Chinese herbal medicine Buyang Huanwu Decoction combined with acupuncture to treat sequela of apoplexy: a meta-analysis of randomized controlled trials.

BACKGROUND: Buyang Huanwu Decoction combined with acupuncture has a wide range of applications in the treatment of stroke sequelae, and there are many clinical trial reports. We systematically evaluated the clinical efficacy and safety of Buyang Huanwu Decoction combined with acupuncture in treating stroke sequelae, and evaluated overall research quality. METHODS: We searched 7 databases which includes the Chinese Journal Full-text Database (CNKI), VIP Database (VIP), China Biomedicine (SinoMed), Wanfang Database and PubMed, Cochrane Central, EMBASE from January 2010 to December 2019 Literature references. We selected randomized controlled trials that tested the effects of Buyang Huanwu Decoction combined with acupuncture on stroke sequelae. The authors extracted data and independently assessed quality. We used RevMan 5.3.0 software to analyze the data of randomized trials. RESULTS: A total of 7 articles were identified, including 902 patients. The overall quality of the included trials was poor, and one of them was moderate. Meta-analysis results showed that the experimental group of Buyang Huanwu decoction combined with acupuncture treatment of stroke sequela compared with the control group clearly improved the clinical efficacy improved the clinical efficacy rate (RR 1.18, 95% CI: 1.12, 1.25), P<0.00001]. Among them, three trials included the incidence of adverse reactions (RR 0.22, 95% CI: 0.09, 0.52, P=0.0006), which also confirmed the safety of its treatment. CONCLUSIONS: Buyang Huanwu Decoction combined with acupuncture is an effective therapy to ameliorate the clinical symptoms of stroke sequelae. In order to further determine the effectiveness and safety of Buyang Huanwu Decoction combined with acupuncture in treating stroke sequelae, more rigorous design, multicenter and prospective RCT must be carried out.

Twenty-year survivors after resection for hepatocellular carcinoma-analysis of 53 cases.

PURPOSE: To clarify the clinicopathologic features of patients surviving > or =20 years after resection for hepatocellular carcinoma (HCC). METHODS: Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC; 53 (13.4%) patients survived > or =20 years, and 343 (86.6%) patients survived <20 years. A comparative study between the two groups was made. RESULTS: By March of 2007, 67.6% (36/53) patients are still alive, disease free; 5.7% (3/53) patients died of tumor recurrence or metastasis; 11.3% (6/53) patients died of liver failure; 5.7% (5/53) patients were lost during follow-up. The longest patient survived 43 years and 2 months. Five young patients got married after resection and have had babies. One patient with a tumor measuring 17 x 13 x 9 cm (largest tumor in this series) survived for 37 years after resection, still alive, free of disease. Reresection for recurrence was done in nine patients, mean survival being 26 years and 11 months. Reresection for solitary pulmonary metastasis was carried out in three patients, mean survival being 29 years and 2 months. In comparison with patients surviving <20 years, patients surviving > or =20 years were significantly younger (P = 0.031), had a higher incidence of asymptomatic tumors (56.6 vs. 34.4%, P = 0.002); lower gamma-glutamyl transpeptidase level (< or =50 U/L, 64.2 vs. 25.9%, P < 0.000), lower proportion of liver cirrhosis (66.0 vs. 83.6%, P = 0.002); higher percentage of small tumors (< or =5 cm, 62.3 vs. 29.9%, P < 0.000), single nodule tumors (90.6 vs. 62.9%, P < 0.000), and well-encapsulated tumors (86.8 vs. 43.6%, P < 0.000); lower proportion of tumor emboli in the portal vein (3.8 vs. 22.5%, P = 0.002), better differentiation of tumor cells (Edmondson grade I, 21.6 vs. 9.1%, P = 0.036), and higher curative resection rate (100 vs. 64.1%, P < 0.000). CONCLUSIONS: Early detection and curative resection are the principal factors improving long-term survival. Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life. Reresection for recurrence and metastasis is important approach to improve prognosis.

Intrahepatic cholangiocarcinoma: report of 272 patients compared with 5,829 patients with hepatocellular carcinoma.

PURPOSE: To clarify clinicopathologic differences between patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC), and identify potential factors influencing survival after hepatectomy for ICC. METHODS: Comparison of clinicopathologic data was made between patients who underwent hepatectomy for ICC (n = 272) and HCC (n = 5,829) during the same period. Twenty-five clinicopathologic variables were selected for univariate and multivariate analyses to evaluate their influence on prognosis of ICC. RESULTS: Compared with patients with HCC, ICC patients were more common in females and more elderly, had a lower proportion of asymptomatic tumors, lower serum alpha-fetoprotein, higher serum carcinoembryonic antigen, carbohydrate antigen 19-9 and alkaline phosphatase levels; lower incidence of hepatitis history, associated cirrhosis and serum hepatitis B surface antigen; lower proportion of small tumors, well-encapsulated tumors and tumor emboli in the portal vein; higher proportion of single tumor, perihila lymph node involvement and poor differentiation; and less frequency of limited resection (all, P < 0.0001). Distant metastasis was less frequent in patients with ICC (P = 0.027). A total of 5-years overall and disease-free survival (in brackets) after resection was 26.4% (13.1%) and 44.5% (33.1%) (P < 0.0001, P < 0.0001) for patients with ICC and HCC, respectively. Factors influencing survival after resection of ICC can be divided mainly into two categories: early detection of asymptomatic ICC (P < 0.0001) and curative resection (P = 0.002). CONCLUSION: ICC Patients have distinct clinicopathologic features as compared with HCC patients. Surgery remains the only effective treatment for ICC. Early detection of asymptomatic ICC and curative resection were the key to achieve optimal survival.

[Treatment of postoperative recurrence of hepatocellular carcinoma with radiofrequency ablation comparing with repeated surgical resection].

OBJECTIVE: To evaluate the efficacy of radiofrequency ablation for the treatment of postoperative recurrence of hepatocellular carcinoma and whether radiofrequency ablation can be used as first line treatment for recurrent hepatocellular carcinoma. METHODS: There were 213 patients with small recurrent hepatocellular carcinoma (tumor size of 3 cm or less and no more than 3 nodules) who treated in Liver Cancer Institute, Fudan University from January 2000 to December 2005. Among these patients 68 were treated with radiofrequency ablation and 145 were treated with repeated surgical resection. Kaplan-Meier method was used to evaluate the overall survival or disease free survival. Log-rank used to determine the survival difference between groups and COX proportional hazard was used for multivariate analysis to evaluate the risk factors for prognosis. The overall survival or disease free survival was calculated from the time treated with radiofrequency or repeated surgical resection. RESULTS: The 1-, 3-, 5-years overall survival rates were 94.7%, 65.1%, 37.3% and 88.1%, 62.6%, 41.0% in radiofrequency ablation group and surgical repeated resection group, respectively. There was no significant difference between two groups (P = 0.693). However, the disease free survival was better in repeated surgical resection than in radiofrequency ablation, which were 79.4%, 48.1%, 34.4% and 58.0%, 27.8%, 12.4% in repeated surgical resection and radiofrequency ablation, respectively (P = 0.001). The interval between recurrence and initial hepatectomy with more than 2 years was independent factor favor to good prognosis. CONCLUSIONS: Radiofrequency ablation seems to be as effective as repeated surgical resection owing to comparable overall survival and can be considered as alternative therapy for surgical resection treatment of small recurrent hepatocellular carcinoma.

Cytokeratin 10 and cytokeratin 19: predictive markers for poor prognosis in hepatocellular carcinoma patients after curative resection.

PURPOSE: Cytokeratin 10 (CK10) was found to be expressed differently in human hepatocellular carcinoma (HCC) cell lines with different metastatic potentials in our previous research. The aim of this study was to assess the value of CK10 alone or in combination with cytokeratin 19 (CK19) in predicting tumor recurrence after curative resection in HCC patients. EXPERIMENTAL DESIGN: CK10 expression in stepwise metastatic HCC cell lines and tumor tissues from 50 HCC patients was investigated using immunofluorescence assay, quantitative real-time reverse transcription-PCR, and Western blot analyses. Tumor tissue microarrays of 300 HCC patients who underwent curative resection between 1997 and 2000 were used to detect the expressions of CK10 and CK19. Clinicopathologic data for these patients were evaluated. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. RESULTS: CK10 was overexpressed in the high metastatic HCC cell line and in tumor tissues of recurrent patients. Both univariate and multivariate analyses revealed that CK10 was a significant predictor for overall survival (OS) and disease-free survival, and that CK19 was a significant predictor for OS. CK10 expression was correlated with poor prognosis regardless of alpha-fetoprotein, tumor-node-metastasis stage, and vascular invasion. The 7-year OS and disease-free survival rates in CK10+ and/or CK19+ patients were 30.0% and 37.6%, respectively, which were significantly lower than that of CK10-/CK19- patients (56.1% and 60.0%, respectively; P < 0.001). CONCLUSION: CK10 is associated with HCC invasiveness. CK10 alone, or in combination with CK19, can be a novel predictor for poor prognosis of HCC patients after curative resection.

Identification of side population cells in human hepatocellular carcinoma cell lines with stepwise metastatic potentials.

PURPOSE: To identify the side population (SP) cells from four hepatocellular carcinoma (HCC) cell lines with stepwise metastatic potentials. METHODS: SP cells were sorted from HCCLM3, MHCC97-H, MHCC97-L and Hep3B by flow cytometry, and then analyzed by differentiation study, clonogenic assay, chemoresistance study and tumorigenicity assay in vivo. The expression of ABCG(2) in SP cells was detected by immunocytochemistry, western blotting and real-time quantitative PCR, respectively. RESULTS: There was significant difference in SP proportion among HCCLM3, MHCC97-H, MHCC97-L and Hep3B (28.7 +/- 1.6%, 14.5 +/- 0.6%, 4.2 +/- 0.4%, 0.9 +/- 0.1%, respectively, P < 0.01). All the SP cells showed similar characteristics of self-renewal, high clonogenicity, remarkable chemo-resistance and high expression of ABCG(2). As low as 2,000 SP cells could initiate tumors in non-obese diabetic/severe combined immunodeficiency mice successfully. CONCLUSIONS: SP cells purified from HCC cell lines harbors cancer stem cell-like properties, and may be related to the metastatic potentials and therapeutic-resistance of HCC.

[Pulmonary infection and its risk factors after orthotopic liver transplantation].

OBJECTIVES: To investigate the characteristics of pulmonary infection and its risk factors after orthotopic liver transplantation (OLT). METHODS: Clinical data of 250 cases having liver transplantations from April 2001 to August 2005 were retrospectively studied in order to analyse the differences between patients with and without pulmonary infection. RESULTS: Fifty-seven (57/250, 22.8%) recipients had 72 episodes of pulmonary infection after liver transplantation. Bacterial infection was the most common followed by fungal infection (13/72, 18.1%), and cytomegalovirus infection (12/72, 16.7%). There were 36 episodes of pulmonary infection caused by one kind of bacteria, 5 episodes by two kinds of bacteria and 6 episodes by multiple kinds of bacteria. Seven episodes of fungal infection were accompanied with bacterial infection, and three episodes of cytomegalovirus infection were accompanied with bacterial infection simultaneously. The 1-, 2- and 3- year survival rates were 71.9%, 61.4%, and 53.4% of the patients with pulmonary infection and 93.1%, 75.8%, and 67.2% of those without the infection. Logistic regression analysis suggested that preoperative infection, mechanical ventilation > 12 hours, a long duration of the operation, total volume of blood transfusion during operation >1000 ml, reoperation after OLT, postoperative pleural effusion and the duration of stay in the intensive care unit were independent risk factors of pulmonary infection after OLT. CONCLUSION: Bacterial infections were the main pulmonary infection after OLT and the infections caused by multiple pathogens or multiple-antibiotic-resistant bacteria were seen more frequently. The risk factors of pulmonary infection should be controlled to decrease the infection rate after OLT. It is important to make a correct diagnosis for pulmonary infection after OLT and use appropriate antibiotics as soon as possible.

[Influence of tumor characteristics on the outcome of liver transplantation among patients with hepatocellular carcinoma].

OBJECTIVE: To identify the influence of tumor characteristics on the outcome of liver transplantation (LT) among patients with hepatocellular carcinoma (HCC). METHODS: A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and February 2006 at our institution. We compared the outcome of the patients classified by different tumor related factors. Survival analysis was performed using Kaplan-Meier and Cox proportional hazards regression methods. RESULTS: Macroscopic vascular invasion, lymph node metastasis, Edmondson pathologic classification, microscopic tumor thrombosis, tumor location, satellite nodules and alpha-fetal protein (AFP) all significantly affected the overall survival and/or recurrence-free survival post-LT (P < 0.01 or P < 0.05). Pre-operative treatment and hepatitis background had no effect to the prognosis (P > 0.05). At multivariate Cox regression analysis, the factors associated with mortality or recurrence were macroscopic vascular invasion, microscopic tumor thrombosis and satellite nodules (P < 0.01 or P < 0.05). CONCLUSION: Edmondson grade III - IV, microscopic tumor thrombosis, left lobar or bilobar tumor, satellite nodules and AFP > or = 300 microg/L were predictive factors of poor prognosis. Presence of macroscopic vascular invasion or lymph node metastasis should be contraindicated.

[Focal adhesion kinase mRNA overexpression in hepatocellular carcinoma HCC) and correlation thereof with prognosis of HCC].

OBJECTIVE: To investigate whether focal adhesion kinase (FAK) is involved in the progression of human hepatocellular carcinoma (HCC) and whether FAK mRNA expression has prognostic significance for HCC. METHODS: Real-time PCR and immunohistochemistry were used to det4ec the mRNA and protein expression of FAK in 50 specimens of HCC obtained during operation. The correlation between FAK expression and clinicopathologic parameters was. RESULTS: The mRNA expression of FAK was significantly higher in the HCC specimens than in the corresponding non-cancerous liver tissues (P < 0.001), in the embolism than in the tumor tissue by the emboli of the same specimen (P < 0.05), and in the HCC with embolism than in the HCC without embolism (P = 0.003). Cox regression analysis showed that the FAK mRNA expression was correlated significantly with embolism (P = 0.003) and invasion (P = 0.020). Univariate and multivariate analyses revealed that FAK expression was an independent prognostic factor for survival. CONCLUSION: FAK plays an important role in HCC progression, especially in vascular invasion and FAK expression has prognostic significance for HCC.

[Clinical observation on head point-through-point electroacupuncture for treatment of poststroke depression].

OBJECTIVE: To observe clinical therapeutic effect of head point-through-point electroacupuncture (EA) on poststroke depression (PSD) and to study the mechanism. METHODS: One hundred and eight cases of PSD were randomly divided into a point-through-point EA group (n = 38), a non point-through-point group (n = 36) and a western medicine group (n = 34). After treatment of 28 days, their therapeutic effects, scores of HAMD depression scale and SDS self-rating scale, and plasma 5-HT contents were compared before and after treatment among the 3 groups. RESULTS: The effective rate of 86.84% in the point-through-point EA group was better than 63.89% in the non point-through-point group and 67.65% in the western medicine group (P < 0.05 or P < 0.01). Plasma 5-HT content in the point-through-point EA group increased significantly, with a very significant difference as compared with that of the non point-through-point group (P < 0.01). CONCLUSION: Head point-through-point therapy can obviously increase plasma 5-HT content of the patient with PSD, so as to cure poststroke depression, with a better therapeutic effect than other two groups.

Focal nodular hyperplasia of the liver in 86 patients.

BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestations, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.

[Inhibition of growth and metastasis of hepatocellular carcinoma by rapamycin: experiment with mice].

OBJECTIVE: To investigate the effects of rapamycin (RPM) in inhibiting the growth and metastasis of hepatocellular carcinoma (HCC). METHODS: Human HCC cells of the line MHCC97H with a high potential of metastasis were divided into 3 groups to be cultured with cyclosporine A (CsA) 100 ng/ml, RPM 10 ng/ml, or CsA + RPM for 48 hours. Flow cytometry was used to examine the apoptosis and cell cycle MTT method was used to examine the effect of RMP on the proliferation of the MHCC97H cells. RT-PCR was used to detect the mRNA expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1alpha (HIF-1alpha), and transforming growth factor b (TGFb). Another MHCC97H cells were cultured in complete medium without RPM for 48 hours, then the protein expression of VEGF in the supernatant was detected by ELISA. Twenty-eight nude LCI-D20 mice were inoculated with human HCC cells and then divided into 4 groups to be fed with CsA (25 mg/kg), RPM (2 mg/kg), CsA + RPM, and normal saline (0.2 ml, as control group) for 35 days. Then the mice were killed to take the weight of inoculated tumor, measure the blood drug concentration, calculate the lung metastasis rate and number of metastatic foci, and observe pathology of the lung. RESULTS: CsA showed no effect on the cycle of the MHCC97H cells. The MHCC97H cells of the RPM and CsA + RPM groups arrested at the stage G(0)/G(1) (both P = 0.000). MMT method also showed that the proliferation of the MHCC97H cells in the RPM and CsA + RPM groups were blocked (P = 0.003 and P = 0.002). However, CsA did not influence the proliferation of the MHCC97H cells. Flow cytometry showed that RPM did not promote the apoptosis of the MHCC97H cells. RT-PCR showed that RPM down-regulated the mRNA expression of VEGF and HIF-1alpha (both P < 0.05), however, did not influence the mRNA expression of bFGF, TGFb, and TGFb. The VEGF protein level in the supernatant of the culture fluid of MHCC97H cells of the RPM group was (890.3 +/- 25.1) pg/ml, significantly lower than that of the control group, (1583.7 +/- 17.3) pg/ml (P = 0.000). The tumor inhibiting rate of the RPM group was 63.7%, not significantly different from that of the RPM + CsA group (80.9%, P = 1.000). The metastatic rate of the CsA and control groups were both 100% with a higher number of metastatic tumors in the CsA group (P = 0.046). CONCLUSION: RPM significantly inhibits the growth and metastasis of HCC. RPM-based immunosuppressive regimen may be of value in HCC patients receiving liver transplantation.

[Indication of liver transplantation for hepatocellular carcinoma: Shanghai Fudan Criteria].

OBJECTIVE: To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) and to explore the new criteria adapted for Chinese National Situation. METHODS: A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. We compared the outcome of the patients meeting different criteria such as milan, UCSF and the Pittsburgh modified TNM criteria. Survival rates were calculated using the Kaplan-Meier method, and differences between the curves were assessed by log-rank test. RESULTS: There was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates between milan criteria (n = 93; 86%, 77%, 77% and 91%, 86%, 86%) and UCSF criteria (n = 131; 90%, 83%, 83% and 92%, 89%, 89%). According to Pittsburgh criteria (n = 207), the 1, 2, 3-year survival rates and recurrence-free survival rates were 84%, 74%, 67% and 85%, 83%, 73%, respectively. For advanced tumors (over all the criteria), the survival rates and recurrence-free survival rates decreased significantly (n = 44; 65%, 43%, 43% and 47%, 43%, 43% respectively). When criteria (named as Shanghai Fudan Criteria) were expanded to HCC patients with solitary lesions < or = 9 cm in diameter, or no more than 3 lesions, the largest < or = 5 cm, with a total tumor diameter < or = 9 cm, there was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates (n = 151; 88%, 80%, 80% and 90%, 88%, 88%, respectively) as compared with milan criteria, but more patients using Shanghai Fudan Criteria could undergo liver transplantation. CONCLUSION: Shanghai Fudan Criteria, which expanded the tumor size limits, does not adversely impact survival of HCC patients after LT.

[Analysis of the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma and summary of relevant clinical experience].

OBJECTIVE: To analyze the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma (HCC) and sum up the relevant clinical experience in diagnosis and treatment of HCC. METHODS: The clinical data of 198 HCC patients, 177 males and 21 females, aged 49 (24-83), were analyzed. RESULTS: The 0.5-, 1-, and 2-year survival rates were 89%, 78%, and 65 respectively. The rates of disease-free survival (DFS) were 85%, 73, and 67% respectively. Univariate analysis revealed that tumor size, presence of vascular invasion, Edmondson grade, TNM classification, and preoperative alpha-fetoprotein (AFP) were significantly related to DFS, and the 4 foregoing factors were also related to the survival rate. Cox regression analysis suggested that presence of vascular invasion was an independent prognostic factor of survival rate and DFS. CONCLUSION: Vascular invasion plays a leading role in evaluating the prognosis of orthotopic liver transplantation for HCC. It is important to discover the micro-metastasis and explore more effective approaches to prevent recurrence after transplantation.

Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma: Report of an initial experience.

AIM: To report a retrospective analysis of preliminary results of 36 patients who received sirolimus (SRL, Rapamune, rapamycin) in a consecutive cohort of 248 liver allograft recipients. METHODS: Thirty-six liver transplant patients with hepatocellular carcinoma (HCC) who were switched to SRL-based immunosuppression therapy from tacrolimus were enrolled in this study. The patients who were diagnosed as advanced HCC before orthotopic liver transplantation (OLT) were divided into group A (n = 11), those who were found to have HCC recurrence and/or metastasis after OLT were assigned to group B (n = 18), and those who developed renal insufficiency caused by calcineurin inhibitor (CNI) were assigned to group C (n = 7) after OLT. RESULTS: The patients were followed up for a median of 10.4 mo (range, 3.8-19.1 mo) after conversion to SRL therapy and 12.3 mo (range, 5.1-34.4 mo) after OLT. Three patients developed mild acute cellular rejection 2 wk after initiating SRL therapy, which was fully reversed after prednisolone pulse therapy. In group A, only 1 patient was found to have HCC recurrence and metastasis 12 mo after OLT. In group B, 66.7% (12/18) patients (2 with progressive tumor, 7 with stable tumor and 3 without tumor) were still alive due to conversing to SRL and/or resection for HCC recurrence at the end of a median follow-up of 6.8 mo post conversion and 10.7 mo posttransplant. In group C, no HCC recurrence was demonstrated in 7 patients, and renal function became normal after SRL therapy. Thrombocytopenia (n = 2), anemia (n = 8), and oral aphthous ulcers (n = 7) found in our cohort were easily manageable. CONCLUSION: The conversion to SRL-based immunosuppression may inhibit the recurrence and metastasis of HCC and improve CNI-induced renal insufficiency in OLT patients with HCC.

Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases.

BACKGROUND/AIMS: The prognosis ofhepatocellular carcinoma with macroscopic portal vein tumor thrombosis is extremely poor. The risk factors may differ at different postoperative intervals. This study was undertaken to clarify the surgical outcome and time dependency of factors influencing survival in these patients. METHODOLOGY: We analyzed clinicopathological variables of 381 hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis who underwent hepatic resection. Survival rates were calculated using Kaplan-Meier method. The stratified Cox models were used to identify factors independently influencing short- and long-term survival, respectively. RESULTS: The cumulative 1-, 2-, 3-, 5-, and 10-year survival rates in 381 patients were 47%, 23%, 16%, 12%, 6%, respectively. The 1-, 3-, and 5-year survival rates calculated from time of re-resection were 36%, 14% and 0% in patients undergoing re-resection for intrahepatic recurrence within 2 years after first operation, and 85%, 53% and 32% in those more than 2 years after first operation (P<0.05). Multivariate analysis showed that portal vein infusion chemotherapy, serum alpha-fetoprotein > 20 mg/L and positive surgical margin were significant prognostic factors within 2 years after operation. In contrast, alanine aminotransferase > 80 U/L was the only significant factor beyond 2 years after operation. CONCLUSIONS: The survival of hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis was poor, but the prognosis of patients who had tumor recurrence more than 2 years after operation was much better than those with tumor recurrence within 2 years. Evaluation of time-dependency of risk factors may have important clinical implication in determining the therapeutic strategy.

Postoperative interferon alpha treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial.

BACKGROUND/AIMS: Recurrence after resection of hepatocellular carcinoma (HCC) is a frequent event. This study evaluated the effect of postoperative interferon alpha (IFN alpha) treatment on recurrence and survival in patients with hepatitis B virus (HBV)-related HCC. METHOD: Two hundred and thirty six patients were randomized after resection into IFN alpha treatment (5 micro i.m. tiw for 18 months) and control groups. Treatment was terminated if recurrence was diagnosed, and recurrence was managed the same way in both groups. Statistical analysis was based on the method of intent-to-treat. RESULTS: The two groups were comparable in all clinicopathological parameters. The median overall survival was 63.8 months in the treatment group and 38.8 months in the control group (P=0.0003); the median disease-free survival period was 31.2 versus 17.7 months (P=0.142). Fever, leucocytopenia, and thrombocytopenia were adverse effects in the treatment group, but were mostly manageable. CONCLUSIONS: IFN alpha treatment improved the overall survival of patients with HBV-related HCC after curative resection, probably by postponing recurrence.

Dendritic cell infiltration and prognosis of human hepatocellular carcinoma.

AIM: To elucidate the relationship between local immunocompetent cells and prognosis of human hepatocellular carcinoma (HCC) after resection. METHODS: HE staining and immunohistochemical study were carried out on specimens from patients underwent surgical resection. Local immunocompetent cells, such as dendritic cells (DCs), memory T cells, CD3+ T lymphocytes and CD8+ T lymphocytes, were counted and their relationships with tumor-free survival rate were analyzed by grouping DCs with the T lymphocytes retrospectively. RESULTS: The number grade of infiltrating immunocompetent cells in HCC nodules and pericancerous tissues under HE staining had no significant correlation with tumor-free survival time (P=0.054, 0.071, respectively). DCs were mainly among tumor cells, encircling tumor cells with their pseudopodia and were in contact with T lymphocytes. A certain number of DCs in HCC nodules (> or =25/10HPF) statistically correlated to tumor-free survival time (P=0.005), while a certain number of DCs in pericancerous tissues (> or =28/10HPF) had no correlation with tumor-free survival time (P=0.329). The number of memory T cells, CD3+ T lymphocytes and CD8+ T lymphocytes in HCC nodules strongly correlated to tumor-free survival time (P=0.003, 0.005, 0.037, respectively). The tumor-free survival rate curves revealed that the more DCs or together with memory T cells/CD3+ T lymphocytes or that the more CD8+ T lymphocytes were detected in HCC nodules, the better the prognosis would be. CONCLUSIONS: Marked infiltration of DCs in HCC nodules was closely related to the prognosis of HCC after surgical resection and can be served as a predictive index for recurrence and metastasis of HCC.

[Time dependency of factors influencing survival of hepatocellular carcinoma patients with portal vein tumor thrombosis after surgery].

OBJECTIVE: To investigate the surgical outcome of the hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) after surgery and the time-dependency of the factors influencing survival. METHODS: The clinicopathological data of 382 HCC patients with macroscopic PVTT who had undergone resection of HCC were analyzed. The survival rte was calculated using Kaplan-Meier method. Stratified Cox model was used to identify the factors independently influencing the short- and long-term survival rates. RESULTS: The 1-, 2-, 3-, 5-, and 10-year survival rates of the 382 patients were 47%, 23%, 16%, 12%, and 6% respectively. The 1-, 3-, and 5-year survival rates re-calculated from the time of re-resection because of recurrence within 2 years after the first operation were 36%, 14%, and 0% 1 respectively. However, the 1-, 3-, and 5-year survival rates re-calculated from the time of re-resection because of recurrence 2 years after the first operation were 85%, 53%, and 32%, all significantly higher than those re-calculated from the time of re-resection within 2 years after the first operation (all P < 0.05). Multivariate analysis showed that portal infusion chemotherapy, serum alpha-fetoprotein < 20 microg/L and negative surgical margin were significant favorable prognostic factors within 2 years after operation. Alanine aminotransferase > 80 U/L was the only significant unfavorable factor beyond 2 years after operation. CONCLUSION: The prognosis of the patients with macroscopic PVTT who suffer from liver tumor recurrence occurring more than 2 years after the first operation is much better than those with the recurrence occurring within 2 years. Evaluation of the time-dependency of risk factors may have important clinical implication in determining the therapeutic strategy.

[Diagnosis and management for early hepatic artery thrombosis after liver transplantation].

OBJECTIVE: To explore the diagnosis and management of early hepatic artery thrombosis (HAT) after liver transplantation. METHODS: Routine examination of Color Doppler Imagine (CDI) was used to detect hepatic artery flow after liver transplantation in 220 cases from April 2001 to November 2004. Suspected patients were further confirmed by immediate hepatic artery angiography, and continuous infusion of urokinase through hepatic artery with catheter was performed to the patients with HAT. RESULTS: HAT was identified in 6 patients (2.7%), occurring 5.5 days (2 - 19 days) after liver transplantation. Hepatic artery recanalization was obtained in 6 cases. One patient died from lung infection 2 months after liver transplantation. One patient underwent the second liver transplantation because of the recurrence of HAT 6 months after the first transplantation, but died from multiple system organ failure 2 months after the operation. The other 4 cases have been surviving well disease-freely. CONCLUSIONS: CDI is useful for the diagnosis of early HAT after liver transplantation. Contributes to recovery of the hepatic artery flow, continuous infusion of urokinase through hepatic artery with catheter may be the first choice of the therapy for early HAT.