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Objective:To explore the efficacy of precision hepatectomy in the treatment of single hepatocellular carcinoma with microvascular invasion (MVI) of and the risk factors of positive incisal margin after operation.Methods:The clinical data of 212 patients with single hepatocellular carcinoma with MVI treated in Affiliated Hospital of Panzhihua University from July 2016 to July 2019 were analyzed retrospectively. 152 patients were treated with precision hepatectomy and 60 patients with traditional hepatectomy. According to the pathological results of postoperative liver resection, the patients treated with precision hepatectomy were divided into two groups: negative group ( n=129) and positive group ( n=23). The operation-related indexes, postoperative complications and disease-free survival rate of precision hepatectomy and traditional hepatectomy were compared, and the general data of patients with negative and positive liver cutting edge were compared. multivariate analysis of the factors affecting the positive liver cutting edge after operation; to construct a line chart prediction model to predict the positive liver cutting edge after operation, and to evaluate its predictive efficiency. Normally distributed measurement data are represented by mean±standard deviation ( Mean± SD), independent t-test is used for comparison between groups; count data are represented by the number of cases and percentages, and χ2 test is used for comparison between groups. Results:The operative time, intraoperative blood loss, postoperative hospital stay, positive rate of surgical margin, total incidence of postoperative complications, AFP negative conversion rate 6 months after operation, and 1-year disease-free survival rate of precision hepatectomy were (328.62±38.74) min, (496.83±59.76) mL, (15.28±3.61) d, 15.13% (23/152), 3.95% (6/152), 81.58% (124/152), 67.11% (102/152), respectively. The mean values of traditional hepatectomy were (315.29±40.95) min, (681.46±58.27) mL, (23.87±4.65) d, 28.33% (17/60), 21.67% (13/60), 66.67% (40/60) and 46.67% (28/60), respectively, the difference was statistically significant ( P<0.05). Univariate analysis showed that the positive liver resection margin after precision liver resection was related to the maximum diameter of the tumor, vascular tumor thrombus, TNM staging, BCLC staging, liver cirrhosis, AFP 2 months after surgery, and the distance between the tumor and the resection margin ( OR=3.645, 5.248, 4.285, 4.462, 3.883, 3.964, 3.872; 95% CI: 2.875-4.415, 4.426-6.070, 3.271-5.299, 3.354-5.570, 3.062-4.704, 3.248-4.680, 2.987-4.757; P<0.05). Maximum tumor diameter >5 cm, vascular tumor thrombus, TNM stage Ⅲ, BCLC stage C, liver cirrhosis, postoperative AFP ≥20 μg Uniql, the distance between the tumor and the resection margin was <1 mm were the risk factors of positive incisal margin after precision hepatectomy in patients with single liver cancer with MVI( OR=6.685, 8.425, 7.758, 7.854, 7.124, 7.246, 6.926; 95% CI: 5.828-7.542, 7.6385-9.212, 6.926-8.590, 7.062-8.646, 6.583-7.665, 6.618-7.874, 6.028-7.824; P<0.05). The constructed line chart prediction model had better differentiation and higher accuracy. Conclusions:Precision hepatectomy in the treatment of single hepatocellular carcinoma with MVI has the advantages of less intraoperative bleeding, faster postoperative recovery, less postoperative complications, low positive rate of liver incisal margin and high disease-free survival rate. The construction of a risk prediction model with positive surgical margin provides a reference for improving the survival rate of patients in clinic.
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Objective To explore imaging manifestations of hepatic epithelioid hemangioendothelioma (HEH). Methods CT and MR images in 14 patients with HEH proven by histopathology were retrospectively analyzed. Plain and two-phase contrast-enhanced CT scan were performed in 5 cases, non-contrast and multiphase contrast-enhanced MR scan were performed in 7 cases, CT and MRI were both performed in 2 cases. Characteristics of CT and MR T2WI images were classified and analyzed. All lesions were classified into three types:multiple, diffuse and solitary form. Results (1) Multiple form of HEH:228 lesions were found in 11 patients, including 178 lesions on MRI and 50 lesions on CT. On T2WI, three or two layered-target-signs with hyperintensity core were found in 79.2% (141/178) of the lesions. Three layer-target-sign included hyperintensity core, hypointensity rim and slightly high signal halo from the inside out. Two layer-target-sign included hyperintensity core and slightly high signal halo from the inside out. Characteristics of dynamic contrast-enhanced scan included peripheral two or three layered-rim-like enhancement in 66.3%( 118/178) of the lesions;peripheral, gradual rim-like enhancement with enhanced core in 27.0%( 48/178) of the lesions;heterogeneously mild enhancement in 2.2%( 4/178) of the lesions;centripetal enhancement in 4.5%( 8/178) of the lesions. Fifty lesions were found in CT, which showed low density nodules or masses with clear margins. Two-layered-black-target sign were found in 42 lesions in contrast-enhanced images, white-target sign were found in 3 cases, and centripetal enhancement was found in 5 cases. (2) Diffuse form of HEH:in one of the two cases of this type, the lesions could not be separated from normal liver parenchyma, gradual enhancements were found along with the vessels in the center of the lesions. (3) Solitary form of HEH: one case, the lesion showed heterogeneous density in non-contrast CT images and gradual enhancement in contrast-enhanced images. Conclusions We found some imaging characteristics of HEH. Two or three layered-target-sign on T2WI and black-target sign, white-target sign on contrast-enhanced images were unique imaging features of HEH.
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Objective:To establish multidrug resistant human hepatoma cell subline(HepG2/DOX) and study its biological features.Methods:Doxorubincin-resistant human hepatoma cell subline (HepG2/DOX) was induced by doxorubincin-gradually increasing concentration.To observe cells by light microscope and analyze number and structure of chromosomes of these tumor cells.Sensitivity of anticancer drugs was screened in HepG2,HepG2/DOX cells by MTT method.The immunohistochemistry method was used to measure MDR-1 gene product Pgp expression.Results:HepG2/DOX and HepG2 were different in shape,growth speed.The number and structure of their chromosomes were also different.The value of 50% inhibitory concentration(IC50,?g/ml) for DOX,CDDP,MMC,5-FU,and MTX in HepG2,HepG2/DOX cells was (0.070 and 1.161),(0.214 and 1.317),(0.162 and 0.498),(0.313 and 1.683),(0,007 and 0.217) respectively.MDR-l gene product Pgp170 expression was found either in HepG2/DOX or HepG2 cells.Pgp170 exprssion in HepG2/DOX was higher than in HepG2.Once HepG2/DOX had been cultured in DOX free RPMl1640 medium for 5 weeks,the IC50(?g/ml)for DOX in HepG2/DOX reduced to 0.684.Conclusion:HepG2/DOX has the characteristics of MDR.The drug-resistance was correlated with over expression of MDR-1 gene product Pgp 170 and slow growth.
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Objective:To study the feasibility and reliability of using phosphorylated H2AX(?H2AX)as a predictor for sensitivity of hepatic carcinoma cell HepG2.215 to chemotherapy agents: etoposide, doxorubicin, mitomycin, and cisplatin. Methods: HepG2.215 cells were exposed to etoposide, doxorubicin, mitomycin or cisplatin of 1, 2, 4 and 20 concentration index (CI). Untreated HepG2.215 cells were taken as control. The proportion of HepG2.215 cells expressing ?H2AX was measured by flow cytometry, the number of ?H2AX foci in HepG2.215 cells was measured by immunocytochemistry, and cell proliferation was measured by MTT. The correlation between the number of ?H2AX foci and the percentage of HepG2.215 cells expressing ?H2AX in HepG2.215 cells was analyzed; the correlation of CI with the percentage of HepG2.215 cells expressing ?H2AX or ?H2AX foci and inhibitory rate of cell proliferation was analyzed; and the correlation of inhibitory rate of cell praliferation with the percentage of HepG2.215 cells expressing ?H2AX or ?H2AX foci was also analyzed. Results: There was a positive correlation between the number of ?H2AX foci and the percentage of HepG2.215 cells expressing ?H2AX in HepG2.215 cells after treatment with the above 4 agents (all P
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Objective Aprotinin, a serine proteinase inhibitor, has been reported to reduce blood loss significantly in patients undergoing cardiac surgery with CPB, heart and liver transplantation. The aim of this study was to evaluate the effect of aprotinin on intraoperative blood loss, transfusion requirement and blood coagulation during liver cancer resection.Methods Eighty-two ASA Ⅰ -Ⅲ patients ( 51 male, 31 female ) aged 33-65 yr undergoing liver cancer resection ( 61 partial hepatectomy, 21 extirpation of liver cancer) were studied. The patients were randomly divided into 2 groups : aprotinin group received a bolus of aprotinin 1 112 EPU after induction of anesthesia, followed by continuous aprotinin infusion at 278 EPU?h-1 until 2 h after operation ( n = 40); control group received normal saline instead of aprotinin ( n = 42) . The patients were premedicated with sodium luminal, droperidol-fentanyl and atropine. Anesthesia was induced with midazolam 2 mg, thiopental 5 mg?kg-1 and succinylcholine 1.5 mg? kg-1 . After tracheal intubation the patient was mechanically ventilated (VT = 8-12 ml?kg-1 ) and PaCO2 was maintained at about 35 mm Hg, Anesthesia was maintained with N2O/O2 , fentanyl and vecuroniurn. Venous blood samples were taken before induction of anesthesia (baseline) , 0.5 h, 2 h and 4 h after skin incision and 6 h and 12 h after operation for routine blood tests, thromboelastography ( TEG), and determination of activated partial thromboplastin time (APTT), thromboplastin time (TT) prothrombin time (PT) and plasma fibrinogen concentration (Fig) . Intraoperative blood loss and amount of blood transfused were recorded. Results The preoperative hypercoagulable state was ameliorated and coagulation was maintained within the normal range in aprotinin group; while in control group the hypercoagulable state was aggravated during operation and at the end of operation it changed to hypocoagulable state. The intraoperative blood loss and amount of blood infused were significantly less in aprotinin group than in control group. Conclusion The use of aprotinin during liver cancer resection results in reduction in intraoperative blood loss and less transfusion requirement.