Thinking and suggestion on the definition, classification and Chinese nomenclature of carcinoma of the bile ducts / 中华外科杂志

At present, the classification, nomenclature, and definition of carcinoma of the bile ducts are controversial. Moreover, there is no uniformity between China and aboard, which has brought confusion to clinical practice. It needs to clarify regarding tumor naming principles, anatomical location, tumor origin, pathological classification, biological characteristics, clinical manifestations, treatment methods, etc. Additionally, the WHO tumor classification, UICC staging, ICD disease classification, relevant Chinese regulations, EASL, AJCC staging, and NCCN guidelines were also needed to be referred. After investigating the above-mentioned latest authoritative literature, based on the existing problems, combined with clinical practice in China, the author reevaluated the definition, classification, and nomenclature of cholangiocarcinoma, and proposes updated suggestions. Hoping to standardize and unify clinical practice for classification and nomenclature of cholangiocarcinoma in China.

Multidisciplinary comprehensive treatment of postoperative recurrence of hepatocellular carcinom / 中国实用外科杂志

The treatment modality of recurrent hepatocellular carcinoma(HCC) includes surgical resection, liver transplantation, ablation, interventional therapy, targeted therapy,and systemic chemotherapy. However,the complexity of disease condition often leads to unsatisfying outcome by single treatment, making multidisciplinary treatment an inevitable choice. Commonly used combined therapies are transarterial chemoembolization(TACE) combined with surgical resection,TACE combined with local ablation,and TACE combined with systemic treatment. In clinical practice,the goal of comprehensive treatment is prolonged survival and improved quality of life. Choosing different combination of therapies according to different liver function,general condition and recurrence of tumors can significantly improve the patients' survival.

Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization / 癌症

<p><b>INTRODUCTION</b>Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.</p><p><b>METHODS</b>A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS).</p><p><b>RESULTS</b>The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5-27.7) months in the antiviral group and 9.6 (95% CI, 7.8-13.7) months in the non-antiviral group (log-rank test, P = 0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P = 0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5-37.7] months, P = 0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P = 0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95% CI, 5.2-13.5] months versus 7.4 [95% CI, 5.9-9.3] months, P = 0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.</p><p><b>CONCLUSION</b>Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.</p>

Long-term survival of patients with hepatocellular carcinoma with inferior vena cava tumor thrombus treated with sorafenib combined with transarterial chemoembolization: report of two cases and literature review / 癌症

The prognosis of hepatocellular carcinoma (HCC) with tumor thrombus formation in the main vasculature is extremely poor. Sorafenib combined with transarterial chemoembolization is a novel treatment approach for advanced HCC. In this study, we report two HCC patients with inferior vena cava tumor thrombus who underwent the combination treatment. The overall survival times for these two patients were 44 months and 35 months, respectively. Our report suggests that sorafenib combined with transarterial chemoembolization may be a viable choice for patients with advanced HCC even with inferior vena cava tumor thrombus. Further studies are required to verify the efficacy and safety of this combination therapy for patients with advanced HCC with inferior vena cava tumor thrombus.

Prognostic value of soluble MICA levels in the serum of patients with advanced hepatocellular carcinoma / 癌症

Serum levels of soluble MHC class I-related chain A (sMICA) are related with the prognosis of various types of cancer; however, few studies on the prognostic value of sMICA in hepatocellular carcinoma (HCC) have been reported. In this study, we retrospectively investigated the relationship between sMICA levels and clinical features of advanced HCC, and we assessed the prognostic value of sMICA in advanced HCC. Furthermore, the relationship of serum sMICA levels and natural killer group 2, member D (NKG2D) expression on natural killer (NK) cells was also evaluated. We detected sMICA levels in the serum of 60 advanced HCC patients using enzyme-linked immunosorbent assay (ELISA) and measured expression levels of NKG2D on NK cells using flow cytometry. We found that serum sMICA levels in HCC patients were in the range of 0.10-6.21 ng/mL. Chi-square analyses showed that sMICA level was significantly related with only tumor size. Survival analysis showed that a high sMICA level was significantly related with poor prognosis among HCC patients. Multivariate analyses indicated that sMICA was an independent prognostic factor. In addition, the levels of CD56+NKG2D+ NK cells were within the range of 11.2%-55.4%, and correlation analyses indicated that sMICA level was negatively correlated with the level of NKG2D+ NK cells. Our results suggest that serum sMICA levels may be an independent prognostic factor for advanced HCC.

Risk factors of survival for recurrent hepatocellular carcinoma treated by percutaneous radiofrequency ablation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma(HCC) treated by percutaneous radiofrequency ablation (PRFA).</p><p><b>METHODS</b>From January 1999 to December 2008, 82 patients with recurrent HCC, with the diameter less than 7 cm for solitary tumor, or the largest tumor less than 5 cm for multiple tumors(the number of tumors less than 3), were treated by PRFA. The significance of 12 clinical or pathological variables in the risk factors of overall survival were assessed.</p><p><b>RESULTS</b>The overall survival 1-, 3-, and 5-year survival rates were 75.8%, 43.9% and 34.5% (from the date of PRFA), and 95.1%, 63.2% and 46.6% (from initial hepatectomy), respectively. Univariate analysis indicated that tumor size before initial hepatectomy, recurrence interval from initial hepatectomy, number of recurrent tumors, diameter of largest recurrent tumor, serum glutamyl transpeptidase (GGT) and serum albumin (ALB) level were significant prognostic factors (P < 0.05, Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy, diameter of largest recurrence tumor, serum GGT and ALB level were significant prognostic (P < 0.05).</p><p><b>CONCLUSION</b>PRFA is effective for recurrent HCC. Recurrence interval from initial hepatectomy, diameter of largest recurrent tumor, serum GGT and ALB level are significant prognostic factors.</p>

Efficacy of combining temperature- and power-controlled radiofrequency ablation for malignant liver tumors / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Single mode of radiofrequency ablation (RFA) often leads to limited ablation in the zone of necrosis. This study clarifies the efficacy of combining temperature- and power-controlled RFA for malignant liver tumors.</p><p><b>METHODS</b>Between April 2008 and August 2008, 58 patients with malignant liver tumors received RFA at Sun Yat-sen University Cancer Center. The patients were divided into 2 groups using a random number table: one group received combined temperature- and power-controlled RFA (the combination group), and the other group received power-controlled RFA alone (the control group).</p><p><b>RESULTS</b>Three patients were lost to follow-up and 55 patients were included for evaluation. Twenty-five patients with 29 tumors were treated by the combination RFA, and 27 tumors (93.1%) achieved either complete response (CR) or partial response (PR). One patient had a seriously decreased heart rate. In the control group, 30 patients with 32 tumors received power-controlled RFA, and 29 tumors (90.6%) achieved CR or PR. There were no serious complications. There was no difference between the combination and control groups in treatment time ((13.3 +/- 1.3) min vs. (10.2 +/- 2.3) min, P = 0.459). The number of sessions of RFA for the combination group was less than that of control group (1.3 sessions vs. 2.4 sessions), but the difference was not significant (P = 0.579).</p><p><b>CONCLUSION</b>RFA controlling both temperature and power is effective and safe for patients with malignant liver tumors, and the number of sessions of RFA for the combination group was less than that of the control group.</p>

Clinical observation of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the efficacy and safety of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Thirty-eight patients with advanced HCC of Child-Pugh status A or B were included in this study. Patients received orally administered sorafenib at a dose of 400 mg twice a day on a continuous schedule. Adverse events were documented. The efficacy and safety were evaluated every four to six weeks.</p><p><b>RESULTS</b>During the treatment, partial response (PR) was observed in 1 patient (2.6%), minor response (MR) in 5 (13.2%), stable disease (SD) in 16 (42.1%), and progressive disease (PD) in 16 (42.1%), respectively. The median oral administration time of sorafenib was 180 days (range, 15-550 d), and the mean overall survival was 370 days (range, 42-562 days). The median response duration was 169 days (range, 42-426 days). The mean overall survival of 22 patients with controlled disease (PR + MR + SD) was 428 days (95% CI 330-526 days). The most frequent adverse events were dermal reaction (27 cases, 71.1%), gastrointestinal reaction (25 cases, 65.8%), and constitutional symptoms (14 cases, 36.8%). Most of the drug related adverse events were mild and easily to manage and reversible.</p><p><b>CONCLUSION</b>Sorafenib monotherapy is effective and tolerable in a part of Chinese patients with advanced hepatocellular carcinoma and liver function of Child-Pugh A or B, and may prolong their survival.</p>

Effects of carbon-coated iron nanocrystals combined with epirubicin on HepG-2 cells and its acute toxicity in mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the cytotoxicity of carbon-coated iron nanoparticles (CCIN) and epirubicin-loaded CCIN on Hep-G2 cells in vitro and compare the acute toxicities of epirubicin and epirubicin-loaded CCIN in mice.</p><p><b>METHODS</b>The cytotoxicities of CCIN and epirubicin-loaded CCIN on HepG2 cells were assessed using MTT assay, and the uptake of CCIN by the tumor cells was observed by optical and electron microscopy. Different doses of epirubicin and equivalent doses of epirubicin-loaded CCIN were injected intravenously in mice to compare their acute toxicities.</p><p><b>RESULTS</b>Optical and electron microscopy revealed cytoplasmic uptake of CCIN in the tumor cells without obvious destruction of the cell structural integrity. Incubation of the HepG-2 cells with different concentrations of CCIN suspension did not result in significant variation in the mean absorbance. MTT assay showed reduced cytotoxicity of epirubicin-loaded CCIN in HepG2 cells as compared with that of epirubicin alone. The cell growth inhibition rate was significantly higher with epirubicin-CCIN mixture that contained a lower proportion of CCIN. In acute toxicity experiment with mice, the median lethal dose (LD(50)) of epirubicin was 16.9 mg/kg, while that of epirubicin-CCIN mixture was 20.7 mg/kg.</p><p><b>CONCLUSION</b>CCIN uptake by HepG-2 cells does not cause obvious cytotoxicity in vitro within a certain concentration range, epirubicin-loaded CCIN has reduced cytotoxicity against HepG2 cells as compared with epirubicin, and the cytotoxicity of the mixture decreases with the increase in the CCIN content in the mixture. Epirubicin delivery in mixture with CCIN can reduce its acute toxicity in mice.</p>

Percutaneous radiofrequency ablation combined with other minimally invasive treatments for recurrent hepatocellular carcinoma after hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of percutaneous radiofrequency ablation (PRFA) and combined with other minimally invasive treatments for recurrent hepatocellular carcinoma (RHCC) after hepatectomy.</p><p><b>METHODS</b>Eighty-four patients with RHCC after hepatectomy who were treated with PRFA or combined with other minimally invasive therapies between August 1999 and February 2008 were analyzed retrospectively.</p><p><b>RESULTS</b>There was no treatment related mortality in the study population, and the morbidity was 2.4% (2/84). The complete ablation rate was 94.0% (79/84), and the 1-, 3- and 5-year overall survival rates were 74.9%, 54.9% and 48.2%, respectively. The 1-, 3- and 5-year overall survival rates of patients with recurrent interval after hepatectomy less than 1 year and over 1 year were 72.1%, 36.2%, 24.2% and 76.8%, 70.6% and 65.1%, respectively (P = 0.040). The 1-, 3- and 5-year overall survival rates of patients with tumor size <or= 3 cm and > 3 cm were 83.2%, 67.7%, 67.7% and 59.1%, 24.2%, 12.1%, respectively (P = 0.003). The 1-, 3- and 5-year overall survival rates of patients treated with PRFA alone and combined with percutaneous ethanol injection (PEI) were 66.7%, 33.3%, 22.2% and 76.5%, 57.3%, 57.3%, respectively (P = 0.017). The 1-, 3- and 5-year overall survival rates of patients treated with PRFA alone and combined with transcatheter hepatic arterial chemoembolization (TACE) were 55.6%, 24.7%, 24.7% and 81.6%, 66.0%, 57.5%, respectively (P = 0.001).</p><p><b>CONCLUSIONS</b>PRFA is an effective and safe treatment for RHCC, and tumor size and recurrent interval after hepatectomy are important prognostic factors. Combination with PEI or TACE may improve the efficacy of PRFA for treatment of RHCC.</p>

Experience of radiofrequency ablation on liver malignancies: a report of 803 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the 8-year experience of radiofrequency ablation (RFA) on liver malignancies and explore the effect and prognostic factors.</p><p><b>METHODS</b>From August 1999 to February 2007, 803 patients with liver malignancies, among which there were 672 with primary liver cancer (PLC) and 131 with liver metastasis, were treated with RFA. There were 781 cases who were performed percutaneously under the guidance of ultrasound, 8 cases under CT, 9 cases with laparoscopy and 5 cases with laparotomy. And there were 117 cases who were treated by RFA combined with percutaneous ethanol injection and 108 cases by RFA combined with trans-catheter arterial chemoembolization.</p><p><b>RESULTS</b>In the treatment of all the 803 patients with liver malignancies, the mortality was 0.25%, the rate of severe complications was 0.37%. The rate of complete ablation was 92.5%, the loco-recurrence rate was 13.8% and the 1, 2, 3, 4, 5-year survivals were 95.1%, 85.6%, 75.7%, 60.7% and 47.5%, respectively. For the 672 patients with PLCs, the 1, 2, 3, 4, 5-year survivals with stage Ia (Chinese staging system) were 97.8%, 91.5%, 84.6%, 77.1% and 61.9%, respectively, with stage Ib were 93.9%, 83.7%, 69.8%, 45.1% and 42.2%, respectively, with stage II were 86.2%, 67.3%, 47.3%, 17.2% and 0, respectively, and the 1, 2-year survivals with stage III were 67.8% and 0, respectively (P < 0.01).</p><p><b>CONCLUSIONS</b>RFA is a safe and effective method for liver malignancy, and the tumor size and stage are important prognostic factors.</p>

Acute toxicity of carbon-coated iron nanocrystal and its effect on liver and kidney functions and hematological system / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the acute toxicity of carbon-coated iron nanocrystal (CCIN) in mice and its effects on hepatic, renal and hematological functions.</p><p><b>METHODS</b>Acute toxicity of CCIN was evaluated by observing the toxic reactions in mice within 14 days following intravenous injection of different doses of CCIN particles. The liver and kidney functions and blood chemistry were tested in rats before and at different time points after CCIN injection.</p><p><b>RESULTS</b>The median lethal dose (LD(50)) of CCIN particles given by intravenous injection was 203.8 mg /kg in mice. Within the intravenous dose of 80 mg /kg injection, CCIN caused only mild alterations of the rats' biochemical and hematological indices that recovered without intervention in two weeks.</p><p><b>CONCLUSION</b>CCIN is characterized by low acute toxicity and mild side effects on the hepatic, renal and hematological functions within a certain dose range.</p>

Preliminary results of postoperative adjuvant treatment with tamoxifen in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate estrogen receptor (ER) expression and the effects of anti-estrogen therapy on the prognosis of colorectal carcinoma.</p><p><b>METHODS</b>ER was measured in fresh colorectal cancer tissues by Dextran-coated charcoal (DCC) assay. The relationships between ER expression and clinicopathological parameters in colorectal cancer were analyzed. Tamoxifen was administrated postoperatively as adjuvant treatment.</p><p><b>RESULTS</b>The positive rate of ER in colorectal tumor tissues was 37.0%. The 5-year survival rates of tamoxifen group and control group were 66.7% and 72.5% respectively, and there was no significant difference between the two groups. The distant metastasis rate of Tamoxifen group was significantly lower than that of control group (3% versus 20%).</p><p><b>CONCLUSION</b>Some colorectal carcinomas are hormone-dependent tumors, and anti-estrogen therapy has no effect on them.</p>

Clinical treatment of small hepatocellular carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the suitable treatment methods of small hepatocellular carcinoma (SHCC).</p><p><b>METHODS</b>From 2000 to 2004, 849 cases of SHCC (< or = c5 cm) were enrolled and divided into two groups: resection group (n = 406) and minimally invasive treatment (MIT) group (n = 443). The survival rates, recurrence rates, and post-treatment complications were compared retrospectively.</p><p><b>RESULTS</b>The 3-year survival rate in the resection group was 72.1%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of resection group were 73.3% and 70.5% (P = 0.46), respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.5%, 29.9%, and 39.8%, respectively. The 3-year survival rates in MIT group was 73.8%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of MIT group were 74.7% and 72.2% (P = 0.45), respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 12.6%, 28.7%, and 40.4%, respectively. The 3-year survival rate was significantly different between these two group in tumor < or = 3 cm (P < 0.05). The post-treatment complication rates of these two group were 30.8% and 6.1% (P < 0.01), respectively.</p><p><b>CONCLUSIONS</b>MIT is as effective as the traditional resection in SHCC. However, MIT is superior to the traditional resection in terms of minimal invasion and less post treatment complication rate. The recurrence rate of HCC was still high after treatment. Comprehensive therapies, including MIT, may increase the survival rate and life quality in SHCC patients.</p>

Randomized clinical trial of percutaneous radiofrequency ablation plus absolute ethanol injection compared with radiofrequency ablation alone for small hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare percutaneous radiofrequency ablation (RFA) alone and RFA combined with percutaneous absolute ethanol injection (RFA-PEI) in the treatment of single hepatocellular carcinoma smaller than 5.0 cm in diameter.</p><p><b>METHODS</b>From Jan. 2002 till Dec. 2003, eighty-six patients were put on a randomized clinical trial. For RFA, the American Radiotherapeutics RF 2000 machine and 3.5 cm/LEE VEEN + electroradiofrequency needle was introduced under ultra-beta sound guide. For tumor < 3 cm, the needle was left in center of tumor and for tumor > 3 cm, the needle was first left in situ and twisted by 180 as it was withdrawn for every 1 cm, till the surface border was reached. Power output was increased from 20 W and raised by 10-20 W per minute until the impedance became rapidly raised and the output decreased. Forty-five patients were treated with RFA-PEI and 41 with RFA, with each group divided into group A (diameter < or = 3.0 cm) and group B (diameter = 3.1-5.0 cm) according to tumor size. The overall and local recurrence-free survival was used to evaluate the treatment effect.</p><p><b>RESULTS</b>There was no mortality or serious morbidity in either group. The 6-, 12-, 18-, 24-month survival rate of RFA-PEI and RFA was 88.9%, 84.0%, 80.6%, 73.9% and 87.7%, 78.3%, 73.7%, 61.4% (P = 0.6181), respectively; and the local recurrence-free survival rates was 95.4%, 95.4%, 87.8%, 73.7% and 94.9%, 72.7%, 68.4%, 57.1% (P = 0.0393), respectively. The local recurrence-free survival rate in group A was 95.7%, 95.7%, 79.1%, 79.1% and 92.3%, 83.2%, 81.3%, 65.9% (P = 0.3679), respectively; while in group B was 95.0%, 95.0%, 95.0%, 72.6% and 100.0%, 58.3%, 45.4%, 45.4% (P = 0.0440).</p><p><b>CONCLUSION</b>Percutaneous radiofrequency ablation combined with percutaneous absolute ethanol injection is safe, and more effective and easily practiced than percutaneous radiofrequency ablation alone in the treatment of small hepatocellular carcinoma, especially when the tumor is greater than 3 cm in diameter, for which RFA-PEI may be able to reduce local recurrence and improve long-term survival.</p>