AIM: To investigate the relationship between hepatitis B virus (HBV) genotype with spontaneous YMDD mu-tations and hepatocellular carcinoma (HCC) in HBV-related cirrhosis. METHODS: We investigated 264 liver cirrhosis ...AIM: To investigate the relationship between hepatitis B virus (HBV) genotype with spontaneous YMDD mu-tations and hepatocellular carcinoma (HCC) in HBV-related cirrhosis. METHODS: We investigated 264 liver cirrhosis pa-tients who were not treated with antiviral drugs, in-cluding 81 patients with HCC. YMDD mutations were detected by fluorescent hybridization bioprobe poly-merase chain reaction (PCR) and melting curve assay using the Diagnosis Kit for HBV YMDD Mutation. Serum HBV genotypes were detected by real-time PCR using genotype-specific TaqMan probes. Statistical analysis was performed according to data type using the t test, χ2 test and unconditional logistic regression analysis. RESULTS: In the HCC group, genotype C strains, spon-taneous YMDD mutations, and genotype C strains with YMDD mutations were detected in 33 (40.74%), 13 (16.05%) and 11 (13.58%) patients, respectively. In the liver cirrhosis (LC) group, HBV genotype C strains,spontaneous YMDD mutations, and genotype C strains with YMDD mutations were detected in 33 (18.03%), 7 (3.83%) and 2 (1.09%) patients, respectively. The dif-ferences in genotype C strains, spontaneous YMDD mu-tations, and genotype C strains with YMDD mutations between the two groups were statistically significant (χ2=15.441, P=0.000; χ2=11.983, P=0.001; P=0.000). In the HCC and LC groups, there were seven patients infected by genotype B strains with YMDD mutations and 13 by genotype C strains with YMDD mutations. Further research revealed that HCC oc-curred in 2 patients infected by genotype B strains with YMDD mutations and 11 infected by genotype C strains with YMDD mutations. The difference was statistically significant (P=0.000). Unconditional logistic regres-sion analysis revealed that patients infected by geno-type C strains with spontaneous YMDD mutations had a 7.775-fold higher risk for the development of HBV-related HCC than patients infected by other type HBV strains (P=0.013, 95%CI: 1.540-39.264). CONCLUSION: Genotype C strains with spontaneous YMDD mutations are an independent risk factor for HCC in LC patients and are important for early warning of HCC.展开更多
Primary liver cancers carry significant morbidity and mortality.Hepatocellular carcinoma(HCC)develops within the hepatic parenchyma and is the most common malignancy originating from the liver.Although 80%of HCCs deve...Primary liver cancers carry significant morbidity and mortality.Hepatocellular carcinoma(HCC)develops within the hepatic parenchyma and is the most common malignancy originating from the liver.Although 80%of HCCs develop within background cirrhosis,20%may arise in a non-cirrhotic milieu and are referred to non-cirrhotic-HCC(NCHCC).NCHCC is often diagnosed late due to lack of surveillance.In addition,the rising prevalence of non-alcoholic fatty liver disease and diabetes mellitus have increased the risk of developing HCC on noncirrhotic patients.Viral infections such as chronic Hepatitis B and less often chronic hepatitis C with advance fibrosis are associated with NCHCC.NCHCC individuals may have Hepatitis B core antibodies and occult HBV infection,signifying the role of Hepatitis B infection in NCHCC.Given the effectiveness of current antiviral therapies,surgical techniques and locoregional treatment options,nowadays such patients have more options and potential for cure.However,these lesions need early identification with diagnostic models and multiple surveillance strategies to improve overall outcomes.Better understanding of the NCHCC risk factors,tumorigenesis,diagnostic tools and treatment options are critical to improving prognosis and overall outcomes on these patients.In this review,we aim to discuss NCHCC epidemiology,risk factors,and pathogenesis,and elaborate on NCHCC diagnosis and treatment strategies.展开更多
AIM: To characterize the clinical features of hepatocellular carcinoma (HCC) associated with autoimmune liver disease, we critically evaluated the literature on HCC associated with autoimmune hepatitis (AIH) and prima...AIM: To characterize the clinical features of hepatocellular carcinoma (HCC) associated with autoimmune liver disease, we critically evaluated the literature on HCC associated with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). METHODS: A systematic review of the literature was conducted using the Japana Centra Revuo Medicina database which produced 38 cases of HCC with AIH (AIH-series) and 50 cases of HCC with PBC (PBC-series). We compared the clinical features of these two sets of patients with the general Japanese HCC population. RESULTS: On average, HCC was more common in men than in women with AIH or PBC. While many patients underwent chemolipiodolization (CL) or transcatheter arterial embolization (TAE) (AIH-series: P = 0.048 (vs operation), P = 0.018 (vs RFA, PEIT); PBC-series: P = 0.027 (vs RFA, PEIT), others refused therapeutic interventions [AIH-series: P = 0.038 (vs RFA, PEIT); PBC-series: P = 0.003 (vs RFA, PEIT)].Liver failure was the primary cause of death among patients in this study, followed by tumor rupture. The survival interval between diagnosis and death was fairly short, averaging 14 ± 12 mo in AIH patients and 8.4 ± 14 mo in PBC patients. CONCLUSION: We demonstrated common clinical features among Japanese cases of HCC arising from AIH and PBC.展开更多
Mallory-Denk Bodies(MDB) are important as investigators,suggesting MDB as an indicator of the histologic severity of chronic hepatitis,causes of which include hepatitis C,primary biliary cirrhosis(PBC),and nonalcoholi...Mallory-Denk Bodies(MDB) are important as investigators,suggesting MDB as an indicator of the histologic severity of chronic hepatitis,causes of which include hepatitis C,primary biliary cirrhosis(PBC),and nonalcoholic fatty liver disease(NAFLD).Matteoni et al scored MDB in patients with NAFLD as none,rare and many,and reported that MDB plays a prominent role in this classification scheme in an earlier classification system.In this study,we evaluated 258 patients with chronic hepatitis due to metabolic,autoimmune and viral etiologies.Liver biopsy samples were evaluated with hematoxylin and eosin,periodic acid-Schiff-diastase,Gordon and Sweet's reticulin,Masson's trichrome,and iron stains.Both staging and grading were performed.Additionally,MDB were evaluated and discussed for each disease.We examined patients with nonalcoholic steatohepatitis(NASH;50 patients),alcoholic hepatitis(10 patients),PBC(50 patients),Wilson disease(WD;20 patients),hepatitis B(50 patients),hepatitis C(50 pati-ents) and hepatocellular carcinoma(HCC;30 patients).Frequency of MDB was as follows;NASH:10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3.PBC:11 patients with mild in 10%,moderate in 70%,and cirrhosis in 20%,and frequently seen in zone 1.WD:16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1.Hep B:3 patients with mild in 66% and severe in 34%.Hep C:7 patients with mild in 40% and moderate in 60% and observed in every stage.HCC:3 patients with hep B in 2 patients.We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology.展开更多
BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results i...BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.展开更多
目的:探讨吲哚氰绿试验15min滞留率(indocyanine green retention rate at 15 min,ICGR15)在评估原发性肝癌(HCC)射频消融术前肝储备功能的临床价值。方法:56例肝功能Child-Pugh分级为A、B级HCC患者行射频消融术治疗,于术前测定ICGR15...目的:探讨吲哚氰绿试验15min滞留率(indocyanine green retention rate at 15 min,ICGR15)在评估原发性肝癌(HCC)射频消融术前肝储备功能的临床价值。方法:56例肝功能Child-Pugh分级为A、B级HCC患者行射频消融术治疗,于术前测定ICGR15。根据术后肝功能损伤程度及凝血功能将患者分为肝功能轻度损伤组(L组)、肝功能中度损伤组(M组)和肝功能重度损伤组(S组)。对术前测定的ICGRl5结果与Child-Pugh分级进行比较;同时比较分析ICGRl5及Child-Pugh评分与术后肝功能不全的关系。结果:射频消融术前不同的Child-Pugh分级间ICGR15变化差异有统计学意义(P<0.05);术后三组间ICGR15差异有统计学意义(P<0.05);L组与S组间Child-Pugh评分差异有统计学意义(P<0.05),L组与M组及M组与S组间Child-Pugh评分差异无统计学意义(P>0.05)。结论:ICGR15与ChildPugh分级有明显相关,且能对HCC患者射频消融术前肝脏储备功能进行评估。展开更多
目的:比较自制的超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)和二乙烯五胺乙酸钆(Gd-DT-PA)用于磁共振诊断肝癌的效果。方法:大耳白兔24只,随机分为两组,每组12只,开腹直视接种法建立VX2肝癌模型。种植后7天、14天分别进行MR平...目的:比较自制的超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)和二乙烯五胺乙酸钆(Gd-DT-PA)用于磁共振诊断肝癌的效果。方法:大耳白兔24只,随机分为两组,每组12只,开腹直视接种法建立VX2肝癌模型。种植后7天、14天分别进行MR平扫及增强扫描并与病理组织学结合评价诊断正确率。结果:种植后7天12个病灶SPIO确诊10个(83.3%),Gd-DTPA13个病灶确诊为9个(69.2%),两组比较差异有统计学意义(P<0.05);种植后14天19个病灶SPIO确诊16个(84.2%),Gd-DTPA17个病灶确诊15个(88.2%),差异无统计学意义(P>0.05)。结论:合成的SPIO可作为MR造影剂诊断早期小病灶肝癌。展开更多
基金Supported by Health Bureau of Sichuan Province,China,No.070283 and 100175
文摘AIM: To investigate the relationship between hepatitis B virus (HBV) genotype with spontaneous YMDD mu-tations and hepatocellular carcinoma (HCC) in HBV-related cirrhosis. METHODS: We investigated 264 liver cirrhosis pa-tients who were not treated with antiviral drugs, in-cluding 81 patients with HCC. YMDD mutations were detected by fluorescent hybridization bioprobe poly-merase chain reaction (PCR) and melting curve assay using the Diagnosis Kit for HBV YMDD Mutation. Serum HBV genotypes were detected by real-time PCR using genotype-specific TaqMan probes. Statistical analysis was performed according to data type using the t test, χ2 test and unconditional logistic regression analysis. RESULTS: In the HCC group, genotype C strains, spon-taneous YMDD mutations, and genotype C strains with YMDD mutations were detected in 33 (40.74%), 13 (16.05%) and 11 (13.58%) patients, respectively. In the liver cirrhosis (LC) group, HBV genotype C strains,spontaneous YMDD mutations, and genotype C strains with YMDD mutations were detected in 33 (18.03%), 7 (3.83%) and 2 (1.09%) patients, respectively. The dif-ferences in genotype C strains, spontaneous YMDD mu-tations, and genotype C strains with YMDD mutations between the two groups were statistically significant (χ2=15.441, P=0.000; χ2=11.983, P=0.001; P=0.000). In the HCC and LC groups, there were seven patients infected by genotype B strains with YMDD mutations and 13 by genotype C strains with YMDD mutations. Further research revealed that HCC oc-curred in 2 patients infected by genotype B strains with YMDD mutations and 11 infected by genotype C strains with YMDD mutations. The difference was statistically significant (P=0.000). Unconditional logistic regres-sion analysis revealed that patients infected by geno-type C strains with spontaneous YMDD mutations had a 7.775-fold higher risk for the development of HBV-related HCC than patients infected by other type HBV strains (P=0.013, 95%CI: 1.540-39.264). CONCLUSION: Genotype C strains with spontaneous YMDD mutations are an independent risk factor for HCC in LC patients and are important for early warning of HCC.
文摘Primary liver cancers carry significant morbidity and mortality.Hepatocellular carcinoma(HCC)develops within the hepatic parenchyma and is the most common malignancy originating from the liver.Although 80%of HCCs develop within background cirrhosis,20%may arise in a non-cirrhotic milieu and are referred to non-cirrhotic-HCC(NCHCC).NCHCC is often diagnosed late due to lack of surveillance.In addition,the rising prevalence of non-alcoholic fatty liver disease and diabetes mellitus have increased the risk of developing HCC on noncirrhotic patients.Viral infections such as chronic Hepatitis B and less often chronic hepatitis C with advance fibrosis are associated with NCHCC.NCHCC individuals may have Hepatitis B core antibodies and occult HBV infection,signifying the role of Hepatitis B infection in NCHCC.Given the effectiveness of current antiviral therapies,surgical techniques and locoregional treatment options,nowadays such patients have more options and potential for cure.However,these lesions need early identification with diagnostic models and multiple surveillance strategies to improve overall outcomes.Better understanding of the NCHCC risk factors,tumorigenesis,diagnostic tools and treatment options are critical to improving prognosis and overall outcomes on these patients.In this review,we aim to discuss NCHCC epidemiology,risk factors,and pathogenesis,and elaborate on NCHCC diagnosis and treatment strategies.
基金Supported by A grant-in-aid from the Ministry of Education, Science, Sports and Culture of Japan
文摘AIM: To characterize the clinical features of hepatocellular carcinoma (HCC) associated with autoimmune liver disease, we critically evaluated the literature on HCC associated with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). METHODS: A systematic review of the literature was conducted using the Japana Centra Revuo Medicina database which produced 38 cases of HCC with AIH (AIH-series) and 50 cases of HCC with PBC (PBC-series). We compared the clinical features of these two sets of patients with the general Japanese HCC population. RESULTS: On average, HCC was more common in men than in women with AIH or PBC. While many patients underwent chemolipiodolization (CL) or transcatheter arterial embolization (TAE) (AIH-series: P = 0.048 (vs operation), P = 0.018 (vs RFA, PEIT); PBC-series: P = 0.027 (vs RFA, PEIT), others refused therapeutic interventions [AIH-series: P = 0.038 (vs RFA, PEIT); PBC-series: P = 0.003 (vs RFA, PEIT)].Liver failure was the primary cause of death among patients in this study, followed by tumor rupture. The survival interval between diagnosis and death was fairly short, averaging 14 ± 12 mo in AIH patients and 8.4 ± 14 mo in PBC patients. CONCLUSION: We demonstrated common clinical features among Japanese cases of HCC arising from AIH and PBC.
文摘Mallory-Denk Bodies(MDB) are important as investigators,suggesting MDB as an indicator of the histologic severity of chronic hepatitis,causes of which include hepatitis C,primary biliary cirrhosis(PBC),and nonalcoholic fatty liver disease(NAFLD).Matteoni et al scored MDB in patients with NAFLD as none,rare and many,and reported that MDB plays a prominent role in this classification scheme in an earlier classification system.In this study,we evaluated 258 patients with chronic hepatitis due to metabolic,autoimmune and viral etiologies.Liver biopsy samples were evaluated with hematoxylin and eosin,periodic acid-Schiff-diastase,Gordon and Sweet's reticulin,Masson's trichrome,and iron stains.Both staging and grading were performed.Additionally,MDB were evaluated and discussed for each disease.We examined patients with nonalcoholic steatohepatitis(NASH;50 patients),alcoholic hepatitis(10 patients),PBC(50 patients),Wilson disease(WD;20 patients),hepatitis B(50 patients),hepatitis C(50 pati-ents) and hepatocellular carcinoma(HCC;30 patients).Frequency of MDB was as follows;NASH:10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3.PBC:11 patients with mild in 10%,moderate in 70%,and cirrhosis in 20%,and frequently seen in zone 1.WD:16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1.Hep B:3 patients with mild in 66% and severe in 34%.Hep C:7 patients with mild in 40% and moderate in 60% and observed in every stage.HCC:3 patients with hep B in 2 patients.We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology.
基金Supported by Health Commission of Hebei Province,No.G2018068
文摘BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.
文摘目的:探讨吲哚氰绿试验15min滞留率(indocyanine green retention rate at 15 min,ICGR15)在评估原发性肝癌(HCC)射频消融术前肝储备功能的临床价值。方法:56例肝功能Child-Pugh分级为A、B级HCC患者行射频消融术治疗,于术前测定ICGR15。根据术后肝功能损伤程度及凝血功能将患者分为肝功能轻度损伤组(L组)、肝功能中度损伤组(M组)和肝功能重度损伤组(S组)。对术前测定的ICGRl5结果与Child-Pugh分级进行比较;同时比较分析ICGRl5及Child-Pugh评分与术后肝功能不全的关系。结果:射频消融术前不同的Child-Pugh分级间ICGR15变化差异有统计学意义(P<0.05);术后三组间ICGR15差异有统计学意义(P<0.05);L组与S组间Child-Pugh评分差异有统计学意义(P<0.05),L组与M组及M组与S组间Child-Pugh评分差异无统计学意义(P>0.05)。结论:ICGR15与ChildPugh分级有明显相关,且能对HCC患者射频消融术前肝脏储备功能进行评估。
文摘目的:比较自制的超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)和二乙烯五胺乙酸钆(Gd-DT-PA)用于磁共振诊断肝癌的效果。方法:大耳白兔24只,随机分为两组,每组12只,开腹直视接种法建立VX2肝癌模型。种植后7天、14天分别进行MR平扫及增强扫描并与病理组织学结合评价诊断正确率。结果:种植后7天12个病灶SPIO确诊10个(83.3%),Gd-DTPA13个病灶确诊为9个(69.2%),两组比较差异有统计学意义(P<0.05);种植后14天19个病灶SPIO确诊16个(84.2%),Gd-DTPA17个病灶确诊15个(88.2%),差异无统计学意义(P>0.05)。结论:合成的SPIO可作为MR造影剂诊断早期小病灶肝癌。
