原发性肝癌患者TACE术后并发肺部炎症原因及临床特征的研究

目的分析原发性肝癌TACE术后肺部炎症的发生原因及临床特征。方法对我院1136例原发性肝癌TACE治疗患者进行分析。结果术后发生肺炎25例(2.20%);肺癌中出现咳嗽、咳痰22例,占88%;发热占84%。白细胞计数升高7例,占28%;CRP升高17例,占68%。CD4+T细胞下降19例,占76%。CD4+/CD8+比例下降15例,占60%。15例白蛋白下降,占60%;影像学表现以右肺下叶肺段不张为主,多伴有胸腔积液;3例死亡。结论 TACE术后部分患者会发生的肺部炎症,多见于右肝癌及巨块型肝癌患者;临床表现不典型。

肝癌中拮抗Wnt信号通路的CpG岛甲基化表型与临床病理特征之间的关系

目的评价肝癌中CpG岛甲基化表型（C1MP）与临床病理特征之间的关系。方法收集南通大学附属肿瘤医院2008年3月～2010年10月问108侧肝癌、癌旁组织、对应血浆及健康体检者血浆标本60例，以病理诊断为标准。采用甲基化特异性PCR方法对所有组织和血浆标本APC，SFRP-l，DKK-3和E-cad基因表达进行分析。结果四种基因在肝癌组织和血浆的阳性表达率：APC为44．44％（48／108）和24．07％（2G／108）；SFRP-l为37．04％（40／108）和28．7％（31／108）；DKK为36．11％（39／108）和23．15％（25／108）；E-cad为34．26％（37／108）和16．67％（18／108）；癌旁组织、正常组织以及健康人血浆中相关基因甲基化很低甚至不表达，癌组织以及癌旁组织相关基因甲基化表达差异均有统计学意义（APC：sX2=43．47．P〈O．05；DKK：X2=30．85，P〈o．05；SFRP-1：X2=43．47，P〈0．05；E-cad-1：：f2—33．37，P〈0．05）。分析CIMP和乙肝表面抗原、抗-HCV、血清AFP水平、肝硬化和TNM分期之间的关系发现：肿瘤组织中cIMP状态与乙型肝炎表面抗原阳性与否、甲胎蛋白浓度以及肿瘤淋巴结转移差异有统计学显著性意义（P＜0．05）；与丙型肝炎病毒抗体、肝硬化无明显差异。血浆中也发现cIMP状态与乙型肝炎表面抗原阳性与否、甲胎蛋白浓度以及肿瘤淋巴结转移差异有统计学显著性意义（P〈O．05）。与丙型肝炎病毒抗体、肝硬化无明显差异。结论肝癌中拮抗wnt信号通路的CIMP与临床病理特征之间有一定联系。

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

The prognosis of patients with HCC still remains dismal. The life expectancy of HCC patients is hard to predict because of the high possibility of postoperative recurrence. Many factors, such as patient's general conditions, macroscopic tumor morphology, as well as tumor histopathology features, have been proven of prognostic significance. Female HCC patient often has a better prognosis than male patient, which might be due to the receptor of sex hormones. Younger patients often have tumors with higher invasiveness and metastatic potentials, and their survival and prognosis are worse than the older ones. Co-existing hepatitis status and hepatic functional reserve have been confirmed as risk factors for recurrence. Serum alpha-fetoprotein (AFP) is useful not only for diagnosis, but also as a prognostic indicator for HCC patients. AFP mRNA has been proposed as a predictive marker of HCC cells disseminated into the circulation and for metastatic recurrence. Many pathologic features, such as tumor size, number, capsule state, cell differentiation, venous invasion, intrahepatic spreading, and advanced pTNM stage, are the best-established risk factors for recurrence and important aspects affecting the prognosis of patients with HCC. Marked inflammatory cell infiltration in the tumor could predict a better prognosis. Clinical stage is still the most important factor influencing on the prognosis. Extratumor spreading and lymph nodal metastasis are independent predictors for poor outcome. Some new predictive systems have recently been proposed. Different strategies of treatment might have significant different effects on the patients' prognosis. To date, surgical resection is still the only potentially curative treatment for HCC, including localized postoperative recurrences. Extent of resection, blood transfusion, occlusion of porta hepatis, and blood loss affect the survival and prognosis of HCC patients. Regional therapies provide alternative ways to improve the prognosis of HCC patients who have no opportunity to receive surgical treatment or postoperative recurrence. The combination of these treatment modalities is hopeful to further improve the prognosis. The efficacies of neoadjuvant (preoperative) or adjuvant (postoperative) chemotherapy or chemoembolization in preventing recurrence and on the HCC prognosis still remain great controversy, and deserve further evaluation. Biotherapy, including IFN-alpha therapy, will play more important role in preventing recurrence and metastasis of HCC after operation.

Characteristics and pathological mechanism on magnetic resonance diffusion-weighted imaging after chemoembolization in rabbit liver VX-2 tumor model

AIM: To investigate dynamic characteristics and pathological mechanism of signal in rabbit VX-2 tumor model on diffusion-weighted imaging (DWI) after chemoembolization. METHODS: Forty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity opened. Forty VX-2 tumor models from them were divided into four groups. DWI was performed periodically and respectively for each group after chemoembolization. All VX-2 tumor samples of each group were studied by pathology. The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values. The statistical significance between different time groups, different area groups or different b-value groups was calculated by using SPSS12.0 software. RESULTS: Under b-value of 100 s/mm2, ADC values were lowest at 16 h after chemoembolization in area of VX-2 tumor periphery, central, and normal liver parenchyma around tumor, but turned to increase with further elongation of chemoembolization treatment. The distinction of ADC between different time groups was significant respectively (F = 7.325, P < 0.001; F = 2.496, P < 0.048; F = 6.856, P < 0.001). Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor, increased quickly in sixteen h after chemoembolization but, from the 16th h to the 48th h, cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at, and then increased continually. After chemoembolization, Cellular necrosis in the area of VX-2 tumor periphery was more significantly high than that before chemoembolization. The areas of dead cells in VX-2 tumors manifested low signal and high ADC value, while the areas of viable cells manifested high signal and low ADC value. CONCLUSION: DWI is able to detect and differentiate tumor necrotic areas from viable cellular areas before and after chemoembolization. ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema, tissue cellular death and microcirculation disturbance after chemoembolization.

Expression of HIF-1α in hepatocellular carcinoma and its relationship with vasculogenic mimicry and clinical pathology

Objective： The aim of this study was to discuss HIF-la expression and vasculogenic mimicry （VM） in hepatocel- lular carcinoma （HCC） and their relationship with the clinical pathological features and clinical significance. Methods： Two hundred and seven specimens from patients in The Affiliated Hospital of North Sichuan Medical College who received hepatic cell carcinoma resection were tested by immunohistochemistry and double staining of CD31 and PSA. Then detected the expression of HIF-la, VM, and analysed the relationship between clinical pathology. Results： The HIF-la positive rate was 71.01% and its expression was associated with liver cirrhosis, tumor size and TNM stage （P 〈 0.05）. HIF-la protein expres- sion was positively associated with the VM （y = 0.1988, P = 0.0041）. Conclusion： Hypoxia may be the reason for VM in high invasive HCC, regulating the tumor microenvironment may have great significance in inhibiting invasion and metastasis of HCC.

Pattern characteristics in patients with primary liver cancer in different clinical stages

OBJECTIVE： To explore the characteristics of prima- ry liver cancer in terms of Traditional Chinese Medi-cine （TCM） by analyzing the variations of the patterns along with the clinical stages. METHODS： The patients who were hospitalized in the Changhai Hospital of Traditional Chinese Medi- cine dated from March 1999 to December 2008 were included in this retrospective study. The patients were grouped according to their cancer stag- es, and their patterns were judged and quantified according to the ＂Standard diagnosis and quantitative criteria of the common patterns in primary liv-er cancer＂ formulated by the Changhai Hospital of Traditional Chinese Medicine. Statistics methods included ANOVA and nonparametric test, among others.RESULTS： The data of the 398 newly diagnosed patients showed that Qi Stagnation, Blood Stasis, and Dampness patterns were more frequent than the other basic patterns with relatively high scores; patterns of Liver Qi Stagnation, Liver Blood Stasis, and Dampness Heat were more than the other complex patterns and scored relatively high. Scores of Dampness and Liver Qi Stagnation patterns varied among the groups at different stages and the differences were statistically significant （PDampeness= 0.002, PLiver Qi Stagnation ： 0.020）. The highest scores of Damp- ness pattern and Liver Qi Stagnation pattern corresponded with Stage Ⅲ b, and Stage Ⅲ a, respectively. Dampness pattern frequency was higher （P = 0.001） in the Stage Ⅲb group than in other groups.CONCLUSION： Pattern characteristics in patients with primary liver cancer of different clinical stages might manifest in the variations of the Dampness pattern along the process of the disease and the major pathogenic factor of primary liver cancer might be Dampness.