Objective To state operative details of lip-shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC).Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip-shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge-shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1-,3-,5-year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface.Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.
Objective To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.
ObjectivesTo analyze the average daily medical expenditures for primary liver cancer in China from 2002 to 2011.MethodsThis study employed retrospective survey on multiple centers from 12 provinces and cities in China from 2002 to 2011, based on the continuous data from the Cancer Screening Program in the Urban China Project. The average daily medical expenditures of primary liver cancer patients and influencing factors were analyzed.ResultsA total of 11 045 liver cancer patients from 12 provinces and cities were included, with an average age of 55 and an average duration of hospitalization of 16.76 days. The average daily medical expenditures of liver cancer patients during the 10 years was 1 251 yuan (95%CI 1 236 to 1 266). The average daily medical expenditures was significantly different in regions (1 356 yuan in the east region, 1 209 yuan in the middle region and 1 068 yuan in the west region), types of hospital (1 341 yuan in general hospitals, 1 213 yuan in specialized hospitals) and hospital levels (1 293 yuan in 3A grade hospital, 805 yuan in non-3A grade hospital) (P<0.05). The average daily medical expenditures were 1 253 yuan for stage Ⅰ, 1 169 yuan for stage Ⅱ, 1 167 yuan for stageⅢ and 1 092 yuan for stage Ⅳ (P<0.05). From 2002 to 2011, the average daily medical expenditures of hospitalization increased from 1 079 yuan (95%CI 1 021 to 1 136) to 1 549 yuan (95%CI 1 486 to 1 613), with an average growth rate of 3.69%. Since 2007, a continuous growth was observed. Subgroup analysis suggested there were obvious differences in growth patterns between different regions and hospitals, as well as differences between various treatments.ConclusionsThe average daily medical expenditures of liver cancer in China had been increasing from 2002 to 2011 and there were significant differences between various regions and hospital levels. Combined with data on the change of duration of hospitalization, it can provide reference for the economic evaluation of the nation’s prevention and treatment policies for liver cancer.
【Abstract】ObjectiveTo investigate the effect of high intensity focused ultrasound (HIFU) on the immunity of patients with advanced primary liver cancer (PLC). MethodsForty cases of PLC admitted to our institution from Mar. 2003 to Dec. 2003 were included in this study. Patients were divided into 2 groups and received either HIFU or radiofrequency ablation (RFA) treatment randomly. CD3, CD4, CD8, CD4/CD8, NK, IL-2, TNF were chosen to assess the immune status before and after treatment. The results were compared statistically. ResultsThe survival rate after HIFU was 80.0%, 61.1%, 42.9%, 33.3% at 3 months, 6 months, 9 months and 1 year respectively, which was similar to that after RFA treatment. The changes of immunity parameters of CD3, CD4, CD8, CD4/CD8, NK, IL-2 and TNF were not significant after HIFU treatment. In addition, the differences of those parameters between HIFU group and RFA group were insignificant. ConclusionThere are no detrimental effects on immunity in the early period after HIFU treatment.
31 case of advanced primary liver cancer were treated by using IL-2 and LAK cells in which 15 cases were combined with surgery (group A) and 16 cases were combined with chemotherpy (Group B). 7～14 months follow-up showed: In group A there was no recurence and metastasis, and the cell-mediated immunity was obviously improved. In group B, the average life time was more than 5.84 months, the tumor average diameter dicreased in 10 cases ,and the cee-mediated immunity was also improved. The role of immunotherapy combined with surgery or chemotherapy was discussed.
Objective To study the effects of pcDNA3/AFP/TK/Angio fusion gene targeting therapy for human primary liver cancer in nude mice implanted with SMMC-7721. Methods Human liver cancer cell line SMMC-7721 was implanted subcutaneously in nude mice to establish experiment model. Animals bearing liver cancer were randomly divided into five groups: control group， vector group， GCV (ganciclovir) group， pcDNA3/TK/Angio group; pcDNA3/AFP/TK/Angio group. Different plasmids were directly injected into tumors and GCV was intraperitoneally administrated simultaneously according to different groups. The growth of tumors was observed and the pathology was examined as well. Serum AFP level was measured by radioimmunology, the ultrastructural change of tumor cells was studied by using electron microscopy, the expressions of MVD and VEGF were respectively detected with immunohistochemistry and the cell apoptosis in situ was detected by TUNEL. Results The success rate to establish subcutaneous implanted liver cancer model in nude mice was 100%. The tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/TK/Angio group and pcDNA3/AFP/TK/Angio group were lower than those in control group, vector group and GCV group (P＜0.05) and more apoptosis cells could be observed. While the tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/AFP/TK/Angio group was lower than those in pcDNA3/TK/Angio group (P＜0.05); and apoptosis index was higher than that of the latter (P＜0.05).Conclusion pcDNA3/AFP/TK/Angio fusion gene inhibits the growth of tumor remarkably and becomes a promising new biological agent to treat human primary liver cancer.
Objective To evaluate the impact of transcatheter arterial chemoembolization（TACE） on survival and tumor recurrence in patients with primary liver cancer， provide reference of clinical diagnosis and treatment for the primary liver cancer patients. Methods Two hundred and twenty-two cases of primary liver cancer were divided into TACE group （n=110） and control group （n=110）， TACE was performed after operation in the TACE group， convention treatment was performed after operation in the control group. The survival and tumor recurrence rates were compared between the TACE group and control group. Results The 1-， 2-， and 3-year survival rates were 83.64%， 56.36%，and 42.73% in the TACE group， respectively， which were 65.45%， 40.91%， and 21.82% in the control group，respectively. The differences were statistically significant （P＜0.05）. The 1-， 2-， and 3-year tumor recurrence rates were 20.91%， 54.55%， and 67.27% in the TACE group， respectively， which were 38.18%， 57.27%， and 70.91% in the control group， respectively. The 1-year tumor recurrence rate in the TACE group was significantly lower than that in the control group （P＜0.05）， but the differences of the 2- and 3-year recurrence rates were not statistically significant（P＞0.05）. Conclusions TACE treatment for primary liver cancer patients can increase long-term survival， but can’tdecrease long-term recurrence.
Soluble interleukin-2 recepter(sIL-2R）levels, NK activity and T lymphocyte subpopulation in peripheral blood were determined in 34 cases of primary liver cancer (PLC). The results showed that the mean level of sIL-2R and CD8 in the patients with primary liver cancer were higher than that in health subjects (Plt;0.01or Plt;0.05), NK activity and T lymphocyte subpopulation (CD3,CD4,CD4/CD8) in the patients with primary liver cancer were much lower than that in health subjects (Plt;0.01), sIL-2R levels in stage II, III patients with primary liver cancer were significantly higher than that in stage I (Plt;0.01). The 6-month mortality rate in 3 groups of patients with sIL-2R level ≥1000u/ml, 500-1000u/ml, andlt;500u/ml were 80.0%, 29.4%and 0 respectively. sIL-2R levels were also decreased (Plt;0.05) in patient with primary liver cancer 4 weeks after immune therapy, but the cell-mediated immunity was increased. It suggests that sIL-2R level determination in peripheral blood is a new biological marker for the assessment of the stage, the response to medical intervention, the prognosis and cell-mediated immunity in primary liver cancer.
The serum level of testosterone (T), estradiol (E2) and progesterone (P) in 86 cases with primary liver cancer (PLC) (male：76 cases; female：10 cases) was determined by RIA method. The result showed that for male cases, serum level of T and ratio of T/E２ in operation group and nonoperation group was significantly higher than that in benign hepatic diseases group (BHD group) and normal control group (NC group), but the value of E２ obviously lower than the later two groups. After tumor resection, the level of E2 increased, while serum level of T and value of T/E２ decreased, which had no significant difference as contrasted with BHD group and NC group. The serum level of T,E2 in female PLC group made no difference to BHD group and NC group, but the value of T/E2 much higher than NC group. No obvious changes of the serum level of progesterone can be observed in both male and female cases. Our research showed that high serum testosterone level and low estradiol level may be concerned with PLC. The possibility and importance of sex hormone imbalance on initializing and developing of PLC is suggested.
Objective To systematically review the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy in patients with primary liver cancer (PLC). Methods We electronically searched the following databases including CENTRAL, MEDLINE, EMbase, WanFang Data, CBM, CNKI and VIP to collect randomized controlled trials (RCTs) on the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy vs. hepatectomy alone for PLC from inception to October, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 RCTs involving 951 patients were included. The results of meta-analysis showed that, implanting sustained-release 5-fluorouracil during hepatectomy significantly decreased the total recurrence rates of 1-year and 3-year (1 year: RR=0.48, 95%CI 0.36 to 0.65, Plt;0.000 01; 3 years: RR=0.69, 95%CI 0.50 to 0.96, P=0.03). However, the two groups were alike in decreasing the surem levels of AFP. Besides, the commonly-seen adverse reaction of implanting sustained-release 5-fluorouracil during hepatectomy included abdominal pain and bile leakage. Conclusion Implanting sustained-release 5-fluorouracil during hepatectomy can decrease the 1-year and 3-year recurrence rates of PLC patients, especially for HCC at the early stage. But this conclusion should be interpreted with caution and needs more strictly-designed RCTs with large sample size and enough long follow-up to verify.