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Objective:To evaluate the effect of microvascular invasion (MVI) on postoperative prognosis of microhepatocellular carcinoma by a meta-analysis system.Methods:Relevant literatures in PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang databases were systematically searched. The search period was from January 2012 to January 2022. The Chinese search terms were "liver cancer" , "hepatocellular carcinoma" , "2 cm" , "microvascular invasion" , and "prognosis" . The English search terms were "small" , "solitary small" , "up to 2 cm" , "< 2 cm" , "liver" , "hepatocellular carcinoma" , "microvascular invasion" . The differences in prognosis of patients with microhepatocellular carcinoma in MVI(+ ) group and MVI(-) group were compared. Meta-analysis was performed using Review Manager 5.4 software.Results:Finally, 7 articles were included in the systematic review, with a total of 1 319 patients. All included literatures were scored ≥7 on the modified Newcastle-Ottawa scale. The results of meta-analysis showed that there were no significant differences in 1-year overall survival (OS) between MVI(+ ) group and MVI(-) group ( OR=3.14, 95% CI: 0.92-10.72, P=0.068). The 5-year OS time of patients in the MVI(+ ) group was shorter than that in the MVI(-) group, and the differences were statistically significant ( OR=2.34, 95% CI: 1.62-3.36, P<0.001). The 1-year and 5-year disease-free survival of the MVI(-) group were better than those of the MVI(+ ) group, and the difference was statistically significant (1-year: OR=3.09, 95% CI: 1.75-5.44, P<0.001; 5 years: OR=1.76, 95% CI: 1.24-2.51, P=0.002). Conclusion:The 5-year and long-term survival of MVI(+ ) patients with microhepatocellular carcinoma was poor, and the postoperative recurrence rate was high.
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Objective:To evaluate the effect of tutorial system for medical undergraduates in a non-affiliated hospital of a medical university in Jiangsu.Methods:32 senior medical undergraduates in non-affiliated hospitals were divided into two groups. The experimental group adopted tutor-guided teaching, and the control group adopted traditional teaching. Professional theoretical knowledge, clinical ability, operational ability, foreign language level, basic research ability and participation of scientific research activities of students in the two groups were evaluated. SPSS 19.0 was used for t test, chi-square test and U test. Results:The results of operational ability ( t=3.537, P=0.000), the number of papers that had been read ( t=6.961, P=0.000), quality of these ( U=68.000, P=0.017), the number of literature reviews that had been written and reading notes ( χ2=4.747, P=0.000), participation in scientific research activities ( t=6.788, P=0.009) of students in the experimental group were better and higher than those in the control group. In the same period, there was no significant difference between the two groups in the scores of theoretical exam, clinical competence and foreign language tests. Conclusion:The implementation of tutorial system for medical students in non-affiliated hospitals is an effective measure to improve the quality of training. We should make full use of the short intership, to improve the comprehensive quality of students by establishing perfect rules, regulations and teaching evaluation system, and educate students in accordance with their own ability.
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Objective To study the impact of adjuvant transarterial chemoembolization (TACE)after curative resection for patients with hepatocellular carcinoma (HCC) and microvascular invasion (MVI).Methods PubMed,Cochrane library,Embase,Web of Science,CNKI,VIP,Wanfang were searched for randomized or non-randomized studies which compared recurrence-free survival and overall survival rates with or without postoperative adjuvant TACE after curative resection for patients with HCC and MVI.The limited search time was from January 1st,1999 to May 1st,2019.Statistical analyses were performed with software programs using Stata (version 15.0) and Review Manage (version 5.3).Results Eight studies which included 1 809 patients were studied.There were 815 patients who received and 994 patients who did not receive postoperative adjuvant TACE after radical hepatectomy.Postoperative adjuvant TACE significantly improved recurrence-free survival and overall survival rates in patients with HCC and MVI when compared with the patients who required no adjuvant TACE (HR =0.74,95％ CI:0.65-0.85,P ＜0.05;HR =0.74,95％ CI:0.62-0.89,P ＜ 0.05,respectively).Subgroup analysis demonstrated that patients with tumor diameter ＞ 5 cm benefited from postoperative adjuvant TACE only in recurrence-free survival rate (HR =0.72,95％ CI:0.58-0.90,P ＜ 0.05),but not in overall survival rate.Conclusion Postoperative adjuvant TACE delayed recurrence of microvascular invasion of HCC and improved long-term prognosis,but not for tumors with diameter ＞5 cm.These results need to be validated in further clinical trials.
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ObjectiveTo investigate the optimal cut-off value of alpha-fetoprotein (AFP) in the diagnosis and early screening of hepatocellular carcinoma (HCC). MethodsThe clinical data of 2212 HCC patients who were diagnosed and hospitalized in our hospital and 1998 non-HCC patients were collected, and the AFP level was summarized. The AFP level was divided into 10 ranges of 10-20 μg/L, 21-65 μg/L, 66-110 μg/L, 111-155 μg/L, 156-200 μg/L, 201-250 μg/L, 251-300 μg/L, 301-350 μg/L, 351-400 μg/L, and ＞400 μg/L, and a comparative analysis was performed for the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of each cut-off value of AFP, ultrasound, and their combination in the diagnosis of HCC. The receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value. ResultsThe cut-off valve of AFP of 200-250 μg/L had the largest sum of sensitivity and specificity (1.370 1) and the largest area under the ROC curve (0.896 4). AFP ＞20 μg/L combined with ultrasound had the highest sensitivity (95.35%) in the diagnosis of HCC, with a diagnostic odds ratio of 26.13. ConclusionThe optimal cut-off value of AFP in the diagnosis of HCC is 200 μg/L. When AFP combined with ultrasound is used for the screening of people at a high risk of HCC, AFP＞20 μg/L is recommended as a positive index, and its combination with differential diagnosis and close follow-up and examinations can reduce the false negative rate of screening.
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Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence.Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled.These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n =32),the treatment group or the no adjuvant treatment group (n =21,the control group).The recurrence-free survival (RFS) and overall survival (OS) were analyzed.Results There was no significant difference between the two groups in clinical characteristics (P＞0.05).The recurrence-free survival (RFS) (mean±S.D.) was (20.1 ± 1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752).The 1-,2-and 3-year RFS rates of the treatment group and the control group were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％,respectively (P＞0.05).The overall survival (OS) (mean±S.D.) was (26.8± 1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037).The 1-,2-and 3-year RFS rates were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％ in the treatment group and the control group,respectively.The 1-,2-,and 3-year OS rates were 87.5％ vs.66.7％,59.4％ vs.38.1％ and 43.8％ vs.19.0％ in the treatment group and the control group,respectively.Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate,but it improved the OS rate in HCC patients with high risks of recurrence.
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Objective To compare the long-term efficacy between laparoscopic liver resection and open liver resection to treat small hepatocellular carcinoma.Methods The clinical data of 52 patients with small hepatocellular carcinoma treated from August 2011 to November 2012 were reviewed.Twenty patients underwent laparoscopic liver resection (the laparoscopic group),while the remaining 32 patients underwent open liver resection (the laparotomy group).The preoperative,postoperative and overall survival data between the two groups were compared.Results The data between the two groups before surgery were comparable (all P ＞ 0.05).The differences in tumor size and pathologic type between the two groups did not reach statistical significance (t =1.087,x2 =0.738,all P ＞ 0.05).However,the length of hospital stay in the laparoscopic group was significantly shorter than in the laparotomy group (t =3.363,P ＜ 0.05).Post-procedural complications occurred in no patients in the laparoscopic group,but in 8 patients in the laparotomy group (x2 =5.909,P ＜ 0.05).The cumulative survival rates in the two groups were not statistically signifi cant (P ＞ 0.05),but the recurrence-free survival of the laparoscopic group was significantly longer than the laparotomy group (P ＜ 0.05).The postoperative 1-year disease-free survival was not significantly different (P ＞ 0.05),though the 3-and 5-year recurrence-free survival rates were significantly different (all P ＜ 0.05).Conclusion The long-term overall survival rate of laparoscopic treatment for small liver cancer was similar to open operation,but the recurrence free survival rate was greatly improved.
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The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.
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Objective To investigate the clinical application of Glissonean pedicle transection method in hepatocellular carcinoma. Methods We analyzed the clinical data of 232 cases of hepatocellular carcinoma underwent hepatic resection in our department from April 2009 to April 2013. Eighty-nine cases underwent hepatic resection by Glissonean pedicle transection method, and 143 cases underwent Pringle maneuver. Results There was no significant differences in the operation time and blood loss between the two groups (P > 0.05). However, the postoperative hospital stay time and the postoperative complications in group A were better than those in group B(P0.05). Conclusion Glissonean pedicle transection method has many advantages including effectively preventing the intraoperative bleeding, maximally reserving the remaining of liver function, decreasing the rate of tumor spread and metastasis. Meanwhile, it is a safe and effective technique for hepatectomy without dissection of the hepatic artery, portal vein and bile duct in the hepatoduodenal ligament.
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Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.
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The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012.Among 11 cases of borderline hepatocellular carcinoma (HCC) (1.0-9.0 cm),6 of them were of micro hepatocellular carcinoma (MHCC) with a diameter ≤2 cm.There were 10 cases of borderline hepatic benign tumor,including liver hemangioma (n =7),hepatic adenoma (n =1),liver lymphoma (n =1) and liver focal necrosis (n =1).According to Couinaud's liver segmentation method,neoplasm was located on segment Ⅲ (n =13),segment Ⅳ (n =6),segment Ⅴ (n =1) and segment Ⅵ (n =1).Laparoscopic hepatectomy was successful in all patients.There was neither conversion into open approach nor postoperative complications of bile leakage,air embolism or perioperative mortality,etc.The mean operative duration was (120 ± 30) minutes,average hemorrhagic volume (165-±79) ml and normal diet & ambulation at Day 1-2 post-operation.The average postoperative hospitalization stay was (16 ± 10)days and l-year survival rate 100％.The parameters of leucocyte,liver enzymes,albumin and bilirubin returned to normal at Week 1 post-operation.Once a reasonable surgical indication is selected,laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma.
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Objective To investigate the clinical value of intraoperative iodine-125 seed implanttation in treating pancreatic carcinoma. Methods Seventy-five patients (fourty-one men, thirty-four women;median age 54 years) with pancreatic adenocarcinoma were enrolled into the study. Thirty-one patients (group A) were accepted tumor resection,eighteen patients(group B) were implanted radioactive iodine-125 seeds into the tumors by a combination of bypass surgery, twenty-six patients(group C) were treated by bypass surgery.Results Sixty-seven patients were followed up. The median survival time was 19, 12 and 7 months in group A,B,C respectively, among which the difference was significant (P ＜ 0.05). The response rate(CR+PR) was 50 % and the effective rate of pain relieving was 80% in the group B. The 97.4 % of accordance rate of seed number was demonstrated by CT film, but the accordance rate of seed space distribution was only 56 %.Conclusion At present, the active resection of the pancreatic carcinoma, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection. The combination of Intraoperative iodine-125 brachytherapy and bypass surgery is safe and effective for pancreatic carcinoma.The seed space distribution completed by seed computer therapeutic plan needs further study.
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Objective To summarize the experience in application of amputation of secondary structures of splenic pedicle and self-made spleen-removing bag in laparoscopic splenectomy the using 3-hole method. Methods The clinical data of 11 patients receiving the procedure from June 2007 to April 2009 in our hospital were retrospectively analyzed. Results Advantages of the procedure were less bleeding, small wound, quick recovery and no occurrence of postoperative complications. Six cases had slight postoperative pain. All 11 patients were cured. Conclusion The technique of amputation of secondary structures of splenic pedicle is safe and feasible in laparoscopic splenectomy using the 3-hole method.
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Objective To introduce clinical diagnostic specificity of hepatocellular carcinoma (HCC) with serum AFP level in 21μg/L to 200μg/L. Methods Making a literature summarizaton based on the papers review.Results and Conclusions (1) The AFP level more than 20μg/L can be used as a diagnostic criteria of HCC when existing liver space occuping lesion (SOL). (2) The clinical diagnostic criteria using AFP level more than 20 μg/L instead of more than 200 μg/L would be helpful to avoid misdiagnosis of HCC with the AFP level in 21 μg/L to 200 μg/L. (3) The Combination of AFP level more than 20 μg/L with ultrasonography, CT scanning would have higher sensitivity and specificity than single diagnostic method.
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ObjectiveTo investigate the value of low positive AFP level for the diagnosis of hepatocellular carcinoma (HCC) when a space occuping lesion (SOL) was already identified in the liver.MethodsUsing randomized controlled clinical trial,a clinical epidemiological analysis was made based on the result of surgery and pathology proven hepatic SOL of 2?878 cases admitted from January 1993 to June 2001.In this series,there were 2?362 HCC cases, among which 424 HCC cases were with a low positive AFP level(between 21 and 200??g/L) which constitutes the basis of our analysis.ResultsIn HCC and non HCC groups,the sensitivity,specificity and positive predictive value were 69 9%(1?650/2?362) vs.8 9%(46/516) ( P
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Objective To introduce clinical diagnostic specificity of hepatocellular carcinoma (HCC) with serum AFP level in 21*!?g/L to 200*!?g/L. Methods Making a literature summarizaton based on the papers review.Results and Conclusions (1) The AFP level more than 20*!?g/L can be used as a diagnostic criteria of HCC when existing liver space occuping lesion (SOL). (2) The clinical diagnostic criteria using AFP level more than 20 ?g/L instead of more than 200 ?g/L would be helpful to avoid misdiagnosis of HCC with the AFP level in 21 ?g/L to 200 ?g/L. (3) The Combination of AFP level more than 20 ?g/L with ultrasonography, CT scanning would have higher sensitivity and specificity than single diagnostic method.