Hepatocellular carcinoma(HCC)is characterized by a high propensity for vascular invasion,frequently leading to the formation of tumor thrombi,which significantly affect prognosis and therapeutic decision-making.Microvascular invasion(MVI)is a key predictor of postoperative recurrence,whereas the presence of macrovascular tumor thrombus indicates advanced disease.In recent years,notable progress has been made in the standardized diagnosis,preoperative prediction,and individualized treatment strategies for vascular tumor thrombi.The integration of radiomics and biomarkers has markedly improved the accuracy of preoperative MVI prediction,while various neoadjuvant and adjuvant treatment approaches have shown potential in controlling postoperative recurrence.Despite continuous optimization of diagnostic and therapeutic systems,challenges remain,including tumor heterogeneity,the lack of dynamic monitoring tools,and the difficulty in improving survival rates in high-risk patients.This review summarizes recent advances in the field of vascular tumor thrombi in HCC,aiming to provide theoretical support for clinical practice and to promote the development of individualized precision therapy.

Hepatocellular carcinoma(HCC)is characterized by a high propensity for vascular invasion,frequently leading to the formation of tumor thrombi,which significantly affect prognosis and therapeutic decision-making.Microvascular invasion(MVI)is a key predictor of postoperative recurrence,whereas the presence of macrovascular tumor thrombus indicates advanced disease.In recent years,notable progress has been made in the standardized diagnosis,preoperative prediction,and individualized treatment strategies for vascular tumor thrombi.The integration of radiomics and biomarkers has markedly improved the accuracy of preoperative MVI prediction,while various neoadjuvant and adjuvant treatment approaches have shown potential in controlling postoperative recurrence.Despite continuous optimization of diagnostic and therapeutic systems,challenges remain,including tumor heterogeneity,the lack of dynamic monitoring tools,and the difficulty in improving survival rates in high-risk patients.This review summarizes recent advances in the field of vascular tumor thrombi in HCC,aiming to provide theoretical support for clinical practice and to promote the development of individualized precision therapy.

Objective To investigate the early diagnostic value of AI-assisted transvaginal ultrasound combined with serum biomarkers for intrauterine and ectopic combined pregnancy(heterotopic pregnancy,HP)after IVF-ET.Methods This retrospective case-control study included 86 patients diagnosed with HP after IVF-ET at Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2022 and December 2024.Control groups consisted of 86 patients with normal intrauterine pregnancies and 86 patients with simple ectopic pregnancy.All patients were diagnosed through clinical diagnosis,imaging examinations,and surgical confirmation.An AI ultrasound image analysis model and serum markers(hCG,PAPP-A,APA,progesterone,PlGF)were used to jointly assess HP diagnostic efficiency.Diagnostic performance was compared by calculating sensitivity,specificity,positive predictive value,and negative predictive value.Results The AI ultrasound image analysis model's AUC was 0.835,significantly superior to traditional ultrasound(AUC=0.696).Serum hCG and PAPP-A levels were(36,210±9,820)IU/L and(0.81±0.25)μg/mL,respectively.The joint diagnostic AUC was 0.909,with a sensitivity of 94.2％,specificity of 88.4％,positive predictive value of 91.6％,and negative predictive value of 92.8％.Conclusion AI-assisted ultrasound combined with serological markers significantly improves the early diagnostic accuracy of HP,outperforming single methods and providing a reliable clinical tool.

Objective To explore the effect of different needle track management on Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on liver cancer after liver biopsy. Methods A retrospective analysis was conducted on the clinical data of 21 patients with liver cancer who underwent Technetium-99m-macroaggregated albumin (^99mTc-MAA) evaluation and ⁹⁰Y-SIRT after liver biopsy from June 2023 to December 2024. The methods of needle track management, hepatic arteriovenous shunting, and lung shunt fraction (LSF) were recorded. The occurrence of hepatic arteriovenous fistula (HAVF), as well as the corresponding countermeasures were analyzed. Results Among the 21 liver cancer patients, 7 cases (medical glue group) underwent embolization of the needle tract with medical glue (N-butyl 2-cyanoacrylate [NBCA]) immediately after biopsy, and no significant HAVF was observed during the ^99mTc-MAA tests; 14 cases (non-medical glue group) were treated with delayed needle extraction or gelatin sponge particle blocking after biopsy, among which 7 cases developed significant HAVF, and the fistulas were treated with NBCA. The LSF of the medical glue group was significantly lower than that of the non-medical glue group ([7.06±2.33] % vs [12.43±7.73] %, P＝0.037). All 21 patients successfully completed ⁹⁰Y-SIRT. Conclusions Liver biopsy may affect ⁹⁰Y-SIRT by causing iatrogenic HAVF. Immediate NBCA-embolization of the needle tract after biopsy or timely NBCA-embolization of fistulas during ^99mTc-MAA tests may reduce the impact.

Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer death in the world,and its prognosis is poor.Most HCC patients are diagnosed at an advance stage and are not candidates for surgery.Even if the early-stage tumor is resected,HCC patients tend to relapse within 5 years.In the era of targeted therapy and immunotherapy,neoadjuvant therapy has gained increasing attention and recommendation.For HCC patients with high recurrence risk,neoadjuvant therapy refers to preoperative local or systemic therapy,which can reduce tumor burden,remove tiny lesions,widen surgical margin,and reduce the recurrence risk.However,if the neoadjuvant therapy is not optimal,the timing of surgery will be delayed,resulting in disease progression or even loss of the chance for surgery.This article reviews the research progress of neoadjuvant therapy for HCC.

Background and aims:Advanced hepatocellular carcinoma(HCC)with pulmonary metastasis(PM)has a poor prognosis,and optimal treatment strategies remain controversial.This study aimed to compare the long-term outcomes of patients with advanced HCC with PM who were treated with resection of pul-monary metastases versus those treated with targeted therapies combined with immunotherapy.Methods:A retrospective analysis was conducted on the medical records of HCC patients with PM who underwent either pulmonary metastasectomy or immunotherapy combined with targeted therapies at the Eastern Hepatobiliary Surgery Hospital,Changhai Hospital of Shanghai,Fujian Provincial Hospital,and West China Hospital of Sichuan University from September 2013 to October 2022.One-to-one propensity score matching(PSM)was employed to control the influence of potential confounders,and the survival outcomes were compared.Results:A total of 119 HCC patients with PM were included in this study.The overall survival(OS)of patients who underwent pulmonary metastasectomy was significantly longer than that of patients who received immunotherapy targeted combinations(OS:1-year,80.0％vs.59.3％;2-year,31.7％vs.20.3％;3-year,20.0％vs.0;P＜0.001).After PSM,the long-term prognosis of the pulmonary metastasectomy group remained significantly better than that of the immunotherapy combination group(OS:1-year,87.0％vs.69.6％;2-year,34.8％vs.30.4％;3-year,21.7％vs.0;P=0.005).Multivariate analysis revealed that treat-ment allocation(hazard ratio(HR)=2.177,95％confidence interval(CI)=1.068-4.439)and hepatic tumor T stage(HR=2.342,95％CI=1.209-4.538)were independent risk factors for OS.Conclusions:Pulmonary metastasectomy was associated with improved survival compared to immu-notherapy combined with targeted therapies and may represent an optimal treatment option for highly selected HCC patients with resectable PM.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

BACKGROUND: Chemotherapy is a common treatment for advanced hepatocellular carcinoma, but the effect is not satisfactory. The study aimed to retrospectively evaluate the effects of adding all-trans-retinoic acid (ATRA) to infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) for advanced hepatocellular carcinoma (HCC). METHODS: We extracted the data of patients with advanced HCC who underwent systemic chemotherapy using FOLFOX4 or ATRA plus FOLFOX4 at the Eastern Hepatobiliary Surgery Hospital, First Hospital of Jilin University, and Zhejiang Sian International Hospital and retrospectively compared for overall survival. The Cox proportional hazards model was used to calculate the hazard ratios for overall survival and disease progression after controlling for age, sex, and disease stage. RESULTS: From July 2013 to July 2018, 111 patients with HCC were included in this study. The median survival duration was 14.8 months in the ATRA plus FOLFOX4 group and 8.2 months in the FOLFOX4 only group ( P  < 0.001). The ATRA plus FOLFOX4 group had a significantly longer median time to progression compared with the FOLFOX4 group (3.6 months vs. 1.8 months, P  < 0.001). Hazard ratios for overall survival and disease progression were 0.465 (95% confidence interval: 0.298-0.726; P  = 0.001) and 0.474 (0.314-0.717; P  < 0.001) after adjusting for potential confounders, respectively. CONCLUSION ATRA plus FOLFOX4 significantly improves the overall survival and time to disease progression in patients with advanced HCC.
Humans ; Carcinoma, Hepatocellular/drug therapy* ; Retrospective Studies ; Liver Neoplasms/pathology* ; Oxaliplatin/therapeutic use* ; Fluorouracil/adverse effects* ; Disease Progression ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Leucovorin/adverse effects* ; Colorectal Neoplasms/drug therapy*

Objective To obsOrvO thO safOty and OffOct of intraopOrativO cOll salvagO and autologous blood transfusion during cOsarOan sOction with cOntral placOnta prOvia.Methods From April 2015 to March 2016, 25 prOg-nants with cOntral placOnta prOvia diagnosOd by MRI and ultrasound and undOrwOnt sOlOctOd caOsarOan sOction in thO POoplO′s Hospital of WOnzhou wOrO includOd. WhOn thO amount of blood in thO rOcovOry tank was 450 mL or thO obstOtrician rOquirOd, thO wash and rOtransfusion dOvicO was startOd-up. Hb and Hct wOrO mOasurOd bOforO and aftOr thO parturiOnt, and thO blood was rOcovOrOd. ThO blood loss, rOcovOry of blood, blood transfusion, allogOnOic RBC infusion and thO sidO OffOcts aftOr transfusion and 42 d of postpartum wOrO rOcordOd.Results No sOrious complica-tions wOrO rOcordOd in all prOgnants. FivO casOs(20% ) wOrO only rOcovOrOd and thO autologous blood transfusion and transfusion of thO allogOnOic RBC wOrO not carriOd out. In 14 casOs(56% ),only thO autologous blood was rOturnOd to thO puOrpOra. ThO volumO of blood transfusion was 705 mL(430,1 535). Six casOs(24% ) had massivO blOOding during thO opOration,3690 mL(1 900,8 750),and thO autologous blood transfusion volumO was 2939 mL(1 167, 4 206),and thO allogOnOic RBC transfusion was 3.5U(1.5,11.5).Conclusion Autologous blood transfusion can bO usOd safOly in thO caOsarOan sOction of thO cOntral placOnta prOvia, and can rOducO thO allogOnOic RBC transfusion.

Objective To compare the preventive effect on bile duct thermal damage of percutaneous transhepatic cholangial drainage (PTCD) intubation with that of endoscopic nasobiliary drainage (ENBD)intubation,through which cooling liquid is continuously infused,in treating hepatocellular carcinoma (HCC)located close to the hepatic hilum by using percutaneous microwave ablation (PMWA) therapy.Methods The clinical data of 23 patients with HCC that was located close to the hepatic hilum,who were admitted to authors' hospital during the period from September 2013 to September 2016 to receive PMWA,were retrospectively analyzed.Among the 23 patients,PTCD intubation was employed in 12 and ENBD intubation was adopted in 11,and the cooling tube was placed in the bile duct near the tumor.Through the tube 4℃ cooling saline was rapidly and continuously infused,meanwhile PMWA was carried out under the guidance of B-ultrasound.The occurrence of thermal damage of the bile duct,the cooling technique-related complications,and the recurrence of HCC were compared between PTCD ~oup and ENBD group.Results The mean follow-up time was 20 months (3.0-36.0 months),and no operation-related death occurred in all 23 patients.In each group,postoperative biloma occurred in one patient.No obvious cooling techniquerelated complications were observed in PTCD group,but in ENBD group 4 patients (36.36％) developed cooling technique-related complications,including hemorrhage after incision of duodenal papilla (n=1,9.09％) and acute pancreatitis (n=3,27.27％);the difference in the incidence of cooling technique-related complications between the two groups was statistically significant (P=0.037).No statistically significant differences in local recurrence rate,intrahepatic recurrence rate and mortality existed between the two gro ups(P=1.00,P=0.77 and P=0.61,respectively).Conclusion For the treatment of HCC located close to the hepatic hilum with radical PMWA therapy,continuous infusion of cooling liquid through PTCD intubation or ENBD intubation to prevent the thermal damage of the bile duct is clinically feasible and effective,and PTCD intubation method has less technique-related complications than ENBD intubation method.