MicroRNA (miRNA) is a class of small ( about 22 nueleotides),single-stranded and noncoding RNA molecule.It is demonstrated that miRNAs participate in a wide array of physiologic processes,such as the development of early embryos and organ,cell proliferation,differentiation and apoptosis.MiRNAwhich has abnormal expression in hepatocellular carcinoma is closely related to the occurrence,developmentand metastasis of liver cancer.Liver cancer stem cells may be the root of cancer recurrence and metastasis.Researches have provided clear evidence that some kinds of miRNAs are important regulators in serf-renewal and differentiation of cancer stem cells.Therefore,regulating the expression of miRNAs in hepatoma cells and liver cancer stem cells may be a new approach to treat hepatocellular carcinoma or prevent the recurrence after treatment.

Resection of huge hepatic tumor located at segments Ⅶ and Ⅷ with reservation of segments Ⅴ and Ⅵ is difficult,because the right hepatic vein is easy to be injured during the operation.A male patient with huge hepatic tumor in the right lobe was admitted to the Cancer Hospital of Guangxi Medical University on July 26,2012.The tumor (diameter:14 cm) was located at segments Ⅶ and Ⅷ.The tumor and the whole structure of the liver were three dimensionally reconstructed by using digital medical technology and liver surgery planning system.The right hepatic vein was closely adjacent to the tumor.During the operation,the right Glisson pedicles were occluded intermittently,the liver parenchyma was dissected with cavitron ultrasonic surgical aspirator,and the right hepatic vein was occlued with non-invasive vascular clamp.The tumor was resected completely,with successful preservation of the trunk of right hepatic vein.No blood transfusion was needed,and the blood supply to segments Ⅴ and Ⅵ was not influenced.The patient recovered rapidly and was discharged on postoperative day 14.

Objective:To study the relationship between preoperative serum carbohydrate antigen 19-9 (CA19-9) levels and long-term prognosis after partial hepatectomy in patients with hepatocellular carcinoma (HCC).Methods:The clinical data of 1102 patients with HCC who underwent partial hepatectomy at the Affiliated Tumor Hospital of Guangxi Medical University from January 2012 to December 2017 were retrospectively analyzed. There were 960 males and 142 females, with an average age of 51 years. The X-tile software determined the best cut-off value of CA19-9 to be 55U/ml. The enrolled patients were then divided into the low-level (CA19-9≤55 U/ml, n=956) and high-level (CA19-9 >55 U/ml, n=146) groups. The Kaplan-Meier method was used to analyze survival, and the log-rank test was performed to evaluate survival rates. The prognostic risk factors of HCC were calculated by the Cox proportional hazards model. Results:The 1, 3, and 5-year survival rates for the low-level group were 85.0%, 68.2%, and 60.9%, respectively, which were significantly higher than those of the high-level group of 80.1%, 58.2%, and 47.0%, respectively ( P<0.05) . The 1, 3, and 5-year recurrence-free survival rates of the low level group were 60.5%, 44.6%, and 37.9% respectively, which were significantly higher than those in the high-level group of 53.4%, 33.3%, and 25.1%, respectively ( P<0.05). Cox regression analysis showed that patients with CA19-9 >55 U/ml ( HR=1.323, 95% CI: 1.070-1.636, P=0.010) had a higher risk of recurrence after hepatectomy, while patients with CA19-9 >55 U/ml ( HR=1.511, 95% CI: 1.163-1.964, P=0.002) had a poor prognosis after hepatectomy. Conclusions:Preoperative serum level of CA19-9>55 U/ml was an independent risk factor for survival and recurrence of HCC patients after partial hepatectomy. CA19-9 had a significant predictive value for prognosis of HCC patients who underwent partial hepatectomy.

Objective To investigate the influences in perioperative variations in serum levels of hepatitis B virus (HBV) DNA in patients with HBV-related hepatocellular carcinoma (HCC),and to observe the differences in postoperative recovery of liver function between the antiviral treatment group and the non-antiviral treatment group of patients.Methods From Feb.2012 to Nov.2012,55 patients whose preoperative serum levels of HBV DNA were below the recommended level of antiviral treatment were included into the study.The serum levels of HBV DNA,IL-6,IL-10 and IL-27 preoperatively and on postoperative day 3 were measured.Using the postoperative serum levels of HBV DNA,the patients were divided into 2 groups:the high level group and low level group.Patients in the high level group received antiviral treatment,but the low level group did not.The changes in preoperative and postoperative liver function and other data of the patients were recorded and analyzed by the SPSS 13.0 software.Results (1) The reactivation rate of serum HBV DNA in the HBsAg-positive HCC patients was 45％ (25/55).In patients with a preoperative HBV DNA level ＜ 1 × 104 IU/ml the postoperative HBV reactivation rate was up to 76％ (19/25).(2) Logistic regression analysis showed tumor diameter (P=0.037,0.006) and injecting anhydrous alcohol into the resection margin (P=0.004) were independent risk factors of postoperative HBV reactivation.(3) Postoperative serum IL-10 elevation was associated with HBV reactivation (P=0.001).On the contrary,serum IL-6 level elevation was associated with HBV reactivation (P＜0.01).(4) When compared with the low level group,postoperative serum alanine aminotransferase,total bilirubin and albumin in the high level group showed no significant difference (P＞0.05).Conclusions Hepatectomy could reactivate HBV replication during the perioperative period.A close monitoring of HBV DNA during the perioperative period was necessary,especially in patients with low HBV DNA levels.The tumor diameter and injecting anhydrous alcohol into the resection margin were independent risk factors of postoperative increase in HBV DNA.Changes in serum IL-10 and IL-6 levels after hepatic resection might be related to the elevation of HBV DNA level.In addition,reactivation of HBV did not aggravate damages in postoperative liver function.Antiviral treatment did not promote recovery of liver function in the early stage.

AIM: To investigate the homing effect of immature dendritic cells (iDC) after injection of iDC into the mouse hepatoma treated by microwave ablation and the possibility of stimulating tumor immunity after thermal ablation. METHODS: The model of hepatoma was established with Hepa 1-6 cells injected into the subcutaneous tissue of C57BL/6J mice. The tumors were treated by microwave ablation under different temperatures, and then fluorescent-labeled iDCs (PKH26-DC) were injected into the ablated tumor tissues. The influences of ablation to homing of PKH26-DC, maturation and excitation ability towards T-cell were observed. RESULTS: There were no homing PKH26-DCs and expression of CCR7 in draining lymph nodes in (65?5)℃ and (90?5)℃ ablation groups after intratumoral injection of iDCs. The number of homing PKH26-DCs was 32?8 in (50?5)℃ ablation group vs 21?6 in un-ablated group, and the expression rate of CCR7 was 100% vs 90%. The number of clusters with immunological synapsis was 8-12 in (50?5)℃ ablation group vs 4-6 in un-ablated group under 100-magnification visual field, and the number of lymphocytes in each cluster was 12-25 vs 3-10. CONCLUSION: Thermal ablation of hepatoma under an appropriate temperature level may promote maturing and homing of iDCs and stimulate immunity of lymphocytes.

Objective To investigate the efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC).Methods The clinical data of 30 HCC patients who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2011 to December 2011 were retrospectively analyzed.All patients were divided into the laparoscopic hepatectomy (LH) group (10 patients) and open hepatectomy (OH) group (20 patients) according to the operation patterns and at the ratio of 1 ∶ 2.The degree of cirrhosis,size and location of tumor of the 2 groups were analyzed using the covariance analysis.The student t test was used for analysing the difference of the 2 groups.Results In the LH group,7 patients received laparoscopic nonanatomical liver resection,3 received anatomical resection of the left lateral lobe,no patient was converted to the hand assisted laparoscopic surgery or open surgery.In the OH group,14 patients received non-anatomical liver resection,and 6 received anatomical liver resection.The volume of blood loss of the LH group was (247 ± 235) ml,which was significantly lower than (408 ± 191)ml of the OH group (t =2.199,P ＜ 0.05).The mean postoperative fasting time,postoperative abdominal drainage time and duration of hospital stay of the LH group were (1.9 ±0.6) days,(3.2 ± 1.2) days and (8.9 ± 2.3) days,which were significantly shorter than (3.0 ± 1.6) days,(4.9±1.6)daysand (11.5±2.3)days of the OH group (t=2.149,2.917,2.921,P＜0.05).The levels of alanine aminotransferase (ALT) of the LH group at day 1,3,5 were (228 ± 100)U/L,(143 ± 51)U/L,(85 ±24) U/L,and the levels of aspartate aminotransferase (AST) of the LH group at day 1,3,5 were (196 ± 67)U/L,(90 ± 35) U/L,(46 ± 10) U/L.The levels of ALT of the OH group at day 1,3,5 were (557 ± 401) U/L,(414 ±397)U/L,(217 ± 199)U/L,and the levels of AST of the OH group at day 1,3,5 were (506 ±317)U/L,(178 ± 122) U/L,(71 ± 33) U/L.The time for hepatic function recovery of the LH group was significantly shorter than that of the OH group (t =3.675,3.001,2.073 ; 4.196,2.223,2.272,P ＜ 0.05).All the 30 patients were followed up for 3-15 months.The level of alpha fetoprotein of 1 patient in the LH group was increased at postoperative month 4,and the results of computed tomography showed multiple intrahepatic lesions.The patient was cured by intervention treatment.One patient of the OH group was diagnosed as with tumor recurrence at the resection margins and adjacent hepatic segments.The patient was cured by radiofrequency ablation,with no tumor recurrence.No tumor recurrence or metastasis was observed in the other patients.Conclusion Laparoscopic hepatectomy is a feasible,safe and minimally invasive approach for patients with HCC.

Objective To evaluate the impact of different treatment strategies on patients with hepatocellular carcinoma (HCC) of less than 10 cm but with portal vein tumor thrombus (PVTT),and to investigate the prognostic factors.Methods Between 2003 and 2008,338 HCC patients with PVTT from the Affiliated Tumor Hospital,Guangxi Medical University,were retrospectively studied.These patients were divided into four groups:the conservative treatment group (n =75),the transarterial chemoembolization (TACE) group (n=86),the surgical resection group (n =90) and the surgical resection with postoperative TACE group (n=87).Survival rates were analyzed by the Kaplan-Meier method and differences among groups were compared using the log-rank analysis.The Cox' s proportional hazards model was performed to explore the risk factors of survival.Results The mean survival periods of patients in the four groups were 3.8,7,8.2,15.1 months respectively.There were significant differences in survival rate among the 4 groups.The survival rates at 1-,2-,and 3-year in the surgical resection with postoperative TACE group were 49％,37％ and 19％,which were significantly higher than the other 3 groups (P＜0.05).The 1-,2-,and 3-year survival rates in the surgical resection group were 28％,20％ and 15％ compared with 17.5％,0％ and 0％ in the TACE group.The survival rates were significantly higher after surgical resection than TACE (P＜0.05).The 1-,2-,and 3-year survival rates in the conservative treatment group were 0％.These were the lowest among the four groups (P＜0.05).Univariate analysis indicated that portal vein occlusion by tumor thrombus was a significant predictor of poor prognosis.Multivariate analysis revealed that the strategy of treatment (TACE) and the number of TACE cycles were independent survival predictors for HCC patients with PVTT.Conclusions Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and with good liver functional reserve.Postoperative TACE is necessary in preventing recurrence and prolonging survival in patients who could tolerate chemoembolization.TACE should be recommended as an effective and safe treatment for unresectable HCC patients with PVTT.The treatment provided a significantly better survival than conservative treatment.

Objective To investigate the role of perioperative antiviral therapy with Entecavir for patients with hepatitis B virus related hepatocellular carcinoma (HBV-HCC) with low serum HBV DNA levels.Methods The HVB-HCC patients were randomly divided into 2 groups.Patients in the antiviral group received Entecavir 4 days before hepatic resection while patients in the control group received no antiviral treatment.The serum HBV DNA,liver function,morbidity and length of hospital stay were compared between the two groups.Results Sixteen patients in the control group (n =44) developed HBV reactivation.On the other hand,only 1 patient in the antiviral group (n =44) developed HBV reactivation.Recovery in liver function in the antiviral group was much faster than the control group,especially for glutamic-pyruvic transaminase level.The antiviral group had significantly lower morbidity and shorter total or postoperative hospitalization (all P ＜ 0.05).Conclusions Patients with HBV-HCC with low levels of HBV DNA have a high risk of developing HBV reactivation in the perioperative period.Perioperative antiviral therapy was safe and efficacious in preventing HBV reactivation,improved liver function,reduced postoperative complications and shortened hospitalization.

Objective To analyze the clinical and pathological characteristics of 35 hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT),and to investigate the expressions of CD133,CD90,EpCAM,CK19,VEGF,and C-kit in the tumor tissues.Methods 35 HCC patients with BDTT out of 943 HCC patients who underwent surgical treatment were studied.The expressions of biomarkers in tissue specimens were determined by immunohistochemistry.35 HCC patients without BDTT were selected using the method of stratified sampling as a control group.Results In 19 of 35 patients,the diameters of the primary tumor were less than 5 cm (range 0 ～ 17 cm,average 6.9 ± 0.7 cm).When compared to the control group,most of the primary tumors were moderately to lowly differentiated (33/35,94％ vs 18/ 35,51％),had incomplete capsules (18/35,51％ vs 3/35,8％) and micro vascular invasion (29/35,83％ vs 7/35,20％).The positive expression rates of CD90,EpCAM,CK19,VEGF,CD133,and C-kit in the group of patients with HCC with BDTT and in the control group were 82.9％,77.1％,71.4％,85.7％,80.0％,80.0％ and 57.1％,54.3％,34.3％,65.7％,54.3％,51.4％,respectively.The 1-,2-,3-year postoperative survival rates of the HCC patients with BDTT were 69％,37％,20％ respectively which were worse than the HCC patients without BDTT (1-,2-,3-year postoperative survival rates were 88％,72％,62％ respectively,P ＜ 0.05).Conclusions The prognosis of HCC patients with BDTT was worse than HCC patients without BDTT.The expressions of liver stem cell biomarkers in the tumor specimens of the group of HCC patients with BDTT were higher than the control group.These findings prompt that this kind of HCC originate from liver stem ceils.

Objective To explore the efficacy of postoperative adjuvant transarterial chemoembolization (TACE) on the survival of patients after radical resection for hepatocellular carcinoma (HCC).Methods Between March 2007 and March 2010,229 HCC patients who underwent radical resection were retrospectively studied.Patients who underwent resection alone were used as the control group (138 patients) while those who received post-operative adjuvant TACE was used as the interventional group.In order to balance the covariates between the groups,a matched comparison of the patients was done by selecting patients using the propensity score matching (PSM).Then,the efficacy of adjuvant TACE upon survival was evaluated.Results After PSM,we obtained 67 pairs of patients.The survival time for the interventional and the control groups were 32.1 months and 28.3 months respectively.The survival rates at year 1,2,3 post-resection were 94.0％,84.8％ and 75.3％ in the interventional group versus 83.6％,69.9％ and 61.5％ in the control group respectively.There were no significant differences between the two groups (P =0.062).Univariate analysis showed the serum level of AFP,tumor size,number of tumor,BCLC stage,and adjuvant TACE significantly affected the survival of HCC patients who received radical resection (P ＜0.05).Cox model suggested that AFP≥400 μg/L and tumor diameter ＞ 5 cm were independent risk factors of survival for HCC patients who received radical resection (P ＜ 0.05).Conclusion Postoperative adjuvant TACE had no positive effect on survival,and AFP level ≥ 400 μg/L and tumor size ＞5 cm were independent risk factors of survival of HCC patients who received radical resection.