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Surgical resection versus radiofrequency ablation for primary hepatocellular carcinoma of 3-5 cm in diameter: a meta-analysis.

Shuang-Shuang WU ; Min-He SHEN ; Shan-Ming RUAN ; Yi-Ming QI

Journal of Zhejiang University. Medical sciences.2014;43(6):695-705.

OBJECTIVETo compare the therapeutic effects of surgical hepatic resection (HR) and radiofrequency ablation (RFA) in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter.

METHODSThe databases PubMed, CBMdisc, CNKI, WanFang Data and VIP databases were searched for controlled clinical trials on evaluating the efficacy between RFA and HR in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter published from January 1990 to February 2014. Two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the studies included. Then the meta-analysis was performed by using RevMan5.0 software.

RESULTSEleven controlled clinical trials were included, including one randomized controlled trial and 10 non-randomized controlled trials. A total of 811 patients were involved: 404 patients were treated with RFA as the initial treatment and 407 patients with surgical resection. Meta-analysis showed that for a single lesion with diameter of 3-5 cm of primary hepatocellular carcinoma, the 3-， 5-year disease-free survival rates in HR group was significantly higher than those in RFA group (all P<0.05). There were no significant difference in the 1-， 3-， 5-year overall survival rates and 1-year disease-free survival rate between RFA group and HR group (P>0.05). For 1-2 nodules with diameters of 3-5 cm of primary hepatocellular carcinoma, the 3-， 5-year disease-free survival rates and 5-year overall survival rates in HR group was significantly higher than those in RFA group (all P<0.05). No significant difference in 1-， 3-year overall survival rates and 1-year disease-free survival rate was found between RFA group and HR group (P>0.05). For maximum nodule of 3-5 cm of multiple primary hepatocellular carcinoma, the 5-year overall survival rates in HR group was significantly higher than that in RFA group (all P<0.05). No significant difference in 1-， 5-year overall survival rates was noted between RFA group and HR group (P>0.05).

CONCLUSIONFor primary hepatocellular carcinoma of 3-5 cm in diameter, HR is better than RFA. For the limitation of quality and quantity of included studies, this conclusion needs to be confirmed by more high quality studies.

Carcinoma, Hepatocellular ; surgery ; Catheter Ablation ; Controlled Clinical Trials as Topic ; Hepatectomy ; Humans ; Liver Neoplasms ; surgery ; Randomized Controlled Trials as Topic ; Survival Rate ; Treatment Outcome

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Concurrent chemoradiotherapy for locally advanced unresectable extrahepatic cholangiocarcinoma: a report of 19 cases.

Wan-Li YE ; Jian-Fang WANG ; Dong-Ping WU

Journal of Zhejiang University. Medical sciences.2014;43(6):688-694.

OBJECTIVETo evaluate the efficacy and toxicity of concurrent chemoradiotherapy for patients with locally advanced unresectable extrahepatic cholangiocarcinoma.

METHODSThirty-eight patients with locally advanced unresectable extrahepatic cholangiocarcinoma admitted in Shaoxing People's Hospital from February 2007 to February 2012 were enrolled in the study. They were randomized into sequential chemoradiotherapy (n=19) or concurrent chemoradiotherapy group (n=19). All patients were treated with intensity modulated radiation therapy (IMRT). Patients in concurrent chemoradiotherapy group received the regimen of gemcitabine plus oxaliplatin. Tumor response and adverse effects were observed periodically. The primary end points were disease progression-free survival (PFS) and overall survival (OS).

RESULTSThe response rates of sequential chemoradiotherapy and concurrent chemoradiotherapy groups were 42.1% (8/19) and 63.2% (12/19). The disease control rates of them were 78.9% (15/19) and 84.2% (16/19))， respectively. The median PFS of sequential chemoradiotherapy group and concurrent chemoradiotherapy group was 8.3 (95%CI: 7.6-9.0) and 10.4 months (95%CI: 9.4-11.4, P=0.037), and the median OS in two groups were 14.2 (95%CI: 12.6-15.8) and 15.6 months (95%CI: 14.2-17.0, P=0.095), respectively. The major adverse reactions were controllable hematology toxicity and gastrointestinal reaction. There was no significant difference in incidence of adverse reactions between two groups (P>0.05).

CONCLUSIONSequential chemoradiotherapy and concurrent chemoradiotherapy may improve PFS and OS in patients with locally advanced unresectable extrahepatic cholangiocarcinoma, and both are well-tolerated. In addition, concurrent chemoradiotherapy might provide additional PFS benefit and would be preferable.

Bile Duct Neoplasms ; therapy ; Bile Ducts, Intrahepatic ; pathology ; Chemoradiotherapy ; Cholangiocarcinoma ; therapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Humans ; Organoplatinum Compounds ; therapeutic use ; Survival Rate

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Long term survival analysis of primary hepatocarcinoma patients received transcatheter arterial chemoembolization plus chemotherapy after radical resection.

Guang-Ping QIU ; Jie LIU ; Hua FAN

Journal of Zhejiang University. Medical sciences.2014;43(6):683-687.

OBJECTIVETo evaluate the survival of hepatocellular carcinoma (HCC) patients received prophylactic use of transcatheter arterial chemoembolization (TACE) after radical resection.

METHODSOne hundred and forty-three cases of HCC from Ningbo No.2 Hospital were divided into intervention prevention group, chemotherapy prevention group and comprehensive prevention group according to different methods of HCC prevention. All patients were followed-up for more than 5 years after TACE, chemotherapy (FOLPOX4) or TACE+ FOLPOX4. Cox regression model of multiple factors analysis was used for analyzing impact factors on HCC prognosis. Survival rate was compared with Kaplan-meier method.

RESULTSAlpha-fetoprotein (AFP) was negatively correlated with the survival time of patients, as an independent risk factor with the regression coefficient of 0.01 and the relative risk of 1.00. Prevention of postoperative increased survival time of patients with HCC, which was a protective factor. The regression coefficient for comprehensive prevention was -2.37 and the relative risk was 0.07, the weight of comprehensive prevention on lifetime was higher than that of other two prevention methods, followed by TACE prevention group. One-year, 2-year, 3-year cumulative survival rates in comprehensive prevention group were 78.35%， 69.16%， 24.43%， that in TACE prevention group were 76.87%， 62.48%， 24.72%， and that in chemotherapy prevention group were 62.23%， 43.22%， 19.54%， respectively.

CONCLUSIONAFP was negative correlation with the survival time of postoperative HCC patients, monitored which of postoperative HCC patients can provide a reference for effect and prognosis of surgery. Application of TACE in HCC patients with postoperative effective in reducing mortality, which prolong the survival time of HCC patients might be extended further by combined chemotherapy based on its own advantages and disadvantages.

Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms ; therapy ; Prognosis ; Risk Factors ; Survival Analysis

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Application of transient elastography in early prognosis after liver transplantation.

Jian-Hua LIU ; ; Sheng YAN ; ; Shu-Sen ZHENG ;

Journal of Zhejiang University. Medical sciences.2014;43(6):678-682.

OBJECTIVETo evaluate the application of transient elastography in early prognosis of patients after liver transplantation.

METHODSForty-three patients receiving orthotopic liver transplant in our hospital during December 2013 and March 2014 were included in this study. Liver stiffness measurement (LSM) was performed by FibroScan on day 1 (LSM-1) and day 7 (LSM-7) after transplantation. Patients were divided into higher LSM group (LSM>16 kPa) and lower LSM group (LSM<16 kPa). Clinical data and laboratory data were collected and the correlation of LSM with liver and renal function was analyzed.

RESULTSThe number of cases in higher LSM-1, lower LSM-7, higher LSM-7 and lower LSM-7 were 29, 11, 31 and 9, respectively. The cold ischemia time was corrected with LSM-7 (r=0.335, P=0.028), but not with LSM-1 (r=0.037, P=0.812); the length of ICU stay was positively correlated with LSM-1 (r=0.488, P=0.001), but not with LSM-7 (r=0.213, P=0.181). LSM was positively correlated with aspartate aminotransferase, bile acid and creatinine levels. The higher LSM-1 group had longer length of ICU and hospital stay than lower LSM-1 group did (9d vs 7d, P=0.013; 34d vs 23d, P=0.023); and the higher LSM-1 group had higher incidence rate of serious complications than lower LSM-1 group did (78.57% vs 27.59%, P=0.002).

CONCLUSIONThe LSM correlates with the liver function and renal function of liver transplantation recipients, and may have value for assessing early prognosis.

Elasticity Imaging Techniques ; Humans ; Liver Transplantation ; Prognosis ; Treatment Outcome

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Risk factors of persistent thrombocytopenia after adult liver transplantation and prophylactic measures.

Long-Yu CHENG ; ; Jun YU ; ; Wu ZHANG ; ; Song-Feng XIE ; ; Lin ZHOU ; ; Min ZHANG ; ; Sa-Xiao TANG ; ; Lin ZHANG ; ; Shu-Sen ZHENG ;

Journal of Zhejiang University. Medical sciences.2014;43(6):670-677.

OBJECTIVETo investigate the risk factors associated with persistent thrombocytopenia after liver transplantation (LT), and to explore effective measures for prevention.

METHODSOne hundred and twenty-eight adult patients, who received liver transplantation in our hospital between January 2009 and June 2012 and met the inclusive criteria, were enrolled in the study. The clinical data were retrospectively analyzed, including pre-LT spleen volume, main portal vein size, coronary vein size, platelet and white blood cell levels, total bilirubin level and model of end stage liver disease score. The risk factors associated with persistent thrombocytopenia after LT were evaluated by logistic regression analysis. The effect of simultaneous splenic artery coarctation for high risk patients was evaluated with χ2 test.

RESULTSLogistic regression analysis showed that per-LT spleen volume larger than 500 ml (P = 0.012, OR=2.789, 95%CI: 1.249-6.227) and portal vein size beyond 15 mm (P = 0.017, OR = 3.124, 95%CI: 1.230-7.933) were independent risk factors for persistent thrombocytopenia after LT. The incidence rate of persistent thrombocytopenia after LT in patients with or without simultaneous splenic artery coarctation were 16.7% (1/6) and 66.7% (32/48), respectively(P < 0.05).

CONCLUSIONSpleen volume larger than 500 ml and portal vein size beyond 15 mm are risk factors for persistent thrombocytopenia after LT. Simultaneous splenic artery coarctation may reduce the occurrence of persistent thrombocytopenia after LT.

Adult ; Humans ; Liver Transplantation ; adverse effects ; Organ Size ; Portal Vein ; anatomy & histology ; Retrospective Studies ; Risk Factors ; Spleen ; anatomy & histology ; Thrombocytopenia ; epidemiology

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Risk factors of biliary complications after liver transplantation from donation after cardiac death.

Jun YU ; Shang-Fen XIE ; ; Wei-Liang XIA ; Long-Yu CHENG ; Wu ZHANG ; Song-Feng YU ; Min ZHANG ; Shu-Sen ZHENG ;

Journal of Zhejiang University. Medical sciences.2014;43(6):664-669.

OBJECTIVETo analyze the risk factors for biliary complications of liver transplantation from donation after cardiac death (DCD).

METHODSClinical data of 109 patients undergoing liver transplantation from DCD in First Affiliated Hospital of Zhejiang University School of Medicine from October 2010 to October 2013 were studied retrospectively. The risk factors of biliary complications following DCD liver transplantation were analyzed.

RESULTSTwenty-four (22%) patients developed biliary complications after DCD liver transplantation. Univariate analysis showed that biliary complications were associated with warm ischemia time (P<0.001) and length of ICU stay (P=0.013), but not associated with ABO blood types match (P>0.05). Administration of inotropic agents and fatty liver increased the trend of biliary complications. Multivariate analysis demonstrated that warm ischemia time and length of ICU stay were independent risk factors for predicting biliary complications.

CONCLUSIONWarm ischemia time and days of ICU stay are independent risk factors for predicting biliary complications after DCD liver transplantation.

Biliary Tract Diseases ; epidemiology ; Death ; Humans ; Length of Stay ; Liver Transplantation ; adverse effects ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Factors ; Time Factors ; Warm Ischemia ; adverse effects

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Association of microvascular invasion with recurrence and prognosis of patients with small hepatocellular carcinoma undergoing liver transplantation.

Yang-Bo ZHU ; ; Xiao XU ; ; Shu-Sen ZHENG ;

Journal of Zhejiang University. Medical sciences.2014;43(6):658-663.

OBJECTIVETo evaluate the risk factors for recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).

METHODSOne hundred and fifteen small HCC patients, who met Milan criteria (single<5 cm or showing up to three nodules, each of them<3 cm without major vascular invasion or distant metastasis) and underwent LT in our hospital from January 2007 to November 2013, were enrolled in the study. The risk factors for recurrence were analyzed by Cox regression and the influence of the Milan criteria and microvascular invasion (MVI) on the disease-free survival (DFS) and recurrence of patients were assessed with survival analysis and ROC method.

RESULTSNinety-eight out of 115 small HCC patients were included for analysis, the 1-,3-, 5-year overall survival of patients was 91.8%, 80.6%, 79.6% and DFS was 87.8%, 74.5%, 73.5%, respectively. Survival analysis identified that MVI, macro-vascular invasion, exceeding the Milan criteria and pre-transplant down-staging treatment were related to tumor recurrence (P<0.05). Multivariate Cox regression analysis showed that MVI and exceeding the Milan criteria were two independent prognostic indicators for early recurrence of small HCC after LT. The 1-,3-,5-year DFS for 69 patients without MVI and 29 patients with MVI were 92.8%, 85.5%, 85.5% and 75.9%, 55.2%, 48.3%, respectively (P<0.01). The 1-,3-,5-year DFS for 84 patients meeting the Milan criteria and 14 exceeding the Milan criteria were 91.7%, 83.3%, 79.8% and 64.3%, 42.9%, 42.9%, respectively (P<0.01).

CONCLUSIONFor early HCC patients undergoing LT, the presence of MVI would predict tumor recurrence and can be an indicator for the adjuvant treatment or other salvage treatments.

Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Liver Neoplasms ; pathology ; surgery ; Liver Transplantation ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; pathology ; Prognosis ; Risk Factors

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Establishment of prediction model for spontaneous rupture of primary liver cancer.

Jian WU ; ; Rong-Liang TONG ; ; Chao-Feng DING ; ; Jie ZHOU ; ; Xiao-Feng XU ; ; Wei-Lin WANG ; ; Xiao XU ; ; Shu-Sen ZHENG ;

Journal of Zhejiang University. Medical sciences.2014;43(6):652-657.

OBJECTIVETo establish a prediction model for spontaneous rupture of primary liver cancer.

METHODSThe clinical data of 77 patients with spontaneous rupture of primary liver cancer and 95 primary liver cancer patients without spontaneous rupture were collected and compared. The risk factors of spontaneous rupture of primary liver cancer were analyzed with multivariate logistic regression.

RESULTSMultivariate logistic regression analysis revealed that moderate or severe ascites, liver cirrhosis, protrusion of tumor from the liver surface, tumor size ≥ 5 cm were independent risk factors of spontaneous rupture of primary liver cancer. The area under the receiver operating characteristic curve of the established model for spontaneous rupture was 0.862 (P<0.05).

CONCLUSIONThe established model base on the severity of ascites, liver cirrhosis, protrusion of tumor and large tumor size can effectively estimate the risk of spontaneous rupture of primary liver cancer.

Ascitic Fluid ; Humans ; Liver Cirrhosis ; pathology ; Liver Neoplasms ; pathology ; Logistic Models ; Models, Theoretical ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Rupture, Spontaneous

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The current status and prospect of laparoscopic hepatectomy.

Xiu-Jun CAI ;

Journal of Zhejiang University. Medical sciences.2014;43(6):646-651.

Since the first laparoscopic hepatectomy has been reported in 1991, significant improvement has been made in this procedure. Laparoscopic hepatectomy has been applied as an importent procedure for treatment of hepatic diseases. In the paper, we give a review for present advances in the area of laparoscopic hepatectomy based on literature and our own experience, especially in the aspects of indications, surgical technique and the apparatus for hepatectomy.
Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Liver Diseases ; surgery

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Progress on genetic basis of primary aldosteronism.

Hong ZHANG ; Wei GU ; Min-yue JIA

Journal of Zhejiang University. Medical sciences.2014;43(5):612-618.

It has been proven that familial aldosteronism type I is related to 11-beta hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) chimeric genes. In recent years, accumulated evidences indicate that the genetic basis of primary aldosteronism may involve chromosome 7p22 candidate genes, polymorphisms of CYP11B1 and CYP11B2 genes, mutations of ion channel- related KCNJ5, ATP1A1, CACNA1D genes. The article reviews the progress on genetic basis of primary aldosteronism.
Cytochrome P-450 CYP11B2 ; genetics ; Humans ; Hyperaldosteronism ; genetics ; Mutation ; Polymorphism, Genetic ; Steroid 11-beta-Hydroxylase ; genetics

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