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Prognosis and management of recurrent primary clear cell carcinoma of liver

Tao LI ; Jia FAN ; Lunxiu QIN ; Jian ZHOU ; Sanyuan HU ; Xuting ZHI ; Zhaoyou TANG

Chinese Journal of Hepatobiliary Surgery.2013;19(10):742-745. doi:10.3760/cma.j.issn.1007-8118.2013.10.006

Objective To evaluate the prognosis and management of recurrent primary clear cell carcinoma of liver (PCCCL).Methods 214 patients with PCCCL treated by curative resection from January 1996 to March 2006 were retrospectively studied.Tumour recurrences were classified into early (≤1 year) and late (＞1 year) recurrences.Results Of 99 patients who developed recurrences,28 developed early recurrence while 71 developed late recurrence.The patients with recurrences were treated with re-resection (n=33),percutaneous ethanol injection (PEI,n=7),radiofrequency ablation (RFA,n=10),transcatheter arterial chemoembolization (TACE,n =27),systemic chemotherapy (n=1),Chinese medicine (n=1),and conservative management (n=20).The re-resection rate was higher in the late than in the early recurrence group (P=0.04).In this study,reresection,PEI,and RFA were considered as curative therapies.There was no significant difference in the overall survival (OS) for patients who received these different curative therapeutic procedures (P=0.68).The 1,3-,and 5-year OS of patients with recurrences who were treated with curative treatment were comparable to those patients who did not develop recurrences (100％,86.0％,63.5％ vs 85.2％,72.2％,64.3％,P=0.71).The 1-,3-,and 5-year OS of patients who received TACE for recurrences were 100％,66.7％,and 44.4％ respectively.The results were poorer than patients who received curative treatment for recurrences (P=0.03),but were better than those who received conservative management after recurrences (80.0 ％,25.0 ％,and 10.0 ％,P＜ 0.01).Conclusions Reresection,PEI and RFA are optimal curative methods for recurrent PCCCL.TACE plays an important role in the management of patients with recurrent PCCCL who cannot be treated with curative methods.

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Analysis of VEGF and TGF-β1 in time-phased rat liver regeneration

Jiebin PAN ; Zuoyi JIAO ; Donghong ZHANG ; Youcheng ZHANG

Chinese Journal of Hepatobiliary Surgery.2013;19(10):767-770. doi:10.3760/cma.j.issn.1007-8118.2013.10.013

Objective To explored vascular epithelium growth factor (VEGF) and transforming growth factor-β1 (TGF-β1) expression profiles in rat liver regeneration after selective portal vein embolization (SPVE).Methods The SPVE model was constructed by embolization of the left portal vein and regenerative liver tissues were collected in postoperative days 1-9.Fifty of the SD rats were divided into the SPVE group (45 rats) and control group (5 rats).The expressions of VEGF and TGF-β1 in regenerative rat liver tissues were detected with immunohistochemistry and Western blot.The relationship between VEGF/TGF-β1 and time-phased rat liver regeneration was analyzed.Results In the SPVE group compared to the control group,the expression of VEGF increased from post operative day 1 to 5,peaking at day 5.The expression of TGF-β1 increased from post operative day 3 to 7,peaking at day 7.Conclusions The results suggest that after SPVE,VEGF fluctuation may correlate with the start of hepatic regeneration,and TGF-β1 fluctuation may correlate with the termination of hepatic regeneration.

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Effect of silence S100A4 mRNA by RNA interference on radiosensitivity of the pancreatic cancer cell lines

Peng LI ; Jiangwei LIU ; Fang YUAN ; Wenjun LI ; Fang ZHAO

Chinese Journal of Hepatobiliary Surgery.2013;19(10):777-781. doi:10.3760/cma.j.issn.1007-8118.2013.10.015

Objective To investigate the siRNA interference of S100A4 mRNA of human pancreatic cancer cell radiosensitivity.Method Cultured human pancreatic BxPC-3,AsPC-1 in vitro,logarithmic phase cells as the experimental object,were divided into three groups:normal control group (without any treatment),negative control group (transfected with negative control fragment),interference group (transfected S100A4 protein fragment siRNA),the chemical synthesis siRNAS100A4 fragment interference of S100A4 mRNA 0,1,2,3,5,7,10 Gy given 6MV X-ray irradiation,the use of clone formation assay,Giemsa stained colony formation rate is calculated and SF2,and the fitting cell survival curve.Results The siRNA interference S100A4 after BxPC-3 cells SF2 value are:the control group 0.68±0.02,negative control group 0.65±0.01.interference group,0.38±0.02,P＜0.05.AsPC-1 cells SF2 value:control group 0.48±The0.02,negative control group 0.47±0.02; interference group:0.37±0.04,P＜0.05.Conclusion siRNA interference S100A4 after increased radiosensitivity of human pancreatic cancer cell lines.

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Research progress of liver regeneration after partial hepatectomy

Long YANG ; Yamin ZHANG ; Zhongyang SHEN

Chinese Journal of Hepatobiliary Surgery.2013;19(10):786-789. doi:10.3760/cma.j.issn.1007-8118.2013.10.018

Partial hepatectomy (PH) is widely used and the preferred method for the surgical treatment of hepatocellular carcinoma,and liver regeneration is directly related to the prognosis of the patients after the operation.Therefore,the specific mechanism and cytokines related to liver regeneration have become a hot topic in recent years.Currently,there is a wide variation of reported gene expressions and signal transduction pathways in the literature,but the mechanism and interactions are still unclear,especially for postoperative liver regeneration with hepatitis or cirrhosis.This review summarizes current research on the liver regeneration process,the mechanism of liver regeneration after partial hepatectomy,and the different mechanisms of hepatocirrhosis.

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Expression of sirtuin in hepatocellular carcinoma and its clinical significance

Chong HAO ; Lixin WEI

Chinese Journal of Hepatobiliary Surgery.2013;19(10):789-793. doi:10.3760/cma.j.issn.1007-8118.2013.10.019

Hepatocellular carcinoma (HCC) development is closely related to overexpression of tumor promoters or down-regulation of tumor suppressors.The mammalian sirtuin family was found to be a nicotinamide adenosine dinucleotide (NAD/NADH)-dependent histone deacetylase (HDAC),which implicated in the regulation of critical biological processes through deacetylation modifying on histone and nonhistone.SIRT1 can regulate metabolism,aging,inflammation and cancer progression.In particular,more and more evidence proves that SIRT1 can act as a tumor promot er in hepatocellular carcinoma through deacetylation on tumor suppressors.On the other hand,SIRT1 can strongly suppress metabolic syndrome-associated liver cancer in the mouse model.This review will discuss the expression of sirtuin family member in liver cancer and its clinical significance.

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The application of diffusion-weighted magnetic resonance imaging in evaluating the therapeutic efficacy of hepatocellular carcinoma intervention

Maozhen CHEN ; Ting QIAN ; Huabin YIN

Chinese Journal of Hepatobiliary Surgery.2013;19(10):793-795. doi:10.3760/cma.j.issn.1007-8118.2013.10.020

Magnetic resonance diffusion-weighted imaging (MR-DWI) is a functional technology at the molecular level.Compared to other imaging exams (such as DSA,CT,US),DWI is non invasive,has no radiation,and objective.Thus,it is widely accepted in clinical settings.As a means to assess the therapeutic efficacy of intervention,DWI has a promising prospect.In this article,we review the application of MR-DWI in evaluating the therapeutic efficacy of hepatocellular carcinoma intervention.

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CT angiography in the detection of aberrant hepatic arteries before pancreaticoduodenectomy

Feng YANG ; Chen JIN ; Qiang WANG ; Ji LI ; Yang DI ; Yongjian JIANG ; Deliang FU

Chinese Journal of Hepatobiliary Surgery.2013;19(9):645-648. doi:10.3760/cma.j.issn.1007-8118.2013.09.002

Objective To assess the value of multi-slice computed tomography angiography (MSCTA) in the preoperative detection of aberrant hepatic arteries in patients scheduled to undergo pancreaticoduodenectomy.Methods Patients with pancreatic and peri-ampullary tumors were preoperatively studied using contrast-enhanced abdominal CT angiography (CTA).The results on hepatic arterial anatomy were compared with those obtained from digital subtraction angiography (DSA) and on surgical findings.Results Eighty-one patients were included into this study.DSA was carried out in 29 patients to evaluate tumor resectability,and 66 patients received surgery.Anomalous hepatic arteries were detected in 17 (21％) patients on CTA.Thirteen (16.0％) patients had a single arterial variant,and 4 (4.9％) patients had two arterial variants.One patient each was seen in the Michels type Ⅳ,Ⅶ,and Ⅷ respectively,while 2 patients each were seen in the Michels type Ⅲ and Ⅴ respectively.Five patients were diagnosed as the Michels type Ⅵ,and four as the Michels type Ⅸ.One patient demonstrated a rare variant which was not included into the Michels classification.MSCTA had an accuracy of 100％,a sensitivity of 100％,and a specificity of 100％.Regarding the traceability scores of hepatic arterial segment,there were no statistically significant differences between MSCTA and DSA.Conclusions MSCTA is an effective imaging tool to assess arterial anatomical variation around the pancreatic head.It is non-invasive,and it provides valuable information on the peri-pancre atic vascular anatomy before pancreaticoduodenectomy.

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Right hepatic resection for large hepatocellular carcinoma using the anterior approach versus the conventional approach: a Meta-analysis

Jian DONG ; Ying ZHU ; Xinglong ZHENG ; Zhida LONG ; Muxing LI ; Yi Lü

Chinese Journal of Hepatobiliary Surgery.2013;19(9):649-653. doi:10.3760/cma.j.issn.1007-8118.2013.09.003

Objective To compare the results of the anterior approach (AA) with the conventional approach in the treatment of large hepatocellular carcinoma (HCC).Methods We searched the Medline,PubMed,Cochrane Library,Wanfang database on randomized clinical controlled trials and non-randomized clinical controlled trials comparing AA with the CA in right hepatic resection for large hepatocellular carcinoma.The data were analyzed with the RevMan5 software.Results Five non-randomized clinical controlled trials (NRCTs) and three randomized clinical controlled trials involving 615 patients (304 in the AA group,311 in the CA group) were enrolled into the analysis.There was no significant difference in the operation time between the two groups.Compared with the CA,the AA had lower intraoperative blood loss (WMD=-680.2 ml; 95％CI,-1023.97～-336.43;P=0.0001),blood transfusion rate (OR=0.38;95％ CI,0.25～0.59;P＜0.0001),intraoperative tumor rupture (OR=0.33;95％CI,0.11～0.97;P=0.04),surgical complication (OR=0.59;95％CI,0.38 ～ 0.93 ; P =0.02),hospital mortality (OR =0.37 ; 95 ％ CI,0.21 ～ 0.67 ; P =0.0009),and hospital stay (WMD=-4.75 d;95％CI,-7.82～-1.67;P=0.002).Conclusion AA is superior to CA in the treatment of larger.The operation time is the same for the 2 approaches.

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Risk factors of post-pancreaticoduodenectomy complications

Lei YU ; Qiang HUANG

Chinese Journal of Hepatobiliary Surgery.2013;19(9):691-695. doi:10.3760/cma.j.issn.1007-8118.2013.09.013

Objective To investigate the risk factors of post-pancreaticoduodenectomy complications.Methods The clinical data of 207 patients with pancreatic carcinoma or peri-ampullary carcinoma who underwent pancreaticoduodenectomy at the Anhui Provincial Hospital from Dec.2007 to Dec.2012 were studied.Seventeen clinicopathologic factors to correlate with the postoperative mortality and methods were selected for univariate analysis and multivariate analysis using logistic regression.Results Univariate analysis showed the major risk factors of postoperative mortality and morbidity were a history of previous operation,pre-operative drainage,total serum bilirubin level,alanine aminotransferase level,serum albumin level,serum pre-albumin level,parenchyma texture and pancreatic duct diameter (P＜0.05).Multivariate analysis showed alanine aminotransferase level,parenchyma texture and pancreatic duct diameter were independent risk factors of postoperative complications.Pancreatic duct diameter was the independent risk factor of pancreatic fistula.Pancreatic fistula was the independent risk factor of hemorrhage.Conclusion The postoperative complications of pancreaticoduodenectomy was closely related to alanine aminotransferase level,parenchyma texture and pancreatic duct diameter.

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Effects of the dominant negative form of protein phosphatase 2A catalytic subunit α driven by alpha-fetoprotein enhancer/phosphoglycerate kinase promoter on hepatoma cell xenografts

Feiran GONG ; Wei LI ; Kai CHEN ; Min TAO ; Daoming LI ; Zekuan XU

Chinese Journal of Hepatobiliary Surgery.2013;19(9):696-700. doi:10.3760/cma.j.issn.1007-8118.2013.09.014

Objective To investigate the effects of AFP enhancer/pgk promoter driven expression of the dominant negative form of the PP2A catalytic subunit α (DN-PP2Acα) in vivo.Methods The previously constructed AFpg promoter-driven DN-PP2Acα was recombined into an adenovirus,and the expression of PP2Ac was tested using Western blot.Cell growth was tested using the MTT and flat plate clone formation assays.In vivo studies were performed in tumor xenograft models.Results AFpg promoter-driven expression of DN-PP2Acα exerted cytotoxic effects against the AFP-positive human hepatoma cell line HepG2,but did not affect AFP-negative human hepatoma cells (SKHEP-1) or normal human liver cells (L-02).Moreover,AFP enhancer/pgk promoter driven expression of DN-PP2Acα inhibited the growth of AFP-positive HepG2 tumors in nude mice bearing solid tumor xenografts,but did not affect AFP-negative SK-HEP-1 tumors.Conclusion The recombinant AFP enhancer/pgk promoter-driven DN-PP2Acα expression adenovirus presented selective cytotoxicity against AFP-positive hepatoma cells and provides a useful gene therapy strategy to selectively target hepatocellular carcinoma.

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