ObjectiveTo study the epidemiologic characteristics of primary liver cancer (PLC). MethodsThe literatures about regional distribution and etiologic epidemiology of PLC were reviewed. Results PLC was mainly distributed on caostland in the south-east of China. The main cause of PLC was hepatitis B virus, aflatoxin and contamination of drinking water. Otherwise, PLS was also related with lack of some trace element, sex horemones, genealogy cause and so on.Conclusion The genesis of PLC was by multiple factors.
【Abstract】ObjectiveTo evaluate the value of MR imaging with a contrast-enhanced multi-phasic isotropic volumetric interpolated breath-hold examination (VIBE) in diagnosis of primary liver carcinoma. MethodsThirty-two consecutive patients with surgical-pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two-dimensional (2D) T1WI and T2WI images were acquired before administration of Gd-DTPA for contrast enhancement. Then, contrast-enhanced multi-phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non-enhanced T1WI, enhanced T1WI and enhanced 3D-VIBE images (P＜0.05). The hepatic arterial anatomy of 30 patients （93.8%） and the portal venous structure of 31 patients （96.9%） were clearly depicted on enhanced 3D-VIBE images. Using MIP and MPR reconstruction techniques, the feeding arteries of 14 foci and draining vein of 12 foci were clearly displayed.ConclusionHigh-quality 3D-VIBE images are not only better than 2D images in lesion detection and characterization for primary liver carcinoma, but also able to provide much more information about hepatic vascular anatomy.
ObjectiveTo investigate the expression of gasdermin (GSDM) gene family in primary liver cancer and its clinical significance. MethodsThe Gene Expression Profile Data Dynamic Analysis (GEPIA2) database was used to analyze the expression levels of GSDM gene family in primary liver cancer and normal tissues, and survival analysis was performed to explore its relationship with prognosis; GEPIA2 database was used to explore the relationship between GSDM gene family and TNM staging of patients with primary liver cancer. We used GeneMANIA database to predict genes that may interact with GSDM gene family, and used Metascape website for functional enrichment analysis. Finally, we used TIMER database to explore the relationship of expression of GSDM gene family and immune cell infiltration in the tumor microenvironment of primary liver cancer. ResultsCompared with normal liver tissues, GSDMA, GSDMC, GSDMD, and GSDME were highly expressed in primary liver cancer (P<0.050), and GSDMB and DFNB59 were low expressed (P<0.050); results of univariate Cox proportional hazard regression model showed that the differential expressions of GSDMD, GSDME, and DFNB59 were related to the overall survival of patients (P<0.050), and the results of the multivariate Cox proportional hazard regression model showed that GSDME could be used as an independent predictor of the prognosis of liver cancer patients (P<0.050). With the increase of TNM staging in patients with liver cancer, the expressions of GSDMA and GSDMC also gradually increased (P<0.050). Further enrichment analysis showed that the GSDM gene family was involved in pyrolysis and various immune-related biological processes. ConclusionThe GSDM gene is differentially expressed in primary liver cancer, participates in immune-related biological processes, and its expression is related to clinicopathological staging and patients’ prognosis.
ObjectiveTo systematically review clinical value of des-γ-carboxy prothrombin (DCP) in the diagnostic of primary hepatocellular carcinoma (PHC).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Medline (Ovid), CNKI, VIP, WanFang Data and CBM were electronically searched to collect relevant studies on DCP in the diagnosis of PHC from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software and RevMan 5.3 software.ResultsA total of 50 studies involving 15 099 cases were included. The results of meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio and area under the curve of SROC were 0.69 (95%CI 0.67 to 0.70), 0.89 (95%CI 0.89 to 0.90), 7.35 (95%CI 6.08 to 8.90), 0.31 (95%CI 0.27 to 0.35), 26.63 (95%CI 20.42 to 34.73) and 0.909 9, respectively.ConclusionsSerum DCP has higher diagnostic efficacy for PHC, especially with higher specificity of diagnosis. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
ObjectiveTo explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio (GPR) and overall survival (OS) of patients with hepatitis B virus-associated hepatocellular carcinoma (Abbreviated as “patients with HCC”), and to establish a nomogram for predicting OS. MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital, from January 15, 2012 to December 15, 2018, were retrospectively analyzed. The optimal critical value of GPR was determined by receiver operating characteristic curve, then the patients were divided into a low GPR group (GPR was optimal critical value or less ) and high GPR group (GPR was more optimal critical value). The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients. The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC. According to the risk factors of OS for patients with HCC, a nomogram was established. The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated. ResultsA total of 213 patients were gathered. The optimal critical value of GPR was 0.906. There were 114 patients in the low GPR group and 99 patients in the high GPR group. The Kaplan-Meier survival curve analysis showed that the 1-, 3- and 5-year accumulative OS rates were 99.1%, 81.8%, 60.6% in the low GPR group, respectively, which were 74.2%, 49.1%, 35.7% in the low GPR group, respectively. The OS curve of the low GPR group was better than that of the high GPR group (χ2=25.893, P<0.001). The multivariate analysis results showed that the microvascular invasion, incomplete capsule, intraoperative bleeding ＞1 000 mL, postoperative complications, GPR >0.906, low tumor differentiation, and late TNM stage did not contribute to accumulative OS in the patients with HCC (P<0.05). The consistency index (95%CI) of the nomogram in predicting accumulative OS rates at 3- and 5-year for patients with HCC were 0.761 (0.739, 0.783) and 0.735 (0.702, 0.838), respectively. The calibration curves of 3- and 5-year accumulative OS rates of the nomogram were in good agreement with the actual results. ConclusionsPreoperative GPR is associated with OS, and patients with higher GPR have worse prognosis. The nomogram based on GPR has a good accuracy and differentiation.
Selectionofandinfluenceofseveralhepatovascularocclusionsonintraoperativeandpostoperativefactorswereinvestigatedinaseriesofhepatocelluarcarcinoma(HCC)patientsundergoingliverresection.Comparisonandstatisticalanalysisofseveralobservationindexeswerecarriedoutin163HCCpatientsexperiencingliverresectionwithdifferentvascularocclusions,versus65caseswithoutvascularocclusions,whichselectedfromourhospitalduringthesameperiodoverthepast5years.Results:Hepatovascularocclusionsproducedsomeliverparenchymainjury,althoughcontrollingintraoperativebleeding.Inthestudy,advantagesanddisadvantagesofthreehepatovascularocclusionsweredemonstrated,including:①simplicityandconvenienceinportaltriadclamping(PTC);butocclusiontimelimitedandresultinginsevereliverfunctioninjury;②widerliverfunctioninjuryandquickerrecoverydespitelongerocclusioninhemihepaticvascularocclusions(HVO);③limitedapplicationofnormothermichepaticvascularexclusion(NHVE)forwastetimeandcomplexity.WeconcludethatHVOisrecommendedasthefirstselectionformostliverresection,exceptportalandcentraltumors.
Objective To formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma. Methods The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal. Conclusion The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.
【摘要】 目的 探讨三维适形放疗(3DCRT)联合介入栓塞化疗(TACE)治疗Ⅲ、Ⅳ期原发性肝癌的方法和临床价值。 方法 回顾性总结2006年6月-2008年12月采用3DCRT联合TACE治疗原发性肝癌的临床资料40例。 结果 3DCRT联合TACE治疗Ⅲ、Ⅳ期原发性肝癌有效率为85%。0.5、1、2年局部控制率分别为92%、70%、52%。0.5、1、2年生存率分别为75%、46%、30%，治疗不良反应轻微。 结论 3DCRT联合TACE能提高原发性肝癌患者生活质量，延长生存期,是治疗中晚期原发性肝癌的有效治疗方法之一。【Abstract】 Objective To investigate the application and clinical value of three-dimensional conformal radiation therapy (3DCRT) combined with transcatheter arterial chemoembolization (TACE) on stage Ⅲ and Ⅳ primary hepatic carcinoma. Methods A Total of 40 cases of stage Ⅲ and Ⅳ primary hepatic carcinoma treated by 3DCRT combined with TACE from June 2006 to December 2008 were analyzed retrospectively. Results The response rate was 85%. The 0.5-, 1-, and 2-year local response rates were 92%, 70%, and 52%, and the 0.5-, 1-, and 2-year survival rates were 75%, 46%, and 30%, respectively. The adverse reactions of radiotherapy were tolerable. Conclusion 3DCRT combined with TACE could improve prognosis of stage Ⅲ and Ⅳprimary hepatic carcinoma.
Objective To improve the prognosis of primary liver cancer with portal vein tumor thrombus （PVTT）， the progress of treatment for primary liver cancer with PVTT was reviewed. Methods The therapeutic approach and its efficacy for primary liver cancer with PVTT were summarized by literature search within recent years. Results PVTT is a common complication of primary liver cancer， the therapeutic approach are surgical resection， transcatheter arterial chemoembolization (TACE), intraportal venous therapy， radiotherapy， ablation therapy, molecular targeted therapy， etc. The excision rate for primary liver cancer with PVTT is low， the treatment is difficult and the outcome is dismal. It remains a poor prognosis at present， and the therapeutic effect need to be promoted. Conclusions The main treatment for primary liver cancer with PVTT should be surgical excision combine with other multidisciplinary comprehensive treatment to improve the survival in patients with PVTT， moreover， the therapeutic approach should be individualized and sequentially according to the patient’s condition and the type of PVTT.