Minutes of seminar on 2023 multi-center cooperation project of liver transplantation for metastatic liver cancer in China / 器官移植

Led by Zheng Shusen, Academician of Chinese Academy of Engineering (CAE) from Zhejiang University, the first multi-center cooperation project of liver transplantation for metastatic liver cancer in China, gathering 28 liver transplantation centers nationwide, was launched in Shanghai. All participating experts conducted in-depth exchanges and discussions regarding four topics including inclusion criteria of liver transplantation for metastatic liver cancer, the risk assessment and prognostic evaluation of liver transplantation for metastatic liver cancer, perioperative medication of liver transplantation for metastatic liver cancer, and the implementation details of multi-center cooperation project. Questionnaires were distributed to reach consensus and pinpoint the directions, aiming to carry out high-quality and standardized clinical researches on liver transplantation for metastatic liver cancer in China.

Research progress of FAPI PET/CT in the diagnosis of malignant liver tumors / 中华肝脏病杂志

Malignant liver tumors have a high incidence and mortality rate. Therefore, it is of great significance to promptly learn about tumor advancement status through relevant examinations for patients' follow-up, diagnosis, and therapy as well as the improvement of the five-year survival rate. The primary lesions and intrahepatic metastases of malignant liver tumors have been better demonstrated in the clinical study with the use of various isotope-labeled fibroblast activating protein inhibitors because of their low uptake in liver tissues and high tumor/background ratio, which provides a new method for early diagnosis, precise staging, and radionuclide therapy. In light of this context, a review of the research progress of fibroblast-activating protein inhibitors for the diagnosis of liver malignant tumors is presented.

Espression and significance of TMSG-1 expression in primary and liver metastases of colorectal cancer tissues / 临床与实验病理学杂志

Purpose To investigate the expression of tumor metastasis suppressor gene-1 (TMSG-1) in colorectal cancer tissues and liver metastases,and to analyses the relationship between expression of TMSG-1 and clinicopathologic characteristics. Methods Immunohistochemical SP methods was used to detect the expression of TMSG-1 protein in 200 cases of colorectal cancer and 52 cases of liver metastases. Results The ratio of high,moderate and negative of TMSG-1 expression in primary colorectal carcinoma were 42. 5％ (85/200) ,29. 5％ (59/200) and 28. 0％ (56/200) respectively. The expression of TMSG-1 was significantly associated with tumor differentiation, invasion depth,lymph node metastasis,distant metastasis and TNM stages (P < 0. 05) ,but unrelate to age,gender and tumor size. The high, moderate and negative expression ratio of TMSG-1 in liver metastases were 17. 3％ (9/52) ,50. 0％ (26/52) ,32. 7％(17/52) ,respectively. The expression of TMSG-1 in liver metastases was significantly lower than that in primary lesion (P < 0. 05) . The expression of TMSG-1 in liver metastases, and there was no significant correlation between the expression of TMSG-1 in liver metastases and clinicopathologic characteristics. Conclusion The expression of TMSG-1 is significantly down-regulated in the liver metastases,which is associated with the development and progression of colorectal cancer. TMSG-1 will be used as a new tumor marker for predicting the prognosis of colorectal cancer.

Diagnostic value of contrast-enhanced ultrasound for the maximum diameter ≤2 cm metastatic liver cancer: compared with contrast-enhanced CT / 中华超声影像学杂志

Objective@#To compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) with contrast-enhanced computed tomography (CECT) for the maximum diameter ≤2 cm metastatic liver cancer (MLC).@*Methods@#Sixty-nine pathologically diagnosed MLC patients (maximum diameter ≤2 cm) were retrospectively recruited. The lesion detection rate, diagnostic confidence and enhancement pattern of CEUS and CECT for MLC were analyzed. Diagnostic value of CEUS and CECT for MLC were evaluated and compared by using diagnostic test.@*Results@#The cases of 0, 1, 2, multiple lesions detected by CEUS and CECT in these 69 patients with ≤2 cm MLC were 0 case (0%), 41 cases(59.42%), 13 cases(18.84%), 15 cases(21.74%) and 9 cases(13.04%), 29 cases(42.03%), 13 cases(18.84%), 18 cases(26.09%), respectively. The positive cases detected by CEUS and CECT were 69 cases(100%) and 60 cases(86.96%) respectively, with a statistically significant difference between the two groups (P=0.006). However, for the detection rate of non-single-lesion cases, there was no statistical difference between CEUS and CECT (P=0.409). The cases showed typical manifestation in CEUS and CECT were 56 cases(81.16%)and 29 cases(42.03%)(P<0.001). The cases with diagnostic confidence level of 3, 4, 5 in CEUS were 3 cases(0.04%), 11 cases(15.94%), 55 cases(79.71%), and those of CECT were 19 cases(27.54%), 20 cases(28.99%), 20 cases(28.99%), respectively. The diagnostic sensitivity of CEUS and CECT for ≤2 cm MLC were 100% (69/69) and 85.51% (59/69), with statistically significant difference(P=0.001).@*Conclusions@#The lesion detection rate and diagnostic value of CEUS for the maximum diameter ≤2 cm MLC might be superior to that of CECT, but the detection rate shows no significant difference in the non-single-lesion cases. CEUS has important clinical value in the diagnosis of ≤2 cm MLC.

The clinical features and treatment of liver abscess formation after TACE for metastatic liver tumors / 介入放射学杂志

Objective To investigate the clinical features,related risk factors,the efficacy and safety of clinical management about liver abscess formation occurring after transcatheter arterial chemoembolization (TACE) for metastatic liver cancer.Methods Among 1812 patients with metastatic liver tumors who were receiving TACE,23 patients developed liver abscess.The clinical features and risk factors for abscess formation were retrospectively analyzed.The curative effects and safety of percutaneous puncture cavity drainage (PCD),or combined with percutaneous transhepatic cholangiography and drainage (PTCD) were analyzed.Results The incidence of liver abscess after TACE for metastatic liver tumors was 1.3％ (23/1812).Postoperative high fever,chill,elevated white blood cell count and increased neutrophil proportion were the main clinical features of liver abscess.The mean time before the diagnosis of liver abscess was confirmed was (11.3±3.7) days after TACE.The hepatic metastatic malignancy originated from the malignant tumor of digestive tract was seen in 73.9％ of patients,18 patients (78.3％) had a history of gastroenteric surgery,and 12 patients (52.2％) had a history of diabetes mellitus.The number of hepatic metastatic lesions was more than 3 in 19 patients (82.6％).After the formation of liver abscess,the liver functions became worse in all patients (P=0.024).In 19 patients (82.6％),angiography showed that the metastases were hypovascular lesions.Blood and pus cultures revealed that E.coli was the main infectious bacteria of liver abscess.The mean time of using anti-infective drugs before hepatic abscess developed liquefaction was (10.4±3.3) days,and the mean time of abscess liquefaction was (15.9±3.7) days.The mean value of the maximum diameters of abscesses was (9.2±2.0) cm.PCD was employed in all patients,the average times of PCD procedure was (3.7±1.7) times.PCD followed by PTCD was performed in 7 patients as they had biloma associated with obstructive jaundice.The average drainage time for liver abscess was (3.1 ±1.7) months.No infectious peritonitis,tumor rupture,or tumor implantation at puncture point was observed.The median survival time of 23 patients with liver abscess was (8.0±0.7) months.The median survival time in patients who received PCD procedure only was (9.0±1.0) months,while it was (5.0±0.7) months in patients who received PCD together with PTCD,and statistically significant difference in the median survival time existed between the above two groups (P=0.041).Conclusion The risk factors of liver abscess formation after TACE in patients with metastatic liver tumors include the site of primary tumor and gastrointestinal surgery.Diabetes may be one of the risk factors.Clinically,the lesions of liver abscess are usually multiple and they often occur in hypovascular lesions with central necrosis,The nain infectious bacteria are from digestive tract,and biloma is easy to develop.Active and effective antibiotic treatment plus puncture drainage of abscess cavity,or combined with PTCD,are effective treatment measures for this kind of liver abscess.

Expression and significance of KL-6 mucin in the tissue and serum of hepatoma / 中华消化外科杂志

Objective To detect the expression of KL-6 mucin in the tissue and serum of hepatoma in different hepatoma patients,and to investigate the value of KL-6 mucin as a tumor marker in the diagnosis of hepatoma.Methods The expression of KL-6 mucin in the hepatoma tissues of 81 patients with hepatocellular carcinoma(HCC),21 patients with cholangiocarcinoma(CC),12 patients with combined hepatocellular and cholangiocarcinoma(HCC-CC)and 56 patients with metastatic liver cancer(MLC)was detected by immunohistochemical analysis.The expression of KL-6 mucin in the serums of 34 HCC patients,8 CC patients,30 MLC patients and 19 healthy individuals was detected by enzyme-linked immunosorbent assay,and all the data were analyzed by t test.Results Expression of KL-6 mucin was detected in the cholangiocarcinoma tissues in all CCand HCC-CC patients.In several hepatoma cells and partial hepatoma tissues of patients with MLC,the expression of KL-6 mucin was detected.No expression of KL-6 mucin was detected in the hepatocellular carcinoma tissuesand non-cancerous tissues of patients with HCC or HCC-CC.The serum levels of KL-6 mucin expression in CC patients were signifcantly higher than those in healthy individuals,HCC and MLC patients(t=5.58,5.34,4.00.P＜0.01).The difference of the serum levels of KL-6 mucin expression between MLC patients and healthy individuals had statistical significance(t=2.77,P＜0.01).However,no significant difference in serum levels of KL-6 mucin expression was found between HCC patients and healthy individuals and between HCC patients and MLC patients(t=2.03,1.89,P＞0.05).Conclusion The expression of KL-6 inucin in CC patients is significantly higher than in patients with other types of hepatoma in both tissue and serum levels.Thus,KL-6 may be a usetul new tmnor marker for distinguishing CC from other types of hepatoma.

Expression of thymidine phosphorylase in human metastatic liver cancer tissues from colorectal cancer / 国际外科学杂志

Objective To detect the tbymidine pbospborylnse (TP) expression in metastatic liver cancer tissues from human colorectal cancer by immunohistochemistry, and analyze the correlation between TP ex-pression and the tumor-associated macrophages (TAM), and the prognosis of patients. Methods Twenty-eight metastatic liver cancer specimens resected from patients with colorectsl cancer, were immunohistochem-ically stained by 654-1, an anti-TP monoclonal antibody, IC6-203, another anti-TP monoclonal antibody, PG-M1, anti-macrophage marker CD68 monoclonal antibody. Morphometrical analysis and positive cell counting were performed, and the correlation of TP expression with the patient's prognosis was evaluated. Results In normal liver tissues, the hepatic cells apart from cancer nests were weakly positive for 654-1 as well as for 1C6-203. The most TP-positive cells were distributed mainly along the invasive margin of cancer or around the cancer nests. In the corresponding areas, CD68-positive macrophages were also increased. The distribution patterns of CD68-positive cells were similar to those of TP-pesitive cells. The numbers of the TP-positive cells stained by 654-1 were significantly correlated with numbers of 1C6-203 positive cells (r=0.697, P<0.01), also correlated with the numbors of CD68-positive cells (r=0.703, P<0.01). While the numbers of 1C6-203 positive cells had no significant differences with the numbers of CD68-positive cells (r=0.359, P>0.05). The TP-pesitive cancer cells both for 654-1 and for 1C6-203 were detected only in 2 of 28 specimens. Both the number of TP-pesitive cells for 654-1 and 1C6-203, and the number of CD68-positive cells had no correlation with the survival period of patients. Conclusions In the metastatic liver cancer tissues of human colorectsl cancer, the TP-expreasinn stained by 654-1 was coincidence with 1C6-203, and the most important source of TP-expreasion is the TAM in stromal tissues around cancer nests, while the cancer cells are little expressed. The numbers of TP-positive cells stained by 654-1 are significantly related with CD68-pesitive macrophages, but not with the post-operation survival period of patients.

Expression of beta-catenin in Colorectal Cancer with Liver Metastasis

PURPOSE: Decreased expression of beta-catenin has been known to be associated with tumor metastasis. However, the clinical relationship between the degree of expression and the prognosis in colorectal cancer (CRC) remains unclear. In this study, we evaluated the prognostic value of beta-catenin expression in CRC patients with liver metastasis. METHODS: Paraffin embedded blocks were obtained from 70 patients who underwent potentially curative resection for CRC with liver metastasis. Samples from normal colon mucosa, primary CRC and metastatic liver lesion were prepared in tissue microarrays and were stained by immunohistochemistry with monoclonal antibody against beta- catenin. The membranous beta-catenin expression was assessed and the beta-catenin expression difference between primary CRC and metastatic liver lesion was analysed in relation to overall survival as well as disease free survival rates. RESULTS: In beta-catenin expression, preserved expression (score >6) was observed in 42.0%, and 21.9% of primary CRC tumor samples and tumor samples from metastatic liver lesion respectively. The degree of beta-catenin expression in metastatic liver lesion was significantly lower than that in primary CRC (P=0.022). According to the difference of beta-catenin expression score between primary CRC and liver metastasis, patients were classified as group 'A' and 'B'. Group 'A' was defined as patients showing remarkably decreased expression of beta-catenin in metastatic liver lesion in that the difference of the score was three or more. Group 'B' was defined as patients showing maintained or increased beta-catenin expression in metastatic liver lesion in comparison to primary CRC, in that the difference of beta-catenin expression score was less than three. Overall survival rate and disease free survival rate were significantly better in group 'B' than group 'A' (P=0.02, P=0.002). CONCLUSIONS: Decreased expression of beta-catenin in metastatic liver lesion may be a poor prognostic marker in colorectal cancers with liver metastasis. A further large-scaled investigation is necessary to define the role of beta-catenin in CRC.

Therapeutic Effect Evaluation of Arsenious Acid-FOLFOX4 Combined Chemotherapy in Metastatic Liver Cancer / 中国普外基础与临床杂志

0.05),but the benefit was significantly different (P

Intrahepatic arterial infusion combined with intravenous chemotherapy in the treatment of metastatic hepatic carcinoma / 中国微创外科杂志

Objective To evaluate the efficacy of FAP combined intrahepatic artery with intravenous infusion chemotherapy in the treatment hepatic metastatic carcinoma. Methods 23 patients with metastatic hepatic carcinoma were diagnosed with CT or MRI. EPI 40mg/m 2, CDDP 60mg/m 2 were given intrahepcic arterial by means of one shot infusion and 5-FU 500mg/m2 (d1, d8) intravenously respectively. All patients were reexamined by with CT or MRI after 2～4 weeks. Results The total response rates was 74%. The survival rates at 1 year, 2 year and 3 year were 88 8%?7 9%;66 9%?12 3% and 24 6%?23 4% respectively. The median survival time was 25 months. Conclusions FAP was a traditional regimen,combined intrahepatic arterial and intravenous chemotherapy can improve response rate and prolong median survival to metastatic liver cancer .

Analysis of synchronous metastatic liver cancer of colorectal cancer for risk factors / 中国微创外科杂志

0.05). Metastasis of the liver of colorectal cancer occurred higher in the patients with serum CEA concentration ≥15ng/ml than that in those with serum CEA

Cell proliferation index and the expression of p53 and Bcl-2 in tumorous and non-tumorous lesions of hepatocellular carcinoma and metastatic liver cancer

In the development of a cancer, unlimited cell proliferation has been believed to play an important role. In addition, a programmed cell death called apoptosis, which is regulated by several oncogenes and tumor suppressor genes, has been suggested to be another important different pathway of carcinogenesis. Recently, several reports on cell proliferation capacity and apoptosis in the development of human liver disease have been published, but the cell proliferation index and its relationship between the expression of the bcl-2 and p53 genes involving apoptosis has not yet been discussed in view of the clinical differences of primary and metastatic liver cancer. In this study, we investigated the cell proliferation index and expression of p53 and bcl-2 in the tumorous and non-tumorous portions of both hepatocellular carcinoma and metastatic liver cancer. The expression of p53 was observed in both hepatocellular carcinoma and metastatic liver cancer, but bcl-2 expression was observed neither in hepatocellular carcinoma nor in metastatic liver cancer. In hepatocellular carcinoma, the p53 positive group showed a higher Ki-67 score (cell proliferation index) and more tumor numbers than the p53 negative group (p<0.05). In metastatic liver cancer, the results were the same as in hepatocellular carcinoma (p<0.05). However, we could not correlate the p53 expression and its prognostic significance in hepatocellular carcinoma.