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Objective To investigate the consistency of mRECIST criterion and RECIST criterion in evaluating the curative effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) for primary hepatocellular carcinoma (PHC) which condition exceeds Milan liver transplantation standard in order to determine which criterion can evaluate the curative effect better.Methods A total of 78 PHC patients,whose lesion's extent exceeded Milan standard and who had received TACE combined with RFA therapy,were included in this study.The curative effect was separately evaluated by mRECIST criterion and RECIST criterion.KAPPA coefficient was calculated to determine the consistency of the evaluation results by the two criteria.By using Kaplan-Mier method,the median survival time (MST) of patients achieving different remission degree was calculated.Log-rank test was used to draw survival curve.The MST and the survival curve of patients with different remission degree were statistically compared between the two criteria.Results By using SPSS19.0 software,the KAPPA coefficient of the evaluation results of the two criteria was 0.243 (x2=5.250,P＜0.01).The MST of patients,which was calculated by Kaplan-Mier method,had multiple overlapping parts with SD and PR curves that were drawn by log-rank test based on RECIST criterion,the difference between the two was not statistically significant (P＞0.05).When mRECIST criterion was based on,the survival curve of patients with different remission degree was relatively balanced and showed no overlapping parts,the difference between the two was statistically significant (P＜0.01).Conclusion (1) The mRECIST criterion is not suitable for the evaluation of the curative effect of PHC patients whose lesion's extent exceeds Milan standard,and mRECIST criterion can not apply to make evaluation of the curative effect for PHC when the lesion's border is unclear and its enhancement is not obvious.(2) mRECIST criterion can more accurately evaluate the curative effect of TACE combined with PRA in treating PHC which extent exceeds Milan liver transplantation standard.
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Objective To investigate the clinical effects of autologous tumor immune cells (DC-CIK)assisted interventional therapy in the treatment of advanced primary liver cancer.Methods Totally 76 patients with advanced primary liver cancer were divided into 2 groups with 38 cases in each group by random number table method.The control group were merely treated with interventional therapy while the ob-servation group were treated with autologous DC-CIK cell assisted interventional therapy.The short-term curative effect,adverse reactions,liver function indexes before and after treatment,alpha fetal protein (AFP)and changes of immune function were compared between the 2 groups. Results There was no statistically significant difference in short-term curative effect and incidence of adverse reactions between the 2 groups (P >0.05).After treatment,the levels of AST,ALT and AFP in the observation group [(30.4 ±6.0)u/L,(45.2 ±3.8)u/L,(168.5 ± 49.3)mg/L]were significantly lower than those in the control group [(65.1 ±6.3)u/L,(61.8 ±5.3)u/L,(315.2 ±39.5)mg/L],and the differences were statistically significant (P <0.05).After treatment,CD3 +,CD4 + and CD4 +/CD8 + in the observation group were significantly higher than those in the control group (P <0.05).Conclusion Autologous DC-CIK cell assisted interventional therapy can sig-nificantly improve the liver function of patients with advanced primary liver cancer,and it can reduce the level of tumor marker AFP and sig-nificantly improve the immune function of patients.
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Objective To investigate the expression and significance of β-catenin and p28GANK in residual hepatocellular carcinoma (HCC)cells after transcatheter arterial chemoembolization (TACE).Methods We collected forty-five cases of surgical specimens of hepatocellular carcinoma after TACE ( TACE group ) and thirty cases of surgery without any treatment (pure surgery group).The expression of β-catenin and p28GANK were detected by using immunohistochemical SP method and compared between the two groups .Results The positive expression of β-catenin and p28GANK in TACE group were 77.78%and 75.56%respectively,which were significantly higher than those in pure surgery group (46.67%and 53.33%respectively,P<0.05).In the residual hepatocellular carcinoma cells of TACE group ,the positive expression of β-catenin showed correlation with the positive expression of p28GANK(Φ=0.318,P =0.033).The high expression of β-catenin and p28GANK were closely related to portal vein thrombosis and distant metastasis (P<0.05).Conclusion The ex-pression of β-catenin and p28GANK in the residual hepatocellular carcinoma cells were increased significantly after TACE.The high expression of β-catenin and p28GANK were closely related to portal vein thrombosis and distant metastasis.The high expression of β-catenin and p28GANK may be one of the reasons of hepatocellular carcinoma invasiveness and metastasis .
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Objective To investigate the feasibility, safety and efficacy of endovascular implantation of 125I seeds under the dual-guidance of ultrasound and digital subtraction angiography (DSA) for the treatment of hepatocellular carcinoma (HCC) associated with portal vein tumor thrombus. Methods A total of 30 patients with primary HCC complicated by portal vein tumor thrombus underwent implantation of 125I seeds via portal vein. Guided by ultrasound, percutaneous transhepatic puncturing of portal vein was performed first, then, catheter was inserted, which was followed by transcatheter 125I seeds implantation into the affected portal vein under DSA guidance. The technical success rate, postoperative complications, routine blood tests, liver function, the suppression of portal vein tumor thrombus and survival time were analyzed. Results Successful implantation of 125I seeds was achieved in all patients, no serious procedure-related complications occurred. All patients were followed up for 3-36 months, the portal vein tumor thrombus showed a significant shrinkage in all patients. The median survival time was about seven months. Conclusion For the treatment of hepatocellular carcinoma associated with portal vein tumor thrombus, endovascular implantation of 125I seeds under the dual-guidance of ultrasound and digital subtraction angiography is clinically safe and feasible. This treatment has satisfactory effect on the portal vein tumor thrombus.
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Primary liver cancer ( PLC) is one of the most invasive malignant tumors in the clinics .The PLC within Milan criteria can be cured by liver transplantation or liver resection .However,PLC exceeding Milan criteria has been a question for us to overcome all the time .In recent years ,transcatheter arterial chemoemboliza-tion( TACE) and its combination therapy for PLC exceeding Milan criteria have made some breakthrough .A great deal of literatures have confirmed that TACE and its combined therapy for PLC exceeding Milan criteria can im -prove the survival rate obviously,it also contains many advantages,such as low cost,safe,painless,minimally in-vasive,repetitive operation and so on .The progress of TACE for PLC exceeding Milan criteria in recent years is summarized in this paper .
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Objective To investigate the relationship between the liver pain and the short-term curative effect in patients with primary hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods According to the degree of liver pain,118 HCC patients after the initial TACE treatment were divided into two groups:group A(with no complaint of serious liver pain)and group B (complaining of severe liver pain).Short-term curative effects at the fourth and sixth week after initial TACE were compared between the two groups,and the factors related to the liver pain after TACE were analyzed.Results Four to six weeks after the initial TACE,CT scan was performed in all patients.Based on the RECIST criteria the short-term curative effects were evaluated.The CR,PR,SD,PD of group A and B were 0%.1.45%.88.41%,10.14%and 0%,14.29%.81.63%,4.08%,respectively.The difference in OR(CR +PR)between two groups was statistically significant(P=0.0087).The postoperative liver pain was probably related to the preoperative tumor blood supply pattern,the tumor capsule.the cirrhosis and the type of iodized oil deposit.The type of iodized oil deposit showed a negative correlation with the grade of liver pain (r=-0.539,P＜0.001).Conclusion The liver pain occurred after TACE is a useful suggestive sign,which indicates that a good curative result will be obtained.It is of clinical significance to make a full understanding of the relationship between the liver pain and the therapeutic effect.
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Objective To establish rabbit model of remnant carcinoma after RFA therapy, and to observe pathomorphological changes of remnant carcinoma in different time. Methods Forty-eight New Zealand white rabbits underwent ultrasound-guided percutaneous inoculation with VX2 carcinoma, then RFA therapy was performed to made models of remnant carcinoma. These models were averagely divided into 6 groups randomly (each n=8). Rabbits in each group was killed and pathologically observed before RFA and 1 d, 3 d, 1 week, 2 and 3 weeks after operation, respectively. Results The expression of MVD,VEGF and PCNA in remnant VX2 carcinomas tissues decreased significantly, but increased 2-3 weeks after RFA. The remnant VX2 carcinomas tissues were in inhibitory state 2 weeks after RFA. Conclusion The growth of remnant carcinoma could be inhibited in short term after RFA. Further therapy is necessary.
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Objective To investigate the feasibility of establishing tumor model of MDR in rabbit liver with VX2 tumor induced by adriamycin. Methods 20 white rabbits were randomly divided into 4 groups with 5 for each. Liver tumor was established with VX2 tissue together with or without MDR-induced for their formations. VX2 tumor without MDR-induced was included in group A and B ,while MDR-induced tumor was employed in groupe C and D. Contrast enhanced CT was performed three weeks later to assess the volume of tumors. 4 mg adriamycin (dilute with 2ml of saline) was infused in group A and C via the common herpatic artery directly and respectirely; whereas same amount of saline adminisfrated through the same way for group B and D. Follow up CT was performed one week later to assess the change of tumor. Apoptosis rate was analized for each group by means of flow cytometry (FCM). Results No significant difference was found between the 4 groups three weeks after the establishment in term of tumor volume. Follow up CT performed 1 week after the treatment showed the volume increase of tumor for all groups. Group A was significantly lower than the other three groups in tumor growth rate (P0.05). The apoptosis rate of group A detected by FCM was significantly higher than the other three groups(P0.05). Conclusion Implanted liver tumor with VX2 induced by, adriamycin in tumor carrying rabbits possesses the character of drug resistance, which is profitable to be a liver tumor model of MDR for the therapeutic trial.