HtrA2 expression was correlated with lymph node metastasis and recurring within liver during 2 years. Statistical analysis estimation showed the cumulative survival rate of post-hepatectomy for the patients with the positive expression of Omi/HtrA2 was higher than that for other patients with the negative expression of Omi/HtrA2 (χ(2) = 6.13, P = 0.013). In the common paraffin-embedded specimen of hepatocellular carcinoma, most of the samples showing negative or weak positive HIF-1α immunopositivity showed moderate positive or strong positive Omi/HtrA2 immunopositivity, while most of the samples showing moderate positive or strong positive HIF-1α immunopositivity showed negative or weak positive Omi/HtrA2 immunopositivity. The mRNA expression intensity of Omi/HtrA2 was decreasing with the HIF-1α expression increasing, and the difference was statistically significant(F = 106.766, P < 0.01).</p><p><b>CONCLUSIONS</b>Omi/HtrA2 may be an important prognostic marker for primary hepatocellular carcinoma. Omi/HtrA2 expression is reversely correlated with HIF-1α expression in hepatocellular carcinoma. During the apoptotic process Omi/HtrA2 participating in hepatocellular carcinoma cells, HIF-1α is involved in the controlling and regulating of Omi/HtrA2 expression.</p>

Inducible expression of hypoxia-inducible factor 1alpha on the proliferation and invasion property of HepG2 cells under normoxia in vitro / 中华外科杂志

<p><b>OBJECTIVE</b>To study the inducible expression of hypoxia-inducible factor 1alpha (HIF-1alpha) on the proliferation and invasion property of HepG2 cells under normoxia in vitro.</p><p><b>METHODS</b>Constructed the HepG2(Tet-on-HIF-1alpha) cell line which could induce the expression of HIF-1alpha by doxycycline; Under normoxia in vitro, MTT assay was used to observe the proliferative and adhesive activity of cells, and the invasive activity was determined by transwell cell culture chamber method.</p><p><b>RESULTS</b>Under normoxia, the HIF-1alpha mRNA and protein of HepG2(Tet-on-HIF-1alpha) cells could be induced up to (5.899 +/- 2.176) and (2.179 +/- 0.742) folds by doxycycline (1 microg/ml); There were no difference of A(490 nm) between the Dox(+)and Dox(-) group in experiment detecting the proliferation activity (P > 0.05); But in adhesive experiment, the A(490 nm) of Dox (+) group was 0.662 +/- 0.058, higher than the Dox(-) group 0.526 +/- 0.808 (P = 0.008); The invasive cell number of Dox(+) group was 37.611 +/- 8.424, but in the Dox(-) group, the number was 25.333 +/- 8.117 (P < 0.01).</p><p><b>CONCLUSIONS</b>Under normoxia in vitro, the Tet-on gene regulate system could increase the HIF-1alpha protein by inducing the HIF-1alpha mRNA; HIF-1alpha has no influence with the proliferation activity, but it could enhance the adhesive and invasive properties of HepG2 cells.</p>

Expression of Twist gene in human hepatocellular carcinoma and its clinicopathological significance / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression and clinicopathological significance of transcription factor Twist in hepatocellular carcinoma (HCC), paraneoplastic and cirrhotic tissues.</p><p><b>METHOD</b>Immunohistochemistry was used to detect the expression of the Twist protein in 26 cases of HCC and paraneoplastic tissue and 10 cases of cirrhotic tissue. Meanwhile, the Twist mRNA and its protein were detected in 10 HCC tissues and 10 paraneoplastic tissues by RT-PCR and Western blot. And the expression differences and clinicopathological significances of the expression of Twist gene and its protein were analyzed.</p><p><b>RESULTS</b>The positive rates of the Twist protein in HCC, paraneoplastic and cirrhotic tissues were 84.6%, 19.2 % and 20.0 %, respectively. The positive rate of Twist in HCC was higher than that in paraneoplastic or cirrhosis tissues (P < 0.05). Compared with in paraneoplastic tissues, the mRNA and protein expression of Twist were up-regulated in HCC by 2.52 and 2.13 times, respectively.</p><p><b>CONCLUSION</b>Twist has an inappropriate expression in hepatocellular carcinoma and it may play an important role in the tumorigenesis and progression of HCC.</p>