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The pandemic of Corona Virus Disease 2019 (COVID-19) continues, which shows the concentrated or sporadic cases in multiple places. Current COVID situation is still complex. During the COVID-19, routine diagnosis and treatment of liver cancer patients has been affected in different degrees. Under the premise of following the treatment guidelines, how to reduce the risk of infection of patients and medical staff, utilize limited medical resources to maximally ensure anti-tumor treatment and related emergency treatment, and help patients get through the epidemic period is a problem for liver oncologists. Thus, experts of liver cancer treatment related disciplines of Zhongshan Hospital, Fudan University have written the Expert guidance on overall management of liver cancer during the COVID-19, which aims to provide references for liver oncolo-gists to conduct clinical work safely and effectively under the epidemic prevention and control, and to help patients fight against the epidemic smoothly.
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Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT). PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments, and the optimal treatment strategy remains controversial. With recent advances in techniques, the efficacy and safety of radiation therapy for PVTT has been improved. The optimization of individualized radiotherapy and multimodality treatment is the future direction of research. In this review, we will investigate the current state and future opportunities of radiation therapy and multimodality treatment for HCC with PVTT.
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In the twentieth session of the National Clinical Oncology Conference and 2017 annual meeting of Chinese Society of Clinical Oncology (CSCO),many progressions have been made in the diagnosis and treatment of primary liver cancer.(1) A preliminary report of the real world study of primary liver cancer in China was released.(2) Emerging diagnostic techniques and predictive models can detect preoperative liver cirrhosis and risk of postoperative liver failure in patients with hepatocellular carcinoma (HCC).(3) Photodynamic diagnostic technology can ensure histological clearance with negative surgical margin and preserve as much liver parenchyma as possible.(4) Lenvatinib is expected to be the first-line targeted drug for the treatment of patients with unresectable HCC following sorafenib.(5) Immunotherapy with Nivolumab and Pembrolizumab is still a hot topic in the field of HCC management.(6) Though a vast heterogeneity of patterns of liver resection for HCC exists between two large centers from the East and the West,their surgical safety and long-term efficacy are actually comparable.(7) Routine lymphadenectomy,active surgical intervention for patients with late-stage tumors,ensuring the negative margins of resection and comprehensive treatment of postoperative recurrence are expected to improve the long-term outcomes of intrahepatic cholangiocarcinoma (ICC).
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Objective To evaluate the clinical efficacy of microwave ablation and surgical resection for the treatment of early primary hepatocellular carcinoma (HCC).Methods The Cochrane Library, Medline,PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang database, VIP database were searched with the key words of tumor, liver cancer, primary hepatic carcinoma, hepatocellular carcinoma, HCC,surgery, surgical, surgical resection, liver resection, hepatic resection, thermal ablation, percutaneous thermal ablation, microwave coagulation, microwave ablation, 肝癌, 原发性肝癌, 肝细胞癌, 手术, 切除, 手术切除, 肝切除, 微波, 热消融, 微波治疗, 微波凝固, 微波消融 between the database establishment and February 2015.Chinese and English literatures on microwave ablation and surgical resection for the treatment of early primary HCC were retrieved, and data were extracted and analyzed by 2 independent researchers.All the patients were divided into the microwave ablation group and the surgical resection group.Measurement data were represented by the standardized mean difference (SMD) and 95％ confidence interval (CI), and count data were represented by the odds ratio (OR) and 95％ CI.Heterogeneity of the publication was analyzed using the I2 test.Results Seven literature including 6 retrospective cohort studies and 1 randomized controlled trial were retrieved, and total sample size were 993 patients including 648 in the microwave ablation group and 345 in the surgical resection group.There were significant differences in the volume of blood loss and duration of postoperative hospital stay between the2groups (SMD=-5.03,-1.74, 95％ CI:-6.21-3.85,-2.21--1.28, P＜0.05).There were no significant difference in the incidence of postoperative complications, 1-, 3-year overall survival rates, 1-, 3-year tumor-free survival rates and 1-, 2-, 3-year recurrence rates between the 2 groups (OR =1.57, 1.10, 1.20,0.77, 1.23, 1.32, 2.31, 1.39, 95％CI: 0.25-9.78, 0.43-2.86, 0.70-2.06, 0.19-3.12, 0.54-2.81,0.62-2.80, 0.96-5.55, 0.47-4.14, P ＞ 0.05).Conclusions The safety, feasibility and clinical efficacy of microwave ablation for the treatment of early primary HCC is comparable to surgical resection, and microwave ablation has the advantages of lesser blood loss and shorter duration of hospital stay.
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Objective To summarize the experience of emergency treatment of primary liver cancer rupture bleeding and improve the level of diagnosis and treatment of the disease.Methods From October 2008 to December 2012.The clinical data of 11 patients with spontaneous rupture of primary liver cancer were analyzed retrospectively.Results Three cases were given conservative treatment.Among them,1 case died,2 bleeding cases were hemostasis,8 cases were operated.Surgical operation is the main method of emergency treatment.The effect after operation was satisfactory.1 case with liver tumor resection died in the first days after the operation,1 case was transferred to higher level hospitals for further treatment because massive ascities in third days after operation,6 cases were successfully discharged,survival rate was over 3 months.Conclusions In the process of emergency treatment we should pay attention to reduce the rate of misdiagnosis and missed diagnosis.When the diagnosis was confirmed,we must treat the shock and plan an active operation scheme.Operation mode can be selected of tumor resection or simple hemostatic gauze tamponade suture hemostasis,saving lives of patients in the shortest time is the goal of emergency treatment.
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Objective Study on the diagnosis value of expression of serum macrophage inhibitory factor 1 (MIC-1) combined with alpha-fetoprotein isoforms 3 (AFP-L3) in primary liver cancer detected by enzyme linked immunosorbent assay (ELISA).Methods MIC-1 and AFP-L3 concentrations were detected by ELISA from selected 116 patients of primary liver cancer.Results were compared both in combined and sigle detection.Results In primary liver cancer group AFP-L3 concentration [(127.12±51.43) ngmml] was significantly higher than that in normal control group [(27.11±7.26) ng/ml,P ＜ 0.001].With AFP-L3 ＞ 38.0 ng/ml as the critical value,the sensitivity was 85.34 ％ (99/116),specificity was 88.33 ％ (53/60) and the diagnostic accuracy was 86.36 ％ (152/176).In primary liver cancer group MIC-1 concentration [(3140.43±1138.23) pg/ml]was significantly higher than that in normal the control group [(701.88±302.34) pg/ml,P ＜ 0.001],the sensitivity was 91.38 ％ (106/116),specificity was 85.00 ％ (51/60),the diagnostic accuracy was 89.20 ％(157/176).The two combined detection sensitivity was 83.62 ％ (97/116),specificity was 91.67 ％ (55/60),diagnostic accuracy was 86.36 ％ (152/176).Conclusion MIC-1 combined with AFP-L3 concentration detection can improve the specificity of the diagnosis of primary liver cancer,which has certain clinical value.
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Objective To investigate the clinical value of serum tumor marker alpha-fetoprotein heterogeneity 3 (AFP-L3),golgin 73 (GP73) and glypican 3 (GPC-3) in primary hepatic cancer by ROC curve.Methods The AFP-L3,GP73,GPC-3 levels in serum were detected in 34 patients of primary hepatic cancer by enzyme immunoassay.Meanwhile,same terms from 20 healthy volunteers were detected as normal group.The area under curve was made by SPSS 17.0.Each laboratory indicator levels were compared and analyzed.Results The AFP-L3,GP73,GPC-3 levels in primary hepatic cancer group were significantly higher than those in normal control [(1890.13±506.47) ng/L vs (623.40±317.89) ng/L,(219.53±136.33) ng/ml vs (56.40± 25.63) ng/ml,(14.28±7.15) μg/L vs (7.33±3.71) μg/L,P ＜ 0.01].The areas under the concentration-time curve of receiver operating characteristic of single tumor marker were 0.909,0.832,0.817,the areas of AFP-L3+ GP73,AFP-L3+GPC-3,GP73+GPC-3 were 0.935,0.945,0.912,the area of combined detection of primaryhepatic cancer was 0.96.Conclusion AFP-L3 combines with GP73 and GPC-3 can increase the positive rate in patients with primary hepatic cancer and has important clinical significance.
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Objective To investigate the prognosis of patients with primary liver cancer in different pathological types after hepatectomy,and to analyze the effects of clinicopathological factors on the survival.Methods The clinical data of 567 patients with primary liver cancer who received hepatectomy at the Affiliated Hospital of Qingdao University from January 1997 to December 2008 were retrospectively analyzed.All patients were divided into hepatocellular carcinoma (HCC) group,cholangiocarcinoma (CC) group and combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) group.The survival and risk factors of the patients were analyzed.All data were analyzed by using the chi-square test,t test,analysis of variance.The survival curve was drawn by the Kaplan-Meier method and the survival of the 3 groups was compared by the Log-rank test.The risk factors were analyzed by the one-way analysis of variance and COX regression model.Results The results of pathological examination confirmed that 92.9％ (527/567) patients were with HCC,4.6％ (26/576) with CC and 2.5％ (14/567)with cHCC-CC.The median cumulative survival time of patients with HCC was 48 months,which was significantly longer than 19 months of patients with CC and 14 months of patients with cHCC-CC (Log-rank value =4.354,8.847,P ＜ 0.05).The median tumor-free survival time of patients with HCC was 26 months,which was significantly longer than 9 months of patients with CC and 9 months of patients with cHCC-CC (Log-rank value =6.479,7.708,P ＜ 0.05).The tumor recurrence rate within 1 year of patients with HCC was 28.8％ (152/527),which was significantly lower than 57.7％ (15/26) of patients with CC or 9/14 of patients with cHCC-CC (F =17.046,P ＜ 0.05).No vascular thrombosis was detected in patients with CC,but the regional lymph node metastasis rate was 19.2％ (5/26),which was significantly higher than 2.8％ (15/527) of patients with HCC (x2 =19.082,P ＜ 0.05).Level of alpha-fetoprotein,TNM staging,tumor diameter,multiple foci,liver capsule invasion,satellite foci and lymph node metastasis were risk factors for the survivals of patients with primary liver cancer after hepateetomy (x2 =8.648,118.786,59.548,7.639,13.200,43.842,15.540,P ＜ 0.05).Vascular tumor thrombosis and Child-Pugh classification were the risk factors for the survivals of patients with HCC or cHCC-CC (x2 =70.446,6.230,P ＜ 0.05).TNM staging,tumor diameter,satellite foci and vascular tumor thrombusis were the independent risk factors for the survivals of patients with primary liver cancer (RR =1.420,1.050,1.513,1.899,P ＜ 0.05) ; TNM staging,tumor diameter and vascular tumor thrombosis were the independent risk factors for the survivals of patients with HCC (RR =1.432,1.888,1.052,P ＜ 0.05).TNM staging and tumor diameter were the independent risk factors for the survivals patients with CC (RR =1.473,1.503,P ＜ 0.05).Conclusion Although CC and cHCC-CC take small proportion in the primary liver cancer,the tumor recurrence rate is higher and the survival rate is lower when compared with patients with HCC.
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Primary liver cancer is a high incidence and common malignant tumor in China. Portal vein tumor thrombus is one of the biologic marks of advanced liver cancer and difficult to be cured, and the prognosis is extremely poor. This paper systematically describes the formation mechanism, diagnosis,classification and prognosis of portal vein tumor thrombus. It would provide a theoretical basis for this clinical problem in order to reasonably understand and actively treat it.
