In order to rise the efficiency of combined therapy and evaluate the value and status of cryosurgery in advancedstage liver cancer, liquid nitrogen was employed in treating 90 patients with hepatic carcinoma in our department from Nov. 1994 to Dec. 1997. The results revealed that cryotherapy could induce unrecoverable coagulation necrosis of the tumors. The levels of serum AFP decreased after cryosurgery and one patient has been surviving for three years. The authors believe that cryosurgery is an effective method for unresectable lesions of hepatic carcinoma and has a probability in decreasing its postoperative recurrent rate.
【Abstract】ObjectiveTo investigate the perioperative management in hepatectomy using hepatic energy metabolisom for enhancing safety of and improving the survival in patients with primary liver cancer (PLC).MethodsTwo thousands and one hundred fortythree patients with PLC were treated in this hospital from January 1990 to January 2004. The perioperative data, operative approach, postoperative treatment, postoperative clinical course and follow up data were retrospectively analyzed. All patients were divided into two groups: the early period group and the late period group(from January 1997 to January 2004) and comparison was taken between two groups. The preoperative redox tolerance index (RTI), intraoperative hepatopetal blood occlusion of half liver, and postoperative arterial ketone body ratio (AKBR) were investigated and evaluated.Results①The proportion of small PLC and resection rate increased, the morbidity of complications and mortality after hepatectomy decreased, also the survival rate prolonged in the late period group. ②When using RTI as an indicator for selection of hepatectomy, the morbidity of complications decreased from 21.1% to 11.0%, the mortality form 1.6% to 0.3%. ③Comparising hepatopetal blood occlusion of total liver (n=476) with half liver (n=523),the postoperative morbidity of complications and mortality were 25.8% to 11.9% and 2.3% to 0.6% respectively. ④Postoperative AKBR measurements was a reliable indicator to assess the energy status of the liver and liver failure.ConclusionRTI is of potential value in predicting preoperative hepatic functional reserve, hepatopetal blood occlusion of half liver could protect the residual liver function, and postoperative AKBR measuremeant is a simple and accurate means of determining the immediate state of metabolic dysfunctioning in liver resection. The authors propose that perioperative treatment is an important factor in decreasing operative complications and mortality rate after liver resection.
Objective To investigate the variety of telomerase activity in the course of liver cancer development, and the possibility of using telomerase as a marker of HCC. Methods Human liver specimens, comprising 22 HCC and adjacent peritumoral tissues, 12 liver cirrhosistissues, 6 nodulat regenerative hyperplasia (NRH) tissues and 10 normal liver tissues, were examined for telomerase activity by TRAP assay based on PCR. Results Twenty of 22 HCC and 14 of 22 adjacent tissue specimens were positive for telomerase activity with a positive rate of 90.9% and 63.6% respectively. Ten of 12 liver cirrhosis tissues were positive with a positive rate of 83.3%. 5 of 6 NRH were positive with a positive rate of 83.3%. Telomerase activity was negative in 10 normal liver tissues. Conclusion Telomerase may occur in the progress of hepatocarcinogenesis. Telomerase can be used as a tumor marker of HCC.
Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
Objective To investigate the impact of laparoscopic versus. open hepatic resection for liver cancer on clinical rehabilitation and humoral immune function in patients organism. Methods Forty-four patients of laparoscopic and open left-lateral sectionectomy from January 2010 to June 2012 were selected， including 22 patients of laparoscopy group and 22 patients of conventional laparotomy group. The levels of IgG， IgA， IgM， C3， C4， C reactive protein （CRP）， IL-2， IL-6， and TNF-α in peripheral blood of patients on the last day before operation， first day and 5th day after operation were determinated by using ELISA assay. At the same time， the operative time， intraoperative bleeding， hospitalization time， and complications after operation between two groups were compared. Results The postoperative analgesic using time， first time eating， and hospitalization time in laparoscopic group were （1.9±0.8） days， （2.2±0.5） days， and （6.3±1.3） days， respectively， they were shorter than that in conventional laparotomy group （P＜0.05）. The operative time， intraoperative bleeding， complication rate， and mortality in two groups were not significant differences（P＞0.05） . Compared with before operation， the levels of C3， C4， IgA， IgG， IgM， and IL-2 on the first day after oper-ation in two groups were obviusly reduced， the levels of CRP， IL-6， and TNF-α on the first day after operation in two groups were significantly increased. The levels of C3， C4， lgA， IgG， lgM， and IL-2 on the first day after operation in conventional laparotomy group were significantly decreased than that in laparoscopic group （P＜0.05）. On the 5th day after operation， the levels of C3， C4， lgA， IgG， lgM， and IL-2 of laparoscopy group increased， the levels of CRP， IL-6，and TNF-α were reduced，that were no difference compared with before operation. Compared with before operation，the levels of C3， C4， lgA， IgG， lgM， and IL-2 of conventional laparotomy group were still at a low level state， and the levels of CRP， IL-6， and TNF-α were still at a high level state on the 5th day after operation. Conclusions Laparoscopic resection of liver cancer after operation， the patients’ recovery are quickly， and the impact on humoral immune function of laparoscopic radical resection for liver cancer patients is significantly less than that conventional laparotomy.
ObjectiveTo understand the role of metformin on reducing incidence of type 2 diabetes mellitus (T2MD) patients complicated with liver cancer. MethodThe related literatures of metformin treated patients with T2MD complicated with liver cancer at home and abroad in recent years were reviewed. ResultsA large number of epidemiological and clinical data showed that the metformin might prevent the occurrence of the T2MD patients complicated with liver cancer, its mechanism was mainly inhibited the proliferation of hepatoma cells through the ATM-LKB1-AMPK-mTOR pathway, PI3K/Akt/mTOR pathway, or miRNA. The current controversy was the authenticity of the data, the influencing factors included the aging problem and characteristics of metformin user. The prospective study design rigorous remained to be clarified. ConclusionMetformin could reduce the incidence of T2MD patients complicated with liver cancer, and could inhibit the growth of liver cancer cells, which provides a new way of thinking for the comprehensive treatment of liver cancer.
【Abstract】ObjectiveTo construct the eukaryotic expressing plasmid of tumor necrosis factor-related apoptosisinducing ligand（TRAIL），and study its inhibitory effect on hepatic tumor which implanted subcutaneously in nude BALB/c mice.MethodsTotal RNA of U937 cell was extracted, and its extracellular domain (114-281aa) was amplified by RTPCR, then signal peptide was ligated. The recombinant secreting plasmid for TRAIL was constructed successfully which was confirmed by enzyme cleavage identification and sequencing identification. Liver cancer cell (strain No.7402) was implanted subcutaneously in 32 nude BALB/c mice. These mice were randomly divided into two groups: study group and control group. The mice in study group received muscular injection of plasmids for transfection, and the mice in control group received the injection of normal saline at the same time. The size of implanted tumors were measured continuously till the day of sacrificing, tumor cell apoptosis effect was examined by TUNEL method. ResultsIn study group，tumor volume was smaller than that in control group and the bluepurple apoptosis cells were observed under microscope. ConclusionTRAIL plasmid can induce apoptosis of liver cancer cell and can inhibit the growth of liver tumor.
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．
Objective To overview the systematic reviews/meta-analyses of radiofrequency ablation combined with transcatheter arterial chemoembolization for primary liver cancer. Methods We searched China National Knowledge Infrastructure, Wanfang, Chongqing VIP, SinoMed, PubMed, Embase, and Web of Science databases using computers, with a search deadline of December 31, 2022 for systematic reviews/meta-analyses of radiofrequency ablation combined with transcatheter arterial chemoembolization for primary liver cancer. The AMSTAR 2 scale, PRISMA statement, and GRADE grading system were used to evaluate the reporting quality, methodological quality, and evidence level. Results A total of 13 systematic reviews/meta-analyses were included, published from 2011 to 2022. The evaluation results of the AMSTAR 2 scale showed that 4 systematic reviews/meta-analyses were of low quality, while the rest were of extremely low quality, without medium to high quality systematic reviews/meta-analyses. The evaluation results of PRISMA statement showed that the scores of 9 systematic reviews/meta-analyses were 15-21, with certain reporting defects, and only 4 were relatively complete. The GRADE system evaluation of 75 evidence bodies for 9 clinical outcome indicators showed that there was no high quality of evidence, with medium quality accounting for 29%, low quality accounting for 32%, and extremely low quality accounting for 39%. Conclusions Radiofrequency ablation combined with transcatheter arterial chemoembolization can improve the 1-year and 3-year overall survival rates of patients with primary liver cancer with medium quality of evidence. However, its impact on 5-year overall survival rate, recurrence-free survival rate, complications, and whether it is more effective for hepatocellular carcinoma with a diameter of 3-5 cm still require more high-quality clinical research and systematic evaluation to verify.
Objective To explore the effect of Tie-2 small interference RNA (siRNA) treatment in human hepatoma transplanted subcutaneously in nude mice. Methods Tumor cells were implanted in the hind flank of male nude mice of 6 weeks. Tumor-bearing mice were divided into two groups （gene therapy group and control group） and injected intra-tumorally with Tie-2-siRNA/Lipofectamine and saline/Lipofectamine respectively. The tumor volume and weight, serum AFP and microvessel density (MVD) and the histological change of the tumor were tested after gene therapy. Results The growth inhibitory rates in gene therapy group were 26.94%， 53.01% and 68.91% on day 4， 7 and 10 after gene therapy respectively. The tumor volumes of gene therapy group (118.47, 111.57 and 104.59 mm3) were smaller than those of the control group (162.17, 237.46 and 336.41 mm3) respectively (P＜0.01), and the weight of tumor in gene therapy group was lighter than that of the control group 〔(0.89±0.09) g vs (1.24±0.03), P＜0.01〕. The AFP value in gene therapy group was obviously lower than that of the control group 〔(107.66±24.13) ng/ml vs (266.08±50.96) ng/ml, P＜0.01〕. There was significant diference of MVD between the gene therapy group (34.63±4.07) and the control group (81.01±9.44) with the method of immunohistochemitry (P＜0.01). Histopathology in the control group showed that the tumor volumes were bigger, and a high atypic of tumor cells were seen. The main pathological changes in tumor tissue of gene therapy group were necrosis, there were massive necrosis. The apoptosis cells were seen in the both of necrosis and non-necrosis areas in only 2 mice of gene therapy group. Conclusion Tie-2-siRNA inhibits the tumor growth and tumor angiogenesis， and is a possible new approach for liver neoplasm gene therapy.