The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTT）. Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively. Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation： portal vein infusion drug deliver system （PVIDDS）group （n=19） and transcatheter arterial chemoembolization（TACE） group（n=32），and to compare the treatment effect of the two groups. Results The recurrence rate of 1-month, 1-year，3-year， and 5-year after operation in TACE group was 3.1%（1/32），46.9%（15/32），84.4%（27/32）， and 100%（32/32），respectively. And in PVIDDS group, which was 5.3%（1/19），52.6%（10/19），100%（19/19）， and 100%（19/19），respectively. There were no differences in recurrence rate of 1-month, 1-year, and 5-year after operation in two groups（P＞0.05）. Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group（P＜0.05）. There were no differences in medial survival time（17.1 months vs.15.9 months）， survival rate of 1-year（93.8% vs.94.7%） and 3-year（40.6% vs. 36.8%） after operation in TACE group and PVIDDS group（P＞0.05）. Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group（21.9% vs.0, P＜0.05）. The rate of complication in TACE group was lower than that in PVIDDS group（65.6% vs.94.7%，P＜0.05）. Conclusions If the HCC patients with PVTT could endure operation，surgical resection should be considered firstly，furthermore antivirus treatment, improving immune，and chemotherapy should be considered after operation. The effect of TACE is better than PVIDDS.
Objective To evaluate the clinical effectiveness and safety of transcatheter arterial chemoembolization (TACE) combined with argon-helium cryotherapy system (AHCS) for primary hepatic carcinomas (PHC), and to provide references for clinical practice and research. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were searched, and other sources like the relavant references were also retrieved to collect the randomized controlled trials (RCTs) about TACE combiend with AHCS for PHC published by May 1st, 2012. After literature screening, data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria, the meta-analysis was conducted using RevMan 5.1 software. Results A total of 16 RCTs involving 1 467 patients were included. The results of meta-analysis showed: a) The TACE+AHCS group was superior to the TACE alone group in total effective rate, complete necrosis rate, 0.5-, 1-, 1.5-, 2- and 2.5-year survival rates, AFP, CD4 and Th/Ts cells, and there were significant differences (Plt;0.05); and b) The TACE+AHCS group was superior to the AHCS alone group in 0.5-, 1.5-, 2- and 2.5-year survival rates, AFP and Th/Ts cells, and there were significant differences (Plt;0.05). Conclusion Compared with the TACE or AHCS alone, TACE combined with AHCS can improve long-term survival rate and short-term curative effect, and improve PHC patients’ immunity. However, its long-term curative effect and safety still needs to be further verified by more large sample and high quality RCTs.
Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with thermotherapy for primary hepatic carcinoma (PHC), and to provide references for clinical practice and research. Methods The following databases as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched electronically, and the other sources as supplying, such as tracing related references, were also retrieved. Besides, some unknown information was also obtained by communicating with other authors. All randomized controlled trials (RCTs) on TACE combined with thermotherapy versus TACE alone were collected. The literature was screened according to inclusive criteria, data were extracted and the quality of included studies was assessed, and then meta-analysis was conducted using RevMan 5.1 software. Results A total of 17 RCTs with 907 patients were included. Meta-analysis showed that compared with TACE alone, TACE combined with thermotherapy had a significant difference in 1-year survival rate (HR=2.40, 95%CI 1.65 to 3.48, Plt;0.000 01), 2-year survival rate (HR=3.28, 95%CI 1.87 to 5.76, Plt;0.000 1), total effective rate (RR=1.59, 95%CI 1.42 to 1.79, Plt;0.000 1) and improvement rate of life quality (RR=1.79, 95%CI 1.42 to 2.25, Plt;0.000 1). The incidences of myelosuppression and alimentary canal reactions were lower in TACE combined with thermotherapy group than those in TACE alone group, but statistically significance was only found in myelosuppression (RR=0.79, 95%CI 0.69 to 0.92, P=0.001). Conclusion Compared with TACE alone, TACE combined with thermotherapy can improve long-term survival rate and short-term curative effect, ameliorate the quality of life, and tend to reduce the incidence rate of side effects. But its long-term curative effect and more comprehensive safety still needs to be further verified by more large sample and high quality RCTs.
ObjectiveTo systematically review the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with sorafenib and TACE only treating the intermediate or advanced hepatocellular carcinoma (HCC) in Chinese people. MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data for randomized controlled trials (RCT) on TACE combined with sorafenib (TACE combined with sorafenib group) and TACE (TACE alone group) from inception to December 2014 were searched. The literatures and data were screened and extracted. The meta analysis was performed using RevMan 5.1 software. ResultsSix RCTs involving 498 patients with HCC were included. The results of meta analysis showed that the objective response rate[OR=2.28, 95% CI (1.52-3.42), P < 0.000 1] and the disease control rate[OR=6.62, 95% CI (4.12-10.65), P < 0.000 01] were higher, the 1-year survival rate[OR=3.27, 95% CI (2.06-5.22), P < 0.000 01] and 2-year survival rate[OR=4.55, 95% CI (2.28-9.07), P < 0.000 1] were longer, the safety and tolerability of adverse reactions were better in the TACE combined with sorafenib group as compared with the TACE alone group. ConclusionsIn Chinese people, compared with TACE alone group, TACE combined with sorafenib group have higher objective response rate, disease control rate, 1-year survival rate, and 2-year survival rate. However, due to the lower quality of included literatures, these conclusions should be treated cautiously.
ObjectiveTo systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with partial splenic embolization (PSE) for hepatocellular carcinoma (HCC) with hypersplenism. MethodWe searched The Cochrane Library (Issue 11, 2015), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data databases from inception to November 1st 2015, to collect randomized controlled trials (RCTs) about TACE combined with PSE in treating HCC with hypersplenism. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 708 patients were included. The results of meta-analysis showed that: Compared with TACE alone, TACE combined with PSE could significantly improve postoperative CD4 count (MD=6.99, 95%CI 4.60 to 9.38, P<0.00001), CD4/CD8 ratio (MD=0.64, 95% 0.45 to 0.84, P<0.00001), and the rate of half year survival (RR=1.16, 95%CI 1.02 to 1.32, P=0.02), decrease the incidences of spontaneous peritonitis (RR=0.20, 95%CI 0.05 to 0.48, P=0.03) and varices bleeding (RR=0.17, 95%CI 0.04 to 0.68, P=0.01). The two groups had similar incidence of post-embolization syndrome (RR=1.17, 95%CI 0.79 to 1.75, P=0.44). ConclusionTACE combined with PSE is more safe and effective than TACE alone in unresectable HCC with hypersplenism. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale RCTs.
ObjectiveTo investigate the significance of apparent diffusion coefficient (ADC value) for pretrea-tment prediction of short-term treatment effect in patients with hepatocellular carcinoma (HCC) who underwent transca-theter arterial chemoembolization (TACE). MethodsA total of twelve HCC patients with twenty-three HCC lesions who underwent TACE in our hospital from May. 2014 to May. 2015 were enrolled prospectively, to explore the difference between pre-and post-TACE in diameter of tumor, ADC value of HCC lesions, ADC value of liver parenchyma, and analyze the predictive significance of ADC value of HCC lesions for TACE in treatment of HCC. ResultsThere were no statistical difference between pre-and post-TACE in diameter of HCC lesions and ADC value of liver parenchyma (P=0.635, P=0.473), but the ADC value of HCC lesions was higher after TACE than pre-TACE (P=0.003). After TACE, the area of necrosis in HCC lesions was≥50% in 17 lesions (73.9%, good effect group), and <50% in 6 lesions (26.1%, poor effect group). Compared with poor effect group, ADC values of HCC lesions in good effect group were both higher before and after TACE (P<0.050). Area under ROC curve (AUC value) of ADC value in HCC lesions before TACE for predicting the effect of TACE was 0.690 (95% CI:0.510-0.879), with the sensitivity and specificity of 82.3% (95% CI:65.5%-93.2%) and 53.8% (95% CI:25.1%-80.8%) respectively, and the demarcation point for good effect and poor effect was 1.24×103 mm2/s. ConclusionThis preliminary study demonstrates that the ADC value of HCC lesions before TACE may be a useful indicator to predict early response of TACE in treatment of HCC.
Objective To explore the value of iodine overlay image technique based on dual-source CT dual-energy for the diagnosis in the primary hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (TACE). Methods The imaging data of patients with primary hepatocellular carcinoma after TACE treatment from September 2015 to November 2018 were retrospectively analyzed. All patients completed dual-source CT dual-energy examination and digital subtraction angiography (DSA). The imaging data of the patients were analyzed by conventional linear blending images and iodine overlay image. The results of DSA were taken as the gold standard. The data indexes measured by the two imaging methods were compared. The consistency between the two imaging methods and DSA was determined by Kappa statistics. Results A total of 31 patients were included, and 57 nodes were found under DSA examination. The image quality evaluation (P<0.05), sensitivity (95.35% vs. 69.77%), specificity (92.86% vs. 64.29%), accuracy (94.74% vs. 68.42%), positive predictive value (97.62% vs. 85.71%) and negative predictive value (86.67% vs. 40.91%) of iodine overlay images were higher than those of conventional linear blending images. The consistency between conventional linear blending images and DSA was low (Kappa=0.286, P=0.023), and the consistency between iodine overlay images and DSA was excellent (Kappa=0.861, P<0.001). Conclusions Iodine overlay image could avoid the iodide artifact effectively and evaluate the abnormal enhancement quantitatively and qualitatively in patients undegoing TACE. This method could obtain more information to help diagnose in clinical and evaluate the postoperative efficacy of TACE accurately and objectively.
Objective To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) plus transcatheter arterial chemoembolization (TACE) compared with TACE alone, in the treatment of unresectable hepatocellular carcinoma (HCC). Methods The Cochrane Library, MEDLINE, EMBASE, CANCERLIT, CBM, CNKI and VIP were searched electronically. Relevant journals and conference proceedings were also handsearched. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions, and meta-analyses were performed for homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.10 software. Subgroup analyses by frequency of TACE (lt;3 or ≥3 times) were also performed. Results Thirty seven trials, all published in China, involving 2 653 participants were included. The quality of 2 studies was graded B (medium) and that of the other 35 was graded C (low). Meta-analyses showed that TCM plus TACE, compared with TACE alone, could significantly improve survival, tumor response (complete and partial), quality of life and clinical symptoms, and was also associated with a lower incidence of adverse reactions. Subgroup analyses indicated that, patients with less than three TACE had more significant improvement in survival and clinical symptoms, while patients with three or more TACE had more significant improvement in tumor response and quality of life. The incidence of adverse reactions was similar between these two different frequencies of TACE. Conclusions The treatment regimen of TCM plus TACE is superior to TACE alone in patients with unresectable HCC. As the existing data have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.
ObjectiveTo explore the effect of hydroxyapatite nanoparticle (nHAP) on hepatocellular carcinoma (HCC) and its mechanisms. MethodsThe literatures about the effect of nHAP on HCC were reviewed and summarized. ResultsAs a new nanoparticle, nHAP could suppress the DNA synthesis and subsequent division and proliferation of HCC cells through the inhibition of proliferating cell nuclear antigen (PCNA) and telomerase gene expression and increase of intracellular Ca2+. Moreover, nHAP was able to suppress the differentiation and metastases of HCC cells through the effect on the expressions of Paxillin and P130cas and the decrease of expressions of multiple drug resistance gene protein, microvessel density, and vascular endothelial growth factor. Finally, nHAP induced the apoptosis of HCC tumor cells by the regulation of bcl-2 and bax protein expressions. The combined use of nHAP and chemoembolization drugs could enhance the efficacy, prolong drug duration and reduce toxicity. ConclusionnHAP can inhibit the division, proliferation, differentiation, and metastases, and promote the apoptosis of HCC cells and combined use with chemoembolization drugs can enhance the efficacy and reduce toxicity.