Transarterial Chemoembolization Plus Tyrosinkinase Inhibitors and PD-1 Inhibitors for Spontaneously Ruptured Hepatocellular Carcinoma.

PURPOSE: To compare the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with tyrosinkinase inhibitors (TKI) and PD-1 inhibitors, versus TACE monotherapy for the treatment of ruptured hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This study included 104 patients with ruptured HCC receiving either combination therapy or TACE monotherapy at two centers between June 2015 and June 2022. Propensity score matching (PSM) analysis was used at a 1:2 ratio to reduce bias between the two groups. The primary outcome measures were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were the occurrence of adverse events (AEs, Common Terminology Criteria for AEs, version 5.0.) and the peritoneal metastasis rate. RESULTS: A total of 69 patients were enrolled after PSM, including 23 patients in the combination group and 46 patients in the monotherapy group. The combination group exhibited a significantly longer median OS (553 days, 95% confidence interval [CI] 222.6-883.9) compared to the monotherapy group (105 days, 95% CI 81.2-128.7; P < 0.001). Similarly, the combination group showed a better median PFS (356 days, 95% CI 299.5-412.4) compared to the monotherapy group (97 days, 95% CI 75.9-118.1; P < 0.001). Moreover, there was no significant difference in the peritoneal metastasis rate (combination group: 8.6% vs. monotherapy group: 26.1%, P = 0.119). Grade 3 AEs occurred at a rate of 21.7% and 13% in combination and monotherapy groups, respectively. No Grade 4/5 AEs were observed in either group. CONCLUSIONS: Our study demonstrated that the combination of TACE with TKI and PD-1 inhibitors significantly enhances OS and PFS compared to TACE monotherapy in ruptured HCC patients. Furthermore, this combined approach exhibited an acceptable safety profile.

Radiofrequency ablation is an inferior option to liver resection for solitary hepatocellular carcinoma ≤ 5 cm without cirrhosis: A population-based study with stratification by tumor size.

BACKGROUND: About 10%-20% of all individuals who develop hepatocellular carcinoma (HCC) do not have cirrhosis. Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation (RFA) and liver resection (LR) in survival of HCC without cirrhosis and stratification by tumor size ≤ 5 cm. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database and identified 1505 patients with a solitary HCC tumor ≤ 5 cm who underwent RFA or LR during 2004-2015. Patients were classified into non-cirrhosis and cirrhosis groups and each group was categorized into three subgroups, according to tumor size (≤ 30 mm, 31-40 mm, 41-50 mm). RESULTS: In patients without cirrhosis, LR showed better 5-year HCC cancer-specific survival than RFA in all tumor size subgroups (≤ 30 mm: 82.51% vs. 56.42%; 31-40 mm: 71.31% vs. 46.83%; 41-50 mm: 74.7% vs. 37.5%; all P < 0.05). Compared with RFA, LR was an independent protective factor for HCC cancer-specific survival in multivariate Cox analysis [≤ 30 mm: hazard ratio (HR) = 0.533, 95% confidence interval (CI): 0.313-0.908; 31-40 mm: HR = 0.439, 95% CI: 0.201-0.957; 41-50 mm: HR = 0.382; 95% CI: 0.159-0.916; all P < 0.05]. In patients with cirrhosis, for both tumor size ≤ 30 mm and 31-40 mm groups, there were no significant survival differences between RFA and LR in multivariate analysis (all P > 0.05). However, in those with tumor size 41-50 mm, LR showed significantly better 5-year HCC cancer-specific survival than RFA in both univariate (54.72% vs. 23.06%; P < 0.001) and multivariate analyses (HR = 0.297; 95% CI: 0.136-0.648; P = 0.002). CONCLUSIONS: RFA is an inferior treatment option to LR for patients without cirrhosis who have a solitary HCC tumor ≤ 5 cm.

A CT-based radiomics nomogram for classification of intraparenchymal hyperdense areas in patients with acute ischemic stroke following mechanical thrombectomy treatment.

Objectives: To develop and validate a radiomic-based model for differentiating hemorrhage from iodinated contrast extravasation of intraparenchymal hyperdense areas (HDA) following mechanical thrombectomy treatment in acute ischemic stroke. Methods: A total of 100 and four patients with intraparenchymal HDA on initial post-operative CT were included in this study. The patients who met criteria were divided into a primary and a validation cohort. A training cohort was constructed using Synthetic Minority Oversampling Technique on the primary cohort to achieve group balance. Thereafter, a radiomics score was calculated and the radiomic model was constructed. Clinical factors were assessed to build clinical model. Combined with the Rad-score and independent clinical factors, a combined model was constructed. Different models were assessed using the area under the receiver operator characteristic curves. The combined model was visualized as nomogram, and assessed with calibration and clinical usefulness. Results: Cardiogenic diseases, intraoperative tirofiban administration and preoperative national institute of health stroke scale were selected as independent predictors to construct the clinical model with area under curve (AUC) of 0.756 and 0.693 in the training and validation cohort, respectively. Our data demonstrated that the radiomic model showed good discrimination in the training (AUC, 0.955) and validation cohort (AUC, 0.869). The combined nomogram model showed optimal discrimination in the training (AUC, 0.972) and validation cohort (AUC, 0.926). Decision curve analysis demonstrated the combined model had a higher overall net benefit in differentiating hemorrhage from iodinated contrast extravasation in terms of clinical usefulness. Conclusions: The nomogram shows favorable efficacy for differentiating hemorrhage from iodinated contrast extravasation, which might provide an individualized tool for precision therapy.

High HBV Load Weakens Predictive Effect of Serum miR-122 on Response to Sorafenib in Hepatocellular Carcinoma Patients.

BACKGROUND: MiR-122 is a liver-specific microRNA. The aim of the study was to explore the association of serum miR-122 with response to sorafenib in hepatitis B virus- (HBV-) related hepatocellular carcinoma (HCC) patients and to further reveal the effect of the virus load on such potential relationship. METHODS: A total of 588 patients with HCC were retrospectively included. All of them were diagnosed with HBV-related locally advanced HCC and were treated with sorafenib. Therapeutic and prognostic information and other information were collected from medical records. Stored blood specimens that were obtained before sorafenib treatment were adopted to detect miR-122. RESULTS: The patients were divided into high-level group and low-level group according to the median of serum miR-122 level, and each group contained 294 patients. During the first 24 weeks after sorafenib treatment, the patients in the high-level group had more opportunities to experience progression-free survival (PFS) and overall survival (OS) than those in the low-level group (HR: 2.47, 95%CI: 1.24∼4.88; HR: 1.20, 95%CI: 1.09∼1.32). In the subgroup analysis, the relationship between serum miR-122 level and overall survival still existed in the patients with relatively lower HBV load (HR: 1.22, 95%CI: 1.09∼1.36), but not in the patients with higher HBV load (HR: 1.12, 95%CI: 0.93∼1.35). CONCLUSION: Higher serum level of miR-122 at baseline was associated with a better response to sorafenib in HBV-related locally advanced HCC patients, and relatively high HBV load weakened such predictive effect mentioned above.

Ortho-silicic Acid Inhibits RANKL-Induced Osteoclastogenesis and Reverses Ovariectomy-Induced Bone Loss In Vivo.

Numerous experiments in vitro and in vivo have shown that an appropriate increase intake of silicon can facilitate the synthesis of collagen and its stabilization and promote the differentiation and mineralization of osteoblasts. In this study, we examined whether ortho-silicic acid restrains the differentiation of osteoclast through the receptor activator of nuclear factor κB ligand (RANKL)/receptor activator of nuclear factor κB (RANK)/osteoprotegerin (OPG) signaling pathway by investigating its effect in vitro and in vivo. Bone marrow macrophage (BMM) cells were isolated and cultured with or without ortho-silicic acid, and then TRAP staining and immunofluorescence were performed to detect the differentiation of osteoclast. The RANKL-induced osteoclast marker gene and protein expression including c-Fos, nuclear factor of activated T cells cl (NFATcl), tumor necrosis factor receptor-associated factor 6 (TRAF6), nuclear factor kappa B P50 (NF-κB P50), NF-κB P52, RANK, integrin ß3, cathepsin K (CTSK), DC-STAMP, and TRAP were quantitatively detected by western blot and RT-PCR. Ovariectomized (OVX) rats were injected with ortho-silicic acid (OVX+Si group) and normal saline (OVX group), and sham-operated rats were injected with normal saline (Sham group). And micro-CT, H&E, and TRAP staining, ELISA, and western blot were performed. Ortho-silicic acid could inhibit the differentiation of osteoclast, and the marker genes and proteins were decreased. The OVX-induced bone loss could be reversed by ortho-silicic acid. Our finding demonstrated that ortho-silicic acid suppresses RANKL-induced osteoclastogenesis and has potential value as a therapeutic agent for OVX-induced bone loss.

Ortho-silicic acid enhances osteogenesis of osteoblasts through the upregulation of miR-130b which directly targets PTEN.

AIMS: Osteoporosis is considered a common skeletal disease. Ortho-silicic acid has been found to enhance the osteogenic differentiation of osteoblasts. However, the molecular mechanism of osteogenesis induced by ortho-silicic acid is still undefined totally. MicroRNAs (miRs) play a key role in osteogenesis of osteoblasts. This study investigated the role of miR-130b in promoting osteogenesis induced by ortho-silicic acid. MAIN METHODS AND KEY FINDINGS: In this study, we found ortho-silicic acid enhanced osteogenesis of osteoblasts in vitro and promoted preventing and treating osteoporosis in vivo. Furthermore, the expression of miR-130b increased under application of ortho-silicic acid. In vitro, experiments demonstrated miR-130b overexpression or inhibition significantly promoted or suppressed osteogenic differentiation of osteoblasts under application of ortho-silicic acid, respectively. Consistently, downregulation of miR-130b in ovariectomy (OVX) rats dropped off the beneficial effect of ortho-silicic acid against bone loss. Mechanistically, we identified phosphatase and tensin homologue deleted on human chromosome 10 (PTEN) as the direct target of miR-130b during osteogenesis induced by ortho-silicic acid. SIGNIFICANCE: In conclusion, our findings reveal that ortho-silicic acid promotes the osteogenesis of osteoblasts mediated by the miR-130b/PTEN signaling axis, which identifies a new target to prevent and treat osteoporosis.

Single-crystal structure and intracellular localization of Zn(II)-thiosemicarbazone complex targeting mitochondrial apoptosis pathways.

Tracking of drugs in cancer cells is important for basic biology research and therapeutic applications. Therefore, we designed and synthesised a Zn(II)-thiosemicarbazone complex with photoluminescent property for organelle-specific imaging and anti-cancer proliferation. The Zn(AP44eT)(NO3)2 coordination ratio of metal to ligand was 1:1, which was remarkably superior to 2-((3-aminopyridin-2-yl) methylene)-N, N-diethylhydrazinecarbothioamide (AP44eT·HCl) in many aspects, such as fluorescence and anti-tumour activity. Confocal fluorescence imaging showed that the Zn(AP44eT)(NO3)2 was aggregated in mitochondria. Moreover, Zn(AP44eT)(NO3)2 was more effective than the metal-free AP44eT·HCl in shortening the G2 phase in the MCF-7 cell cycle and promoting apoptosis of cancer cells. Supposedly, the effects of these complexes might be located mainly in the mitochondria and activated caspase-3 and 9 proteins.

Red Spectral Shift in Sensitive Colorimetric Detection of Tuberculosis by ESAT-6 Antigen-Antibody Complex: a New Strategy with Gold Nanoparticle.

Tuberculosis (TB) is a highly contagious life-threatening disease caused by the bacterial pathogen Mycobacterium tuberculosis. ESAT-6, an abundant early secretory antigenic target protein by M. tuberculosis, found to play a vital role in virulence. Developing a friendly method for the detection of ESAT-6 at the lower concentration facilitates to treat TB at an earlier stage and helps to control the spreading of disease. Herein, a new single-step approach was designed and was done by pre-mixing ESAT-6 and antibody before being added to the gold nanoparticle (GNP) followed by the salt-induced aggregation. We could attain the detection limit of 1.25 pM, showing the aggregation of GNP and the red spectral shift. Further, a higher specificity was demonstrated with the lack of electrostatic biofouling by ESAT-6 on GNP and retained the dispersed GNP in the presence of 10-kDa culture filtrate protein from M. tuberculosis. The required precise antibody concentration for this assay was found to be 60 nM. The increment in the antibody concentration from 75 nM drastically diminishes the sensitivity to ~ 680-fold, due to the crowding effect. With this assay, we attested the suitability of colorimetric assay for efficiently detecting the smaller-sized protein.

Transarterial Chemoembolization Monotherapy in Combination with Radiofrequency Ablation or Percutaneous Ethanol Injection for Hepatocellular Carcinoma.

PURPOSE: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. METHODS: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACE+RFA or TACE+PEI). The long-term survival rates were evaluated in those patients by various statistical analyses. RESULTS: The cumulative survival rates in the combined TACE+RFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE+ RFA/PEI group than in the RFA/PEI alone group. CONCLUSIONS: In terms of the effect on the survival period, combined TACE+ RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.

Sequential Transarterial Embolization Followed by Percutaneous Vertebroplasty Is Safe and Effective in Pain Management in Vertebral Metastases.

BACKGROUND: Vertebral metastases are the most frequent vertebral tumor. Transarterial embolization (TAE) devascularizes the tumor, resulting in tumor necrosis. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, can effectively relieve tumor-related pain and improve spine stability. Unfortunately, the PVP technique is of limited use in controlling the progression of vertebral tumor, especially for paravertebral metastases. TAE combined with PVP may achieve a better control on vertebral metastases with paravertebral extension, but little information regarding the combination is available. OBJECTIVES: The present study is intended to assess the safety and effectiveness of the combination of TAE and PVP in patients suffering from vertebral metastases with paravertebral extension. STUDY DESIGN: Sequential TAE followed by PVP was used in 25 patients with symptomatic vertebral metastases. The safety and effectiveness of the sequential therapy were evaluated. SETTING: Three hospitals' clinical research centers. METHODS: This retrospective study was conducted with 25 consecutive patients (11 women and 14 men; mean age 59.3 years, range 38 - 80 years) with vertebral and paravertebral metastases from March 2009 to March 2014. The patients were treated with TAE, and 5 - 7 days later with the PVP procedure. The clinical outcomes were assessed by the control of pain using visual analog scale (VAS) scores, and computed tomography (CT) imaging. X2 or Fisher exact testing was performed for univariate analysis of variables. The VAS scores between groups were compared using ONE-WAY ANOVA, with a P-value of less than 0.05 considered statistically significant. RESULTS: All the TAE and PVP procedures were successfully done. Mean VAS scores decreased after TAE (from 8.64 ± 0.58 to 5.32 ± 1.46, P < 0.05) and further decreased after PVP (from 5.32 ± 1.46 to 2.36 ± 0.54, P < 0.05), and the decrease in VAS lasted until the third month (3.08 ± 1.52, P > 0.05) follow-up. However, VAS scores at the sixth month were statistically higher than those at the third month (4.8 ± 1.24 versus 3.08 ± 1.52, P < 0.05), VAS scores at the twelfth month were statistically higher than those at the sixth month (6.29 ± 1.07 versus 4.8 ± 1.24, P < 0.05). We found paravertebral cement leakage in 6 cases. No clinical or symptomatic complications were observed. In the follow-up, no patient showed further vertebral compression or spinal canal compromise. LIMITATIONS: This is a retrospective clinical study of a small number of patients. CONCLUSION: The sequential TAE followed by PVP is safe and effective in treating vertebral metastases with paravertebral extension. KEY WORDS: Spine, metastases, pain, embolization, vertebroplasty, interventional radiology, PVP, TAE.

Efficacy of Transarterial Chemoembolization Combined with Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma.

PURPOSE: To evaluate efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of patients with hepatocellular carcinoma. MATERIALS AND METHODS: During January 2009 to March 2012, 80 patients with hepatocellular carcinoma underwent TACE, with or without RFA. Alfa- fetoprotein (AFP) was checked before and after procedure. CT scans were obtained one month after TACE or RFA for all patients to evaluate tumor changes. Complete response+partial response+stable disease (CR+PR+SD)/n were used to assess the disease control rate (DCR). Survival at 3, 6 and 12 months was compared in both groups. RESULTS: AFP levels in TACE + RFA group dropped rapidly, becoming obviously lower than that of the TACE group. In the TACE + RFA group DCR was 93.8%, while only 76.8% in the TACE group. The treatment effect between the two groups was statistically significant (P<0.05) by Ridit analysis. 1 year survival rate in the TACE + RFA group was 92.5%, significantly higher than that of the TACE group at 77.5% (P<0.05). CONCLUSIONS: TACE and RFA as combined therapy method for patients with middle and terminal stage HCC gives full play to synergy between the two and improves the therapeutic effect.

Radiofrequency Ablation for Liver Metastases after Transarterial Chemoembolization: A Systemic Analysis.

BACKGROUND: This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survival rate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolization and introduce a new method of radiofrequency ablation by puncture navigation technology for single liver metastases after transarterial chemoembolization. MATERIALS AND METHODS: Clinical studies evaluating tumor recurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastases received transarterial chemoembolization and using radiofrequency ablation by puncture navigation technology to treat the liver metastases. RESULTS: 3 clinical studies which including 235 patients with liver metastases after transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested that tumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure was performed successfully and the patient received a good prognosis. CONCLUSIONS: This systemic analysis suggests that radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization and could receive a relatively good prognosis.

Comparison of infection between internal-external and external percutaneous transhepatic biliary drainage in treating patients with malignant obstructive jaundice.

PURPOSE: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patients with malignant obstructive jaundice. We here compared the infection incidence between internal-external and external drainage for patients with malignant obstructive jaundice. METHODS: Patients with malignant obstructive jaundice without infection before surgery receiving internal-external or external drainage from January 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), if the guide wire could pass through the occlusion and enter the duodenum, we recommended internal-external drainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients with infection after procedure received a cultivation of blood and a bile bacteriological test. RESULTS: Among 110 patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure in the internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainage group, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infection was controlled, as compared to 12 (63.1%) in the external group (p<0.05). The mortality rate for patients with infection not controlled in internal-external group in one month was 42.8%, while this rate in external group was 28.6% (p<0.05). CONCLUSION: External drainage is a good choice, which could significantly reduce the chance of biliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-term prognosis.

Radiofrequency Ablation in Treating Colorectal Cancer Patients with Liver Metastases.

PURPOSE: To evaluate efficacy of radiofrequency ablation (RFA) in treating colorectal cancer patients with liver metastases. METHODS: During January 2010 to April 2012, 56 colorectal cancer patients with liver metastases underwent RFA. CT scans were obtained one month after RFA for all patients to evaluate tumor response. (CR+PR+SD)/n was used to count the disease control rates (DCR). Survival data of 1, 2 and 3 years were obtained from follow up. RESULTS: Patients were followed for 10 to 40 months after RFA (mean time, 25±10 months). Median survival time was 27 months. The 1, 2, 3 year survival rate were 80.4%, 71.4%, 41%, 1 % respectively. 3-year survival time for patients with CR or PR after RFA was 68.8% and 4.3% respectively, the difference was statistically significant. The number of CR, PR, SD and PD in our study was 13, 23, 11 and 9 respectively. CONCLUSIONS: RFA could be an effective method for treating colorectal cancer patients with liver metastases, and prolong survival time, especially for metastatic lesions less than or equal to 3 cm. But this result should be confirmed by randomized controlled studies.

Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice.

PURPOSE: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. METHODS: During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. RESULTS: Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). CONCLUSIONS: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.

Analysis of different ways of drainage for obstructive jaundice caused by hilar cholangiocarcinoma.

OBJECTIVE: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma. MATERIALS AND METHODS: During the period of January 2006- March 2012, percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) were performed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainage was selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if it could. External drainage was the first choice if infection was diagnosed before the procedure, and a metallic stent was inserted in one week after the infection was under control. Selection by new infections, the degree of bilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients as the parameters was conducted to evaluate the methods of different interventional treatments regarding prognosis of patients with hilar obstruction caused by hilar cholangiocarcinoma. RESULTS: PTCD was conducted in 6 patients and PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05). The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). CONCLUSIONS: With both drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liver function was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.

Drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection.

AIM: To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. MATERIALS AND METHODS: We collect 42 patients with obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August 2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting (pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapy including intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoing drainage only. We assessed the two kinds of treatment with regard to patient prognosis. RESULTS: Both treatments demonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The time to reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survival times were 185 and 128 days, the differences being significant. CONCLUSIONS: Interventional drainage in the treatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decrease bilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongs the survival time and period before reobstruction as compared to drainage only.

Safety and efficacy of sequential transcatheter arterial chemoembolization and portal vein embolization prior to major hepatectomy for patients with HCC.

OBJECTIVE: To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE )and portal vein embolization (PVE) before major hepatectomy for patients with hepatocellur carcinoma (HCC). METHODS: In this retrospective case-control study, data were collected from patients who underwent sequential TACE and PVE prior to major hemihepactectomy. Liver volumes were measured by computed tomography volumetry before TACE, and preoperation to assess degree of future remnant liver (FRL) hypertrophy and to check whether intro- or extrohepatic metastasis existed. Liver function was monitored by biochemistry after TACE, prior to and after major hepatectomy. RESULTS: Mean average FRL volume increased 32.3-71.4% (mean 55.4%) compared with preoperative FRL volume. After TACE, liver enzymes were elevated, but returned to normal in four weeks. During PVE and resection, no patient had intro- or extrohepatic metastasis. CONCLUSION: Sequential TACE and PVE is an effective method to improve resection opportunity, expand the scope of surgical resection, and greatly reduce postoperative intra- and extrahepatic metastasis.