Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization / 癌症

<p><b>INTRODUCTION</b>Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.</p><p><b>METHODS</b>A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS).</p><p><b>RESULTS</b>The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5-27.7) months in the antiviral group and 9.6 (95% CI, 7.8-13.7) months in the non-antiviral group (log-rank test, P = 0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P = 0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5-37.7] months, P = 0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P = 0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95% CI, 5.2-13.5] months versus 7.4 [95% CI, 5.9-9.3] months, P = 0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.</p><p><b>CONCLUSION</b>Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.</p>

Expression and clinical impact of vascular endothelial growth factor and matrix metalloproteinase-2 in hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression and clinical impact of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) in hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Ninety specimens obtained from HCC patients were examined immunohistochemically using anti-VEGF and anti-MMP-2 monoclonal antibodies.</p><p><b>RESULTS</b>The positive rates of VEGF and MMP-2 expression in HCC tissues were 76.7% and 60%, respectively. The expression of MMP-2 in HCC tissues was positively correlated with the expression of VEGF (r(s) = 0.32) and both were positively correlated with recurrence (or metastasis) after hepatectomy (r(s) = 0.31, r(s) = 0.32). 2-year tumor-free survival rates of VEGF- group, VEGF+ group and VEGF++ group were 71.4%, 43.5%, 30.4%, respectively, (P < 0.01), while MMP-2- group 66.7% and MMP-2+ group 32.8% (P < 0.01). Multivariate analysis revealed that the expression of VEGF and MMP-2 in HCC tissues, tumor microthrombus and pre-operative dissemination to lymph nodes were independent recurrence (or metastasis) risk factors.</p><p><b>CONCLUSION</b>The expression of VEGF and MMP-2 in HCC tissues, and clinicopathological features (tumor microthrombus and pre-operative dissemination to lymph nodes), could be regarded as valuable indicators for prediction of recurrence (or metastasis) risk in HCC patients.</p>

Expression and clinical significance of certain apoptosis and angiogenesis factors in hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression and clinical significance of some apoptosis and angiogenesis factors in hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The expression of p53, Survivin, matrix metalloproteinases (MMP)-2, MMP-9 and vascular endothelial growth factor (VEGF) in 90 specimens of HCC was detected by immunohistochemistry. Correlations of the factors to the recurrence of HCC after hepatectomy were analyzed.</p><p><b>RESULTS</b>The positive rate of p53, Survivin, MMP-2, MMP-9 and VEGF in HCC tissue was 33.3%, 51.1%, 60.0%, 37.8% and 76.7%, respectively. Of the 5 factors, positive correlation only occurred between the expression of MMP-2 and VEGF, MMP-9 and VEGF. The expression of MMP-2, MMP-9 and VEGF was correlated to the recurrence of HCC. The 1-, 2-, and 3-year tumor-free survival rates were significantly higher in MMP-2 (-) group than in MMP-2 (+) group, and the same results were found with MMP-9 and VEGF. Multivariate analysis revealed that macroscopically disseminated nodules, tumor micrometastasis, serum alpha fetal protein (AFP) level, the expression of MMP-9 and VEGF were independent recurrence risk factors in HCC.</p><p><b>CONCLUSIONS</b>Neither p53 nor Survivin is correlated to the recurrence of HCC; MMPs and VEGF are correlated to the recurrence, and can be used to estimate the risk of postoperative recurrence of HCC.</p>

Clinical treatment of small hepatocellular carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the suitable treatment methods of small hepatocellular carcinoma (SHCC).</p><p><b>METHODS</b>From 2000 to 2004, 849 cases of SHCC (< or = c5 cm) were enrolled and divided into two groups: resection group (n = 406) and minimally invasive treatment (MIT) group (n = 443). The survival rates, recurrence rates, and post-treatment complications were compared retrospectively.</p><p><b>RESULTS</b>The 3-year survival rate in the resection group was 72.1%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of resection group were 73.3% and 70.5% (P = 0.46), respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.5%, 29.9%, and 39.8%, respectively. The 3-year survival rates in MIT group was 73.8%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of MIT group were 74.7% and 72.2% (P = 0.45), respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 12.6%, 28.7%, and 40.4%, respectively. The 3-year survival rate was significantly different between these two group in tumor < or = 3 cm (P < 0.05). The post-treatment complication rates of these two group were 30.8% and 6.1% (P < 0.01), respectively.</p><p><b>CONCLUSIONS</b>MIT is as effective as the traditional resection in SHCC. However, MIT is superior to the traditional resection in terms of minimal invasion and less post treatment complication rate. The recurrence rate of HCC was still high after treatment. Comprehensive therapies, including MIT, may increase the survival rate and life quality in SHCC patients.</p>