ABSTRACT
Hepatocellular carcinoma (HCC) is well characterized as a heterogeneous disease. Its late-stage diagnosis and chemotherapy resistance make it one of the refractory tumors in China. Natural killer (NK) cells play a significant role in immune surveillance. However, NK cells become dysfunctional in the progression of HCC, leading to tumor immune escape. This article reviews the recent progress on different strategies of NK cell-based immunotherapy in treating HCC, including direct adoptive NK cell transfer, gene engineering in NK cell, NK cell receptor targeting, immunosuppressive microenvironment modification, and tumor toxicity enhancement by cytokines or traditional Chinese medicine. These NK cell-based strategies have shown promising therapeutic potential.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Immunotherapy , Killer Cells, Natural , Receptors, Natural Killer Cell , Tumor MicroenvironmentABSTRACT
Immune checkpoint inhibitors (ICIs)-based immunotherapy combined with other treatment for hepatocellular carcinoma (HCC) has achieved significant efficacy in clinical research and practice, and has become the most commonly used and mainstay therapy for the treatment of unresectable HCC. In order to help clinicians administrating immunotherapy drugs and regimens rationally, effectively and safely, we organized a multidisciplinary expert team to adopt the "Delphi" consensus formation method, and finally revised and completed the "Multidisciplinary Expert Consensus on Combination Therapy Based on the Immunotherapy for Hepatocellular Carcinoma (2023 Edition)" on the basis of the 2021 version. This consensus mainly focuses on the principles and methods of clinical application of combination therapy based on the Immunotherapy, aiming to summarize the recommendations for clinical application based on the latest research and expert experience, and provide application guidance for clinicians.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Consensus , Immunotherapy , Liver Neoplasms/therapyABSTRACT
Objective: To explore the predictive factors of concurrent bile duct injury following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: A retrospective study was conducted on 483 HCC patients in relation to TACE postoperative complications. A total of 21 cases of bile duct injury were observed following the TACE procedure. Laboratory data, imaging data, and clinically relevant medical histories were recorded before and after one week following the TACE procedure and follow-up. The χ (2) test, or Fisher's exact probability method, was used for categorical variables. The mean of the two samples was compared using a paired t-test or Wilcoxon rank sum test. The comparison of multiple mean values was conducted using an analysis of variance. Results: Twenty-one cases with bile duct injury had intrahepatic bile duct dilatation, bile tumors, hilar biliary duct stenoses, and other manifestations. 14.3% (3/21) of patients showed linear high-density shadows along the bile duct on a plain CT scan, while 76.2% (16/21) of patients had ALP > 200 U/L one week following TACE procedure, and bile duct injury occurred in later follow-up. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT) were significantly increased in all patients following TACE procedure (t = -2.721, P = 0.014; t = -2.674, P = 0.015; t = -3.079, P = 0.006; t = -3.377, P = 0.003, respectively). Conclusion: The deposition of iodized oil around the bile duct on plain CT scan presentation or the continuous increase of ALP (> 200 U/L) one week following TACE procedure has a certain predictive value for the later bile duct injury.
Subject(s)
Humans , Liver Neoplasms/therapy , Carcinoma, Hepatocellular/therapy , Retrospective Studies , Chemoembolization, Therapeutic/methods , Bile DuctsABSTRACT
According to the latest statistical data, the incidence and mortality rate of hepatocellular carcinoma in China are still on the rise, posing a major threat to the health of the Chinese population. The occurrence is closely related to the formation of precancerous lesions in the liver. The clinical and basic research on precancerous lesions of hepatocellular carcinoma has developed rapidly, and the concepts and specific techniques for diagnosis and treatment have also undergone new changes and advancements. Therefore, based on the first version in 2020, this consensus has organized multidisciplinary experts to compile and improve a new version by integrating the latest progress in their respective professional fields at home and abroad. It aims to enhance clinicians' understanding of precancerous lesions of hepatocellular carcinoma standardize the pathology, imaging, and molecular diagnostic criteria, broaden early screening methods, formulate scientifically rational treatment plans, and help promote the advancement of diagnosis and treatment strategies and to enhance the overall 5-year survival rate of patients with hepatocellular carcinoma.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Consensus , Liver Neoplasms/therapy , Precancerous Conditions/therapyABSTRACT
A 68-year-old male was admitted due to fatigue and poor appetite and diagnosed pathologically as pancreatic adenocarcinoma with liver metastasis. The tumor marker carbohydrate antigen 199 (CA199) level was 2003.4 U/mL. The patient received two cycles of modified FOLFIRINOX plus immune checkpoint inhibitor (penpulimab). However, the tumor did not shrink and CA199 level was even higher. Anlotinib was added from the 3rd cycle, and the size of primary tumor and metastatic lesions were significantly reduced. Laparoscopic distal pancreatectomy and splenectomy as well as liver metastasis resection was performed. Three cycles of combined therapy were adopted after surgery followed by maintenance therapy with anlotinib plus penpulimab. There was no evidence of tumor recurrence during the follow-up (nearly 19 months since diagnosis).
Subject(s)
Male , Humans , Aged , Pancreatic Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Adenocarcinoma , Neoplasm Recurrence, Local/surgery , Immunotherapy , Liver Neoplasms/therapy , PancreatectomyABSTRACT
Introdução: A embolização e a quimioembolização transarterial hepática são procedimentos cirúrgicos usados para tratar pacientes com tumores hepáticos de origem primária e metastática, entretanto causam dor importante no período pós-operatório. O objetivo do estudo foi comparar o bloqueio epidural torácico à morfina endovenosa no tratamento da dor na síndrome pós-embolização hepática. Métodos: Foram randomizados 50 casos de pacientes submetidos a embolização transarterial hepática, os quais foram alocados em dois grupos: grupo morfina endovenosa (GV), submetido a uma dose de morfina na sala operatória; e o grupo bloqueio epidural torácico (GE), submetido a bloqueio epidural de injeção única. Todos os pacientes utilizaram analgesia endovenosa controlada pelo paciente no período pós-operatório. Foram analisados no estudo o consumo de morfina endovenosa no período pós-operatório, a dor aferida pela escala numérica verbal (ENV), o tempo de internação hospitalar, a incidência de náuseas, vômitos, prurido, retenção urinária, depressão respiratória e sonolência. Resultados: Não houve diferença do consumo médio de morfina e da ENV no período pós-operatório imediato. No primeiro dia pós-operatório o consumo médio de morfina no GV foi de 6.3 mg vs. 0.45 mg no GE, p < 0.01. A ENV no GV foi de 3.77 vs. 0.82 no GE, p<0.01. O consumo médio de morfina no período pós-operatório no GV foi de 6.91mg vs. 0.5mg no GE, p<0.01. Apenas dois pacientes do GE ficaram internados por mais de um dia, enquanto no GV oito pacientes receberam alta hospitalar a partir do segundo dia pós-operatório, entretanto não houve diferença estatisticamente significativa do tempo de internação hospitalar. Prurido foi observado em 18.2% dos pacientes do GE, e não houve ocorrência no GV, p=0.04. Conclusões: O bloqueio epidural torácico foi superior à morfina endovenosa no tratamento da dor na síndrome pós-embolização hepática.
Background: Hepatic transarterial embolization and chemoembolization are surgical procedures used to treat patients with hepatic tumors of primary and metastatic origin, however they cause significant pain in the postoperative period. The objective of the study was to compare thoracic epidural block with intravenous morphine in the treatment of pain in hepatic post-embolization syndrome. Methods: A total of 50 patients undergoing hepatic transcatheter arterial embolization were randomized and allocated into two groups: intravenous morphine group (IG) underwent to a morphine dose in the operating room; and thoracic epidural block group (EG) underwent to a single-shot epidural injection. All patients used intravenous patient-controlled analgesia (PCA) in postoperative period. Intravenous morphine consumption in the postoperative period, pain measured by the numerical rating scale (NRS), length of hospital stay, nausea, vomiting, pruritus, urinary retention, respiratory depression and drowsiness were analyzed. Results: There was no difference in the mean morphine consumption and NRS in the immediate postoperative (IPO) period. On postoperative day 1, the IG mean morphine consumption was 6.3 mg vs. 0.45 mg in EG, p<0.01. NRS in IG was 3.77 vs. 0.82 in EG, p<0.01. Morphine consumption in post-operative period in IG was 6.91 mg vs. 0.5 mg in EG, p<0.01. Only two patients in the EG were hospitalized for more than one day, while in the GV eight patients were discharged from the second postoperative day, however there was no statistically significant difference in the length of hospital stay. Pruritus was observed in 18.2% of EG patients and none in the IG, p = 0.04. Conclusions: Thoracic epidural block was superior to intravenous morphine in the treatment of pain in hepatic post embolization syndrome.
Subject(s)
Humans , Male , Female , Liver Neoplasms/therapy , Pain, Postoperative , Analgesia, Patient-Controlled , Chemoembolization, Therapeutic , Anesthesia, Epidural , Morphine , Neoplasm MetastasisABSTRACT
At present, there is no uniform standard for diagnosis and treatment of portal hypertension complicated with hepatocellular carcinoma internationally. Although in recent years, with the significant advances of surgical technique and the positive progress of targeted and immunotherapy in the field of hepatocellular carcinoma, the survival of hepatocellular carcinoma patients has improved, but the risk of surgery in patients with portal hypertension complicated with hepatocellular carcinoma remains high, and surgical treatment is still controversial. Therefore, based on the existing evidence, the Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association has organized relevant experts to develop the consensus on clinical diagnosis and treatment of portal hypertension with hepatocellular carcinoma (2022) after full discussion. This consensus aims to provide the latest guidance for the standardized diagnosis and treatment of portal hypertension with hepatocellular carcinoma in China. Given that most portal hypertension originates from cirrhosis, this consensus only addresses the diagnosis and treatment of cirrhosis-related portal hypertension with hepatocellular carcinoma.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Consensus , Hypertension, Portal/therapy , Liver Cirrhosis/complications , Liver Neoplasms/therapyABSTRACT
Objetivo: Presentar metodología diagnostica y resección atípica, con fines curativos de hepatocarcinoma. Caso clínico: Femenina de 82 años, con múltiples antecedentes entre el que se destaca, hepatitis a virus C de 15 años de evolución, que presenta por estudios complementarios alta sospecha de hepatocarcinoma, se realiza laparotomía exploradora con resección atípica de tumor en segmento 5 y 6 con radiofrecuencia quirúrgica y colecistectomía con colangiografía intraoperatoria. Cursa post operatorio sin complicaciones con alta sanatorial al 8vo dia. Conclusion: Hay que sospechar esta patología en pacientes con antecedentes de hepatopatía viral, plantear screening adecuado para un diagnóstico temprano y la mejor resolución adaptada a cada paciente. Dentro de las opciones terapéuticas encontramos la radiofrecuencia quirúrgica como una buena herramienta, con índice bajo de complicaciones
Objective: To present diagnostic methodology and atypical resection, for curative purposes of hepatocarcinoma. Clinical case: An 82-year-old female, with multiple history factors, among them, hepatitis C virus of 15 years of evolution, which presents high suspicion of hepatocarcinoma due to complementary studies, exploratory laparotomy is performed with atypical resection of tumor in segments 5 and 6 with surgical radiofrequency and cholecystectomy with intraoperative cholangiography. Post-operative course without complications with sanatorial discharge on the 8th day. Conclusion: This pathology must be suspected in patients with history of viral liver disease. We suggest an adequate screening for an early diagnosis and the best resolution adapted to each patient. Among the therapeutic options we find surgical radiofrequency as a good tool, with a low rate of complications
Subject(s)
Humans , Female , Aged, 80 and over , Cholecystectomy/rehabilitation , Incidence , Aftercare/methods , Evaluation Studies as Topic , Early Detection of Cancer/methods , Laparotomy , Liver Neoplasms/therapyABSTRACT
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths and the fifth most common cancer worldwide. Clinically therapeutic options for HCC are very limited, and the overall survival rate of patients is very low. Therefore, early diagnosis and treatment of HCC have important impact on overall survival of patients. At present, alpha-fetoprotein (AFP) is one of the most widely used serological markers for HCC. Many evidences have shown that as a specific onco-protein, AFP has great research value in the occurrence, development, diagnosis and treatment of HCC. Here, we briefly introduce the molecular mechanism of AFP in the regulation of HCC occurrence and development, and its role in tumor escape from immune surveillance. We focus on the application of AFP as an important HCC target or carcino-embryonic antigen (CEA) in HCC clinical diagnosis and treatment.
Subject(s)
Humans , Biomarkers, Tumor/genetics , Carcinoma, Hepatocellular/therapy , Early Detection of Cancer , Liver Neoplasms/therapy , alpha-FetoproteinsABSTRACT
The probability of developing liver metastases in patients with colorectal cancer is 40%-50%. Liver metastases remain an important adverse factor affecting long-term prognosis of colorectal cancer patients. Surgical resection of liver metastases is the only potentially curative treatment option. After comprehensive treatment, initially unresectable liver metastases might be converted to resectable tumors. This concept is known as conversion therapy. In this review, research status of conversion therapy in colorectal cancer liver metastases was summarized, providing updated concept of resectability, discussions on the assessment of tumor response and timing of operation, debates on the influence on tumor sidedness, and latest advancement in the treatment strategy of conversion therapy. Through analyzing existing problems, we hope to offer insights into possible progress in the future and provide references for the development of clinical practice.
Subject(s)
Humans , Biomedical Research , Colorectal Neoplasms/therapy , Combined Modality Therapy/methods , Hepatectomy , Liver Neoplasms/therapy , PrognosisABSTRACT
The liver is the most common anatomical site for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, improve the resection rate of liver metastases and survival. The revised Guideline version 2020 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, with state-of-the-art experience and findings, detailed content, and strong operability.
Subject(s)
Humans , China , Colorectal Neoplasms/therapy , Combined Modality Therapy , Liver Neoplasms/therapy , Patient Care TeamABSTRACT
Nanosecond pulsed electric field (nsPEF) is a novel, nonthermal, and minimally invasive modality that can ablate solid tumors by inducing apoptosis. Recent animal experiments show that nsPEF can induce the immunogenic cell death of hepatocellular carcinoma (HCC) and stimulate the host's immune response to kill residual tumor cells and decrease distant metastatic tumors. nsPEF-induced immunity is of great clinical importance because the nonthermal ablation may enhance the immune memory, which can prevent HCC recurrence and metastasis. This review summarized the most advanced research on the effect of nsPEF. The possible mechanisms of how locoregional nsPEF ablation enhances the systemic anticancer immune responses were illustrated. nsPEF stimulates the host immune system to boost stimulation and prevail suppression. Also, nsPEF increases the dendritic cell loading and inhibits the regulatory responses, thereby improving immune stimulation and limiting immunosuppression in HCC-bearing hosts. Therefore, nsPEF has excellent potential for HCC treatment.
Subject(s)
Animals , Carcinoma, Hepatocellular/therapy , Cell Line, Tumor , Immunity , Liver Neoplasms/therapy , Neoplasm Recurrence, LocalABSTRACT
Hepatic resection represents the first-line treatment for patients with resectable hepatocellular carcinoma (HCC). However, the 5-year recurrence rates of HCC after surgery have been reported to range from 50% to 70%. In this review, we evaluated the available evidence for the efficiency of adjuvant treatments to prevent HCC recurrence after curative liver resection. Antiviral therapy has potential advantages in terms of reducing the recurrence rate and improving the overall survival (OS) and/or disease-free survival of patients with hepatitis-related HCC. Postoperative adjuvant transarterial chemoembolization can significantly reduce the intrahepatic recurrence rate and improve OS, especially for patients with a high risk of recurrence. The efficacy of molecular targeted drugs as an adjuvant therapy deserves further study. Adjuvant adoptive immunotherapy can significantly improve the clinical prognosis in the early stage. Randomized controlled trial (RCT) studies evaluating adjuvant immune checkpoint inhibitors are ongoing, and the results are highly expected. Adjuvant hepatic artery infusion chemotherapy might be beneficial in patients with vascular invasion. Huaier granule, a traditional Chinese medicine, has been proved to be effective in prolonging the recurrence-free survival and reducing extrahepatic recurrence. The efficiency of other adjuvant treatments needs to be further confirmed by large RCT studies.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic , Chemotherapy, Adjuvant , Hepatectomy , Liver Neoplasms/therapy , Neoplasm Recurrence, Local , Treatment OutcomeABSTRACT
OBJECTIVE@#Exercise, as a common non-drug intervention, is one of several lifestyle choices known to reduce the risk of cancer. Mitochondrial division has been reported to play a key role in the occurrence and transformation of hepatocellular carcinoma (HCC). This study investigated whether exercise could regulate the occurrence and development of HCC through mitosis.@*METHODS@#Bioinformatics technology was used to analyze the expression level of dynamin-related protein 1 (DRP1), a key protein of mitochondrial division. The effects of DRP1 and DRP1 inhibitor (mdivi-1) on the proliferation and migration of liver cancer cells BEL-7402 were observed using cell counting kit-8, plate colony formation, transwell cell migration, and scratch experiments. Enzyme-linked immunosorbent assay, Western blot and real-time polymerase chain reaction were used to detect the expression of DRP1 and its downstream phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. A treadmill exercise intervention was tested in a nude mouse human liver cancer subcutaneous tumor model expressing different levels of DRP1. The size and weight of subcutaneous tumors in mice were detected before and after exercise.@*RESULTS@#The expression of DRP1 in liver cancer tissues was significantly upregulated compared with normal liver tissues (P < 0.001). The proliferation rate and the migration of BEL-7402 cells in the DRP1 over-expression group were higher than that in the control group. The mdivi-1 group showed an inhibitory effect on the proliferation and migration of BEL-7402 cells at 50 μmol/L. Aerobic exercise was able to inhibit the expression of DRP1 and decrease the size and weight of subcutaneous tumors. Moreover, the expression of phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) decreased in the exercise group. However, exercise could not change p-PI3K and p-AKT levels after knocking down DRP1 or using mdivi-1 on subcutaneous tumor.@*CONCLUSION@#Aerobic exercise can suppress the development of tumors partially by regulating DRP1 through PI3K/AKT pathway.
Subject(s)
Animals , Mice , Apoptosis , Carcinoma, Hepatocellular/therapy , Cell Line, Tumor , Cell Proliferation , Down-Regulation , Dynamins , Liver Neoplasms/therapy , Phosphatidylinositol 3-Kinase/metabolism , Phosphatidylinositol 3-Kinases/metabolism , Proto-Oncogene Proteins c-akt/metabolism , Signal TransductionABSTRACT
Resumen: La ligadura de una rama de la vena porta constituye un procedimiento con buenos resultados para evitar la falla hepática posoperatoria en caso de hepatectomías extremas al provocar la hipertrofia del hígado contralateral. Sin embargo, la repermeabilización de ésta ha sido demostrada por la presencia de anastomosis porto portales intrahepáticas, pudiendo determinar una disminución de la hipertrofia esperada o necesaria. Como objetivo documentamos un caso clínico de repermeabilización intrahepática de la vena porta, evento no deseado de la hepatectomía en dos tiempos para el tratamiento de metástasis hepáticas bilobares de origen colorrectal y describimos alternativas para evitar o tratar dicha repermeabilización.
Summary: Left or right portal vein ligation to prevent post-operative liver failure in the case of extreme hepatectomy constitutes a procedure with a good prognosis, as it causes contralateral liver hypertrophy. However, its revascularization has been proved by intrahepatic porto-portal anastomoses, which could result in a reduction of the expected or required hypertrophy. The study aims to record a clinical case of intrahepatic revascularization of the portal vein, an unwanted event of the two-stage hepatectomy to treat bilobar hepatic metastasis of colorectal origin, and describe alternatives to avoid or treat such revascularization.
Resumo: A ligadura de um ramo da veia porta é um procedimento com bons resultados para evitar a insuficiência hepática pós-operatória em hepatectomias extremas por causar hipertrofia do fígado contralateral. No entanto, sua repermeabilização tem sido demonstrada pela presença de anastomose porto-portal intra-hepática, que pode determinar diminuição da hipertrofia esperada ou necessária. Como objetivo, documentamos um caso clínico de repermeabilização da veia porta intra-hepática, um evento indesejado de hepatectomia em dois estágios para o tratamento de metástases hepáticas bilobares de origem colorretal, e descrevemos alternativas para evitar ou tratar essa repermeabilização.
Subject(s)
Portal Vein , Liver Failure/therapy , Ligation , Colorectal Neoplasms/therapy , Hepatectomy/adverse effects , Liver Neoplasms/therapy , Neoplasm MetastasisABSTRACT
En las últimas décadas, los cambios en el estilo de vida pro-vocaron un incremento en la prevalencia del síndrome meta-bólico y que la enfermedad por hígado graso no alcohólico (nonalcoholic fatty liver disease, NAFLD sus siglas en inglés) se convierta en la enfermedad hepática crónica más fre-cuente en todo el mundo. Los componentes del síndrome metabólico no son sólo altamente prevalentes en pacientes con hígado graso no alcohólico, sino que a la vez aumentan el riesgo de desarrollarlo. Esta relación bidireccional ha sido claramente establecida. Asimismo se considera que NAFLD podría ser el componente hepático del síndrome metabólico. Aunque NAFLD se considera principalmente una enfermedad benigna, puede progresar a fibrosis hepática grave y carcino-ma hepatocelular (CHC), incluso se encontraría este último en hígados no cirróticos. El objetivo de esta revisión es determinar los procesos fisio-patológicos comunes a estas entidades, cuáles son las estra-tegias diagnósticas recomendadas y cuáles las intervenciones terapéuticas actualmente aprobadas.
Subject(s)
Humans , Male , Female , Carcinoma, Hepatocellular/etiology , Metabolic Syndrome/etiology , Non-alcoholic Fatty Liver Disease/complications , Liver Neoplasms/etiology , Fibrosis/etiology , Fibrosis/physiopathology , Fibrosis/therapy , Risk Factors , Carcinoma, Hepatocellular/physiopathology , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Metabolic Syndrome/diagnosis , Metabolic Syndrome/physiopathology , Metabolic Syndrome/therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/physiopathology , Diabetes Mellitus/therapy , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/physiopathology , Non-alcoholic Fatty Liver Disease/therapy , Liver Neoplasms/physiopathology , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imagingABSTRACT
OBJECTIVE@#To summarize and analyze the treatment process, long-term efficacy and clinical economics of children's hepatoblastoma (HB) in multi-disciplinary team (MDT) mode, so as to provide basis for the rational choice of diagnosis and treatment.@*METHODS@#From January 2014 to February 2019, 13 cases of hepatoblastoma in children who completed the whole treatment course in the Pediatric Hematology Tumor Ward of Peking University First Hospital were collected and analyzed, and were followed up until June 30, 2020. There were 9 males and 4 females who were diagnosed and treated according to the MDT process in the hospital. The median age was 16 months (2-54 months), 69.23% (9/13) were under 2 years old. The characteristics, diagnosis and treatment process and treatment effect of the cases were summarized, and the cost of clinical treatment was analyzed.@*RESULTS@#According to the pretreatment extent of disease(PRETEXT), there were 1, 9 and 3 children with stages Ⅱ, Ⅲ and Ⅳ. 76.92% (10/13) of the patients had the largest tumor diameter > 10 cm. All the patients received preoperative neoadjuvant chemotherapy (8 patients received 4 cycles of chemotherapy, and 6 patients changed the chemotherapy plan), surgical treatment and postoperative chemotherapy, the tumor volume decreased by more than 50% (64%-95%) in 12 cases, except 1 case with no significant increase of alpha fetal protein and multiple lesions.The median length of stay was 87 days (68-214 days), the median cost of stay was 200 000 yuan (115 000-500 000 yuan), the median length of stay was 7 days (5-17 days), the median cost of stay was 20 000 yuan (15 000-60 000 yuan), and the incidence of postoperative complications was 7.69% (1/13). All the patients were followed up for 16-69 months. All the patients survived.@*CONCLUSION@#Under the MDT mode, the treatment is seamless connection, the long-term prognosis of children with HB is good, and the total hospitalization cost and time are within the acceptable range. Standard preoperative neoadjuvant chemotherapy can significantly reduce the tumor, improve the resection rate, reduce postoperative complications, reduce the total individual expenditure, shorten the total hospital stay, and further improve the long-term disease-free survival rate.
Subject(s)
Child , Female , Humans , Infant , Male , Disease-Free Survival , Hepatoblastoma/therapy , Liver Neoplasms/therapy , Neoadjuvant Therapy , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
In this paper, we aim to provide professional guidance to clinicians who are managing patients with chronic liver disease during the current coronavirus disease 2019 (COVID-19) pandemic in Singapore. We reviewed and summarised the available relevant published data on liver disease in COVID-19 and the advisory statements that were issued by major professional bodies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, contextualising the recommendations to our local situation.
Subject(s)
Humans , COVID-19/epidemiology , Carcinoma, Hepatocellular/therapy , Chronic Disease , Hepatitis B, Chronic/therapy , Hepatitis C, Chronic/therapy , Liver Cirrhosis/therapy , Liver Diseases/therapy , Liver Neoplasms/therapy , Liver Transplantation , Singapore/epidemiologyABSTRACT
Hepatocellular carcinoma (HCC) is one of the five most common malignant tumors. According to the latest statistics of the World Health Organization (WHO), the incident and mortality rates of HCC ranks the eighth and third in the world, respectively, which severely affect people's health. Exosomes are extracellular vesicles with a bilayer of phospholipids, which carry active substances such as proteins and nucleic acids derived from their mother cells. These exosomes greatly facilitate the exchange of substances and information between cells, and coordinate physiological and pathological processes in the body. In recent years, a large number of studies have shown that exosomal proteins play important roles in the tumorigenesis, development, diagnosis and treatment of HCC. Here we review the composition and functions of exosomes and the role of exosomal proteins in HCC.
Subject(s)
Humans , Carcinogenesis/genetics , Carcinoma, Hepatocellular/therapy , Exosomes/metabolism , Liver Neoplasms/therapy , MicroRNAs/genetics , ProteomicsABSTRACT
ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.
RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2015 suas primeiras recomendações sobre a abordagem do CHC. Desde então, novas evidências sobre o diagnóstico e tratamento do CHC foram relatadas na literatura médica, levando a diretoria da SBH a promover uma reunião monotemática sobre câncer primário de fígado em agosto de 2018 com o intuito de atualizar as recomendações sobre o manejo da neoplasia. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização baseada em evidências científicas visando que pudesse nortear a prática clínica multidisciplinar do CHC. O texto resultante foi submetido a avaliação e aprovação de todos membros da SBH através de sua homepage. O documento atual é a versão final que contêm as recomendações atualizadas e revisadas da SBH.