Conversion therapy of a giant hepatocellular carcinoma with portal vein thrombus and inferior vena cava thrombus:A case report and review of literature

BACKGROUND The prognosis of hepatocellular carcinoma(HCC)combined with portal and hepatic vein cancerous thrombosis is poor,for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC,with a median survival time of only about 2.7-6 months.In this case report,we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.CASE SUMMARY In our center,a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization(TACE),radiotherapy,targeted therapy and immunotherapy,and was continuously given icaritin soft capsules for oral regulation.After 7 months of conversion therapy,the patient's tumor shrank and the tumor thrombus subsided significantly.The pathology of surgical resection was in complete remission,and there was no progression in the postoperative follow-up for 7 months,which provided a basis for the future strategy of combined conversion therapy.CONCLUSION In this case,atezolizumab,bevacizumab,icaritin soft capsules combined with radiotherapy and TACE had a good effect.For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus,adopting a high-intensity,multimodal proactive strategy under the guidance of multidisciplinary team(MDT)is an important attempt to break through the current treatment dilemma.

International consensus statement on robotic hepatectomy surgery in 2018

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Effect of c-fos antisense probe on prostaglandin E_2-induced upregulation of vascular endothelial growth factor mRNA in human liver cancer cells

AIM: To examine the effect of prostaglandin E2 (PGE2) on the expression of vascular endothelial growth factor (VEGF) mRNA in the human hepatocellular carcinoma (HCC) HepG2 cells and the possible involvement of c-fos protein in this process.METHODS: Human HCC HepG2 cells were divided into three groups treated respectively with PGE2, a combination of PGE2 and c-fos antisense oligodeoxynucleotide (ASO),and PGE2 plus c-fos sense oligodeoxynudeotide (SO). The expression of VEGF mRNA in HepG2 cells after different treatments was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). The relative expression level of VEGF mRNA in HepG2 cells in each group was measured.RESULTS: Administration of PGE2 resulted in an increased expression of c-fosand VEGF mRNA in HepG2 cells. The relative expression level of c-fos mRNA reached the peak at 3 h (68.4±4.7%) after PGE2 treatment, which was significantly higher than that at 0 h (20.6±1.7%, P＜0.01).Whereas, the highest expression level of VEGF mRNA was observed at 6 h (100.5±6.1%) after PGE2 treatment, which was significantly higher than that at 0 h (33.2±2.4%,P＜0.01). C-fos ASO significantly reduced PGE2-induced VEGF mRNA expression in HepG2 cells.CONCLUSION: PGE2 increases the expression and secretion of VEGF in HCC cells by activating the transcription factor c-fos, promotes the angiogenesis of HCC and plays an important role in the pathogenesis of liver cancer.

Palliative operation procedures for pancreatic head carcinoma

Objective: To investigate the procedure choice of pal-liative operation for carcinoma of the head of the pan-creas (CHP).Methods: The clinical data from 187 patients withCHP treated in the last 20 years were analyzed retro-spectively.Results: The operation mortality rate was 8.6%, themortality of hepatic duct-jejunostomy (HDJS) was nothigher than that of cholecystojejunostomy (CJS) (P>0.05). The postoperative relapse of jaundice and cholan-gitis was significantly lower than that of CJS (P<0.025), while the survival was apparently higher thanthat of CJS (P<0.01). The mortality of HJDS or CJSwith gastrojejunostomy (GJS) was not significantlyhigher than that of the simple procedure without GJS(P>0.05), whereas the survival was significantlyhigher than that of the simple procedure without GJS(P<0.01). The occurrence of duodenal obstructionafter HDJS or CJS was 29.3%.Conclusion: As a palliative operation, Roux-en-Y chole-dochojejunostomy especially in combination with pre-ventive gastrojejunostomy is strongly recommended.

Micro RNA-548a-5p promotes proliferation and inhibits apoptosis in hepatocellular carcinoma cells by targeting Tg737

AIM: To investigate whether Tg737 is regulated by micro RNA-548a-5p(mi R-548a-5p), and correlates with hepatocellular carcinoma(HCC) cell proliferation and apoptosis.METHODS: Assays of loss of function of Tg737 were performed by the colony formation assay, CCK assay and cell cycle assay in HCC cell lines. The interaction between mi R-548a-5p and its downstream target, Tg737, was evaluated by a dual-luciferase reporter assay and quantitative real-time polymerase chain reaction. Tg737 was then up-regulated in HCC cells to evaluate its effect on mi R-548a-5p regulation. Hep G2 cells stably overexpressing mi R-548a-5p or mi R-control were also subcutaneously inoculated into nude mice to evaluate the effect of mi R-548a-5p up-regulation on in vivo tumor growth. As the final step, the effect of mi R-548a-5p on the apoptosis induced by cisplatin was evaluated by flow cytometry.RESULTS: Down-regulation of Tg737, which is a target gene of mi R-548a-5p, accelerated HCC cell proliferation, and mi R-548a-5p promoted HCC cell proliferation in vitro and in vivo. Like the downregulation of Tg737, overexpression of mi R-548a-5p in HCC cell lines promoted cell proliferation, increased colony forming ability and hampered cell apoptosis. In addition, mi R-548a-5p overexpression increased HCC cell growth in vivo. Mi R-548a-5p downregulated Tg737 expression through direct contact with its 3' untranslated region(UTR), and mi R-548a-5p expression was negatively correlated with Tg737 levels in HCC specimens. Restoring Tg737(without the 3'UTR) significantly hampered mi R-548a-5p induced cell proliferation, and rescued the mi R-548a-5p induced cell proliferation inhibition and apoptosis induced by cisplatin.CONCLUSION: Mi R-548a-5p negatively regulates the tumor inhibitor gene Tg737 and promotes tumorigenesis in vitro and in vivo, indicating its potential as a novel therapeutic target for HCC.

Procedures for congenital choledochal cysts and curative effect analysis in adults

Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.

Argon supper-cryosurgery for patients with middle and late stage liver cancer

OBJECTIVE: To assess the value of argon supper-cryosurgery for 42 patients with middle and late stage liver cancer. METHODS: Forty-two patients who had received argon supper-cryosurgery were analyzed retrospectively in terms of their clinical characteristics as well as the performance of argon supper-cryosurgery. RESULTS: All patients were ameliorated in symptoms shortly after the operation, including pain alleviation, psyche straightening up, alpha-fetoprotein descending or recovery. Jaundice occurred in 1 patient and intraabdominal hemorrhage in 2. The levels of aspartate transaminase and alanine transaminase in all patients were elevated 1 month after the operation, and normalized after protective therapy of the liver. No operative death was noted. CONCLUSIONS: Cold and heat reversed therapy of argon supper-cryosurgery can drastically destroy tumor tissue, especially the tumors which are too large to resect or close to the large vessels. It is applicable to increase the operative rate, decrease the operative death rate, and enlarge the therapeutic scope.