Downstaging treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression, and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines, studies have shown that some patients may achieve a better outcome via surgical treatment, especially those with tumor thrombus in the first- or second-order branches of the portal vein (type Ⅰ/Ⅱ thrombus according to Cheng’s classification). However in clinical practice, a large proportion of patients cannot undergo radical resection due to extensive lesions, or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein (type Ⅲ according to Cheng’s classification), and therefore, downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy, (90)Y-loaded microsphere radioembolization, and hepatic arterial infusion chemotherapy, some patients may achieve regression or disappearance of portal vein tumor thrombus, tumor shrinkage, and disappearance of satellite lesions, which helps to achieve tumor downstaging, increase surgical resection rate, and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.

Effective ways to improve the prognosis of advanced stage (BCLC stage C) hepatocellular carcinoma / 中华外科杂志

Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) or lymphatic/extrahepatic metastasis is classified as advanced stage (Stage C of Bacelona Clinic Liver Cancer Staging). There is few effective therapy for the advanced stage HCC, leading to an extremly poor prognosis. For these patients, Sorafinib is recommended as the only therapy by European and American guidelines, which has limited clinic effect. In China, besides Sorafinib, various therapies have also been suggested, including surgery, trans-arterial chemoembolization (TACE), radiotherapy, as well as traditional Chinese medicine. Recently, it is reported that several therapies may be effective in treating HCC with PVTT which is classified based on Cheng's classification, including surgery after "down-stage" radiotherapy, early use of sorafinib postoperatively, as well as postoperative antivirus treatment. The modified Folfox4 chemotherapy, is also a potential effective way to improve the prognosis of advanced stage HCC with lymphatic/extrahepatic metastasis. Mutiple disciplinary team which could faciliate the process of diagnosis and treatment of advanced stage HCC, is expected to favor the prognosis of these patients.

Expression of ER,PR,HER-2,PCNA and P53 genes in breast cancer patients in Shanghai and the relevant clinical significance / 第二军医大学学报

Objective To investigate the expression of ER,PR,HER-2,PCNA and P53 in breast cancer patients in Shanghai and the relevant clinical significance.Methods Expressions of ER,PR,HER-2,PCNA and P53 in the breast cancer tissues of 544 patients in Shanghai were detected by immunohistochemistry methods.Statistical analysis was applied to analyze the relationship of these immunohistochemical indices with the clinicopathological features of breast cancer.Results The positive rates of ER,PR,HER-2,PCNA and P53 in the breast cancer tissues of 544 patients were 62.2%,57.2%,15.1%,82.6% and 58.5%,respectively.The expressions of ER,PCNA and P53 were correlated with the tumor size(P

Downstaging treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression, and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines, studies have shown that some patients may achieve a better outcome via surgical treatment, especially those with tumor thrombus in the first- or second-order branches of the portal vein (type Ⅰ/Ⅱ thrombus according to Cheng’s classification). However in clinical practice, a large proportion of patients cannot undergo radical resection due to extensive lesions, or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein (type Ⅲ according to Cheng’s classification), and therefore, downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy, (90)Y-loaded microsphere radioembolization, and hepatic arterial infusion chemotherapy, some patients may achieve regression or disappearance of portal vein tumor thrombus, tumor shrinkage, and disappearance of satellite lesions, which helps to achieve tumor downstaging, increase surgical resection rate, and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.