Mechanisms and therapeutic strategies to combat the recurrence and progression of hepatocellular carcinoma after thermal ablation

Thermal ablation(TA),including radiofrequency ablation(RFA)and microwave ablation(MWA),has become the main treatment for early-stage hepatocellular carcinoma(HCC)due to advantages such as safety and minimal invasiveness.However,HCC is prone to local recurrence,with more aggressive malignancies after TA closely related to TA-induced changes in epithelial-mesenchymal transition(EMT)and remodeling of the tumor microenvironment(TME).According to many studies,various components of the TME undergo complex changes after TA,such as the recruitment of innate and adaptive immune cells,the release of tumor-associated antigens(TAAs)and various cytokines,the formation of a hypoxic microenvironment,and tumor angiogenesis.Changes in the TME after TA can partly enhance the anti-tumor immune response;however,this response is weak to kill the tumor completely.Certain components of the TME can induce an immunosuppressive microenvironment through complex interactions,leading to tumor recurrence and progression.How the TME is remodeled after TA and the mechanism by which the TME promotes HCC recurrence and progression are unclear.Thus,in this review,we focused on these issues to highlight potentially effective strategies for reducing and preventing the recurrence and progression of HCC after TA.

Nanodrug enhances post-ablation immunotherapy of hepatocellular carcinoma via promoting dendritic cell maturation and antigen presentation

Thermal ablation(TA)as an effective method treating hepatocellular carcinoma(HCC)in clinics is facing great challenges of high recurrence and metastasis.Although immune-checkpoint blockade(ICB)-based immuno-therapy has shown potential to inhibit recurrence and metastasis,the combination strategy of ICB and thermal ablation has shown little progress in HCC treatments.The tremendous hurdle for combining ICB with thermal ablation lies with the insufficient antigen internalization and immaturity of tumor-infiltrating dendritic cells(TIDCs)which leads to an inferior immune response to distant tumor growth and metastasis.Herein,an antigen-capturing nanoplatform,whose surface was modified with mannose as a targeting ligand,was constructed for co-delivering tumor-associated antigens(TAAs)and m6A demethylases inhibitor(i.e.,fat mass and obesity asso-ciated gene(FTO)inhibitor)into TIDCs.In vivo results demonstrate that the intratumoral injection of nanodrug followed by HCC thermal ablation promotes dendritic cells(DCs)maturation,improves tumor infiltration of effector T cells and generates immune memory,which synergize with ICB treatment to inhibit the distant tumor growth and lung metastasis.Therefore,the antigen-capturing and FTO-inhibiting nanodrug holds potential to boost the ICB-based immunotherapy against HCC after thermal ablation.

问题驱动联合"计划、执行、检查和行动"循环教学法在介入放射进修医生临床带教中的效果评价

目的评价PBL联合PDCA教学法应用于介入放射进修医生的临床带教效果。方法将我科2017年1月至2021年10月间的26名进修医生分为对照组和实验组。对照组只采用PBL教学法,实验组采用PBL联合PDCA教学法。对进修医生考核成绩和反馈意见进行统计分析。结果实验组的理论和实践考核得分均高于对照组,且差异均有统计学意义(P<0.05)。实验组的教学满意度总体优于对照组。结论PBL联合PDCA的新型教学模式可提高介入放射进修医生的学习效果。

Transarterial chemoembolization combined with sorafenib and iodine-125 seed brachytherapy for hepatocellular carcinoma with portal vein tumor thrombus:a retrospective controlled study

To the Editor:Portal vein tumor thrombus(PVTT)is present in 10%to 40%of patients with hepatocellular carcinoma(HCC)at diagnosis and has a profound adverse effect on progno-sis.[1]Sorafenib is recommended as the first-line treatment for patients with advanced HCC,including those who have PVTT.However,its efficacy is modest.[1,2]A combination of transarterial chemoembolization(TACE)and sorafenib(TACE-S)has been reported to be associated with improved outcomes.[1,3]But unfortunately,its efficacy in controlling PVTT remained limited,with an objective response rate(ORR)of only 9.7%.[3]Previous studies have demonstrated that iodine-125(125I)seed brachytherapy targeting PVTT can lead to a significant reduction in tumor thrombus with few complications.[4,5]We hypothesized that TACE-S combined with 125I seed brachytherapy(TACE-S-I)could improve the control of PVTT and confer a greater survival benefit.Therefore,we conducted this study to evaluate the efficacy and safety of TACE-S-I compared with TACE-S in HCC patients with PVTT.This study was approved by our institutional review board(No.2020-hg-ks-03).