Risk factors for primary liver carcinoma in Chinese population

AIM: To evaluate the risk factors for primary liver carcinoma (PLC) in Chinese population.METHODS: Chinese Biomedical Literature Database,China Hospital Knowledge Database and MEDLINE were searched. All the related literatures were screened, and the risk factors for PLC in Chinese population were studied.Heterogeneity was evaluated by odds ratio (OR) q test.Combined OR and its 95% confidence interval (95%CI)were calculated, the association between the investigated risk factors and PLC was determined. Validity and bias of the findings were evaluated by sensitivity analysis and funnel plot analysis respectively.RESULTS: Fifty-five of one hundred and ninety identified studies were accepted according to the inclusive criteria.Ten factors related to PLC were demonstrated by sensitive analysis and funnel plot analysis. They were cirrhosis (OR = 11.97, P= 0.000), HBV infection (OR = 11.34, P= 0.000),HCV infection (OR = 4.28, P = 0.000), family history of liver cancer (OR = 3.49, P = 0.000), unstable emotion (OR = 2.20, P = 0.000), depressed characters (OR = 3.07,P = 0.000), aflatoxin (OR = 1.80, P = 0.000), alcoholic (OR = 1.88, P = 0.000), intake of musty food (OR = 1.87,P = 0.000) and drinking contaminated water from pond (OR = 1.77, P= 0.003).CONCLUSION: The main risk factors for PLC in China are liver diseases, family history of liver carcinoma, poor psychic status, afiatoxin, and some unhealthy behaviors.

Serial therapies oriented by surgery for large primary liver carcinoma

Objective: To discuss the methods and effects of serialtherapies oriented by surgery in the treatment of pri-mary large liver cancers.Methods: From January 1993 to June 1999, 191 pa-tients with large liver carcinoma were treated surgi-cally. The size of tumors varied from 5.2 to 19.7 cm(mean 9.4 cm). Several types of liver resectionswere made in 121 patients and as a supplement, cry-osurgery was carried out for the remaining 70 pa-tients. Importable drug delivery system was institu-ted intraoperatively. Transcatheter arterial chemo-embolization (THP 30-60 mg, E-ADM 20-40 mg,CDDP 40-80 mg, MMC 10-20 mg, iodin oil 5-30ml), percutaneous ethanol injection, bioimmunother-apy and traditional Chinese medicine were used pre-and post-operatively. CT angiography and CT dur-ing arterial portography were used to find satellitenodules. Early stage recurrences were predicted byAFPmRNA in peripheral blood. Child-Pugh’s classi-fication plus branch chain amino acid/aromatic ami-no acid ratio (BCAA/AAA) was adopted in evalua-ting pre-operative liver functions.Results: Marked results were observed after serialtreatments oriented by surgery. The 1-, 3- and 5-year survival rates in resection group were 75.8 %,45.6% and 30.4%. respectively. The 1- and 3-yearsurvival rates in cryosurgery group were 63.2 % and37.0 %. The operative mortality was 1.57 %. Recur-rence rates were 69.2 % in AFPmRNA positive groupand 33.3% in AFPmRNA negative group (P【0.05). The BCAA/AAA ratio was lower than 1.5 intwo patients who died of hepatic failure after resec-tion.Conclusions: Serial treatments with surgery as thechief modality gives satisfactory results in patientswith large primary liver carcinoma. This regimenshould be regarded as a main strategy to deal withlarge liver carcinoma. AFPmRNA in the peripheralblood, signifying a recurrence, may become a newclinical parameter. The BCAA/AAA ratio plusChild-Pugh’s classification is able to evaluate moreaccurately liver function reserve before surgery.

Antisense EGFR sequence reverses the growth properties of human liver carcinoma cell line BEL-7404 in vitro

A recombinant plasmid containing a full length human epidermal growth factor receptor (EGFR) cDNA sequence in antisense orientation was transferred into cells of a human liver carcinoma cell line BEL-7404. Compared with the control cell clone JX-0 transferred with the vector plasmid and the parent BEL-7404 cells, the antisense EGFR transferred cell clone JX-1 showed a decreased EGFR gene expression and reduced significantly the growth potential either in anchorage-dependent or anchorage-independent growth. Furthermore. JX-1 cells appeared to be distinctly dependent on serum concentration for monolayer growth. The results suggested that antisense EGFR could partly block the EGFR gene ex-pression and reverse the malignant growth properties of human liver carcinoma cells in vitro.

Inhibitory effect of endostatin expressed by human liver carcinoma SMMC7721 on endothelial cell proliferation in vitro

瞄准：为了构造人的肝癌房间的稳定的 transfectant，衬里 SMMC7721 能秘密人的 endostatin 并且在 endothelial 房间增长上由 transfectant 表示了探索人的 endostatin 的效果。方法：Recombinant 制动火箭和老鼠白朊信号肽为人的 endostatin 基因包含 cDNA 的病毒的原生质标志 pLncx-Endo 被设计并且由 lipofectamine 转了进 SMMC7721 房间。在有 G418 的选择以后， endostatin-transfected SMMC7721 房间被选择并且膨胀。Immunohistochemical 染色和西方的污点被用来在 transfected SMMC7721 房间和它的媒介检测人的 endostatin 的表示。endostatin-transfected 和控制 SMMC7721 房间的调节媒介是镇定的与人的脐的静脉 endothelial 房间栽培 72 个小时。endostatin 的禁止的效果，由 transfected SMMC7721 房间表示了，在 endothelial 上，在 vitro 的增长被使用 MTT 观察试金。结果：550 bp endostatin 基因的特定的碎片从 endostatin-transfected SMMC7721 房间的 PCR 产品被检测。Immunohistochemistry 和西方的污点分析由 endostatin-transfected SMMC7721 房间证实了外国人的 endostatin 蛋白质的表示和分泌物。在 vitro endothelial 增长，试金显示出那在有人的脐的静脉 endothelial 房间的耕作以后的 72 个小时，在用从 endostatin-transfected SMMC7721 房间的媒介的组的光密度( OD )是 0.51 +/- 0.06 ，从 RPMI 1640 组比那降低( 0.98 +/- 0.09 )或从控制原生质标志 pLncx-transfected SMMC7721 房间( 0.88 +/- 0.11 )。为从 endostatin-transfected SMMC7721 房间的媒介的禁止的率是 48% ，比那显著地高从空原生质标志 pLncx-transfected SMMC7721 房间(10.2% ， P【0.01 ) 。结论：人的 endostatin 能被与人的 endostatin 基因转移的 SMMC7721 房间稳定地表示，它的产品能显著地在 vitro 禁止人的脐的静脉 endothelial 房间的增长。

Liver Transplantation Outcomes of HBV-,HCV-,and Alcohol-induced Hepatocellular Carcinoma in the United States:Analysis of National Inpatient Samples

Objective Liver transplantation is a current treatment option for hepatocellular carcinoma(HCC).The United States National Inpatient Sample database was utilized to identify risk factors that influence the outcome of liver transplantation,including locoregional recurrence,distant metastasis,and in-hospital mortality,in HCC patients with concurrent hepatitis B infection,hepatitis C infection,or alcoholic cirrhosis.Methods This retrospective cohort study included HCC patients(n=2391)from the National Inpatient Sample database who underwent liver transplantation and were diagnosed with hepatitis B or C virus infection,co-infection with hepatitis B and C,or alcoholic cirrhosis of the liver between 2005 and 2014.Associations between HCC etiology and post-transplant outcomes were examined with multivariate analysis models.Results Liver cirrhosis was due to alcohol in 10.5%of patients,hepatitis B in 6.6%,hepatitis C in 10.8%,and combined hepatitis B and C infection in 24.3%.Distant metastasis was found in 16.7%of patients infected with hepatitis B and 9%of hepatitis C patients.Local recurrence of HCC was significantly more likely to occur in patients with hepatitis B than in those with alcohol-induced disease.Conclusion After liver transplantation,patients with hepatitis B infection have a higher risk of local recurrence and distant metastasis.Postoperative care and patient tracking are essential for liver transplant patients with hepatitis B infection.

Barcelona Clinic Liver Cancer Classification and Treatment of Hepatocellular Carcinoma in a Côte d’Ivoire University Hospital

Context/Objectives: Hepatocellular carcinoma occurs mainly and increasingly in developing countries, where the prognosis is particularly poor. The Barcelona Clinic Liver Cancer classification is used to guide the treatment of hepatocellular carcinoma. The aim of this retrospective study was to describe the Barcelona Clinic Liver Cancer classification and the treatment of hepatocellular carcinoma in a University Hospital in Côte d’Ivoire. Methods: Patients with hepatocellular carcinoma hospitalized in the hepato-gastroenterology unit of the University Hospital of Yopougon from 01 January 2012 to 30 June 2017 were included. The diagnosis of hepatocellular carcinoma was based on the presence of hepatic nodules on the abdominal ultrasound scan, typical images with the helical scanner associated or not with an increase of the α-fetoprotein higher than 200 ng/ml or with histology. Demographic, clinical, biological and radiological data were determined at the time of diagnosis. Patients were classified according to the Barcelona Clinic Liver Cancer classification. Their treatment was specified. Results: There were 258 patients whose median age was 48.1 years. Viral hepatitis B virus was the primary cause of hepatocellular carcinoma in 64.7% of cases. The severity of the underlying cirrhosis was Child-Pugh A in 12.1%, B in 63.6% and C in 24.3% of cases. The median size of the tumor was 63 mm. The α-fetoprotein level was higher than 200 mg/ml in 56.03% of cases. The Eastern Cooperative Oncology Group (ECOG)/World Health Organization (WHO) system was ≥2 in 82.9%. The Barcelona Clinic Liver Cancer classification was A in 1.3%, B in 0%, C in 55.2% and D in 43.5% of patients. There was no transplantation or hepatic resection. Very few patients (1.9%) received radio-frequency curative therapy. The treatment was predominantly symptomatic in 97.8% of patients. During hospitalization 43.7% of patients died. Conclusion: Hepatocellular carcinoma occurs on a liver with severe cirrhosis at a late stage. This does not allow cure treatment and explains a high mortality rate during hospitalization. Hepatitis B virus is the main risk factor and immunization at birth will reduce the incidence of this cancer in Africa.

Clinical value of assessing serum levels of inflammatory cytokines in the early diagnosis of patients with primary liver carcinoma:a retrospective observational study

Objective:To identify potential early diagnostic markers for hepatitis B progression to primary liver carcinoma using routine immunological tests based on 6 cytokine combinations.Methods:Eight hundred and ninety-nine patients with hepatitis B progressing to early primary liver carcinoma admitted to and treated at Changhai Hospital,Naval Military Medical University,Shanghai,China between March 2015 and June 2017 were included in this observational study,including 666 patients with HBsAg^(+),HBeAb^(+),HBcAb^(+)liver carcinoma and 233 patients with HBsAg+,HBeAg+,HBcAb+liver carcinoma.Receiver operating characteristic(ROC)curves were used to evaluate the efficiency of the different cytokine in the diagnosis of hepatocellular carcinoma in patients with hepatitis B.This study was approved by the Institutional Review Board of Changhai Hospital,Naval Military Medical University,China(approval No.CHEC2020-080)on June 6,2020.Results:Changed levels of interleukin(IL)-1β,IL-2R,IL-8,and tumor necrosis factor(TNF)-a were statistically significant(P<0.05).The area under the ROC curve,sensitivity,specificity,positive predictive value,negative predictive value,and Youden index for the diagnosis of primary liver carcinoma using the combination of IL-1β,IL-2R,IL-8,and TNF-α were 0.938,79.2%,96.7%,96%,82.0%,0.759,respectively.The serum alpha-fetoprotein level in patients with primary liver carcinoma was positively correlated with IL-2R(r=0.3502,P<0.001),IL-8(r=0.1558,P=0.0273),and TNF-α(r=0.2544,P<0.001)levels.The equation fitted to the results was logit(P)=0.086+0.01
IL-2R–0.001
IL-8–0.033
TNF-α–0.041
IL-1β.Conclusion:Our study establishes a novel,potentially valuable diagnostic model based on four cytokines related to the early stages of liver carcinoma.

Antitumor effects of interleukin-18 gene-modified hepatocyte cell line on implanted liver carcinoma

Objective To investigate the antitumor effects of intrasplenically transplanted interleukin-18 (IL-18) gene-modified hepatocytes on murine implanted liver carcinoma. Methods Embryonic murine hepatocyte cell line (BNL-CL2) was transfected with a recombinant adenovirus encoding IL-18 and used as delivery cells for IL-18 gene transfer. Two cell lines,BNL-LacZ and BNL-CL2, were used as controls. One week after intrasplenic injection of C26 cells (colon carcinoma line),tumor-bearing syngeneic mice underwent the intrasplenic transplantation of IL-18 gene-modified hepatocyte cell line and were divided into treatment group (BNL IL-18) and control groups (BNL-LacZ and BNL-CL2 ). Two weeks later,the serum levels of IL-18,interferon-γ (IFN-γ),tumor necrosis factor-α (TNF-α) and nitric oxide (NO) in the implanted liver carcinoma-bearing mice were assayed,the cytotoxicity of murine splenic cytotoxic T-lymphocytes (CTLs) was measured,and the morphology of the hepatic tumors was studied to evaluate the antitumor effects of the approach. Results In the treatment group,the serum levels of IL-18,IFN-γ,TNF-α and NO increased significantly. The splenic CTL activity increased markedly ( P <0.01) ,accompanied by a substantial decrease in tumor volume and the percentage of tumor area and prolonged survival of liver carcinomo-being mice. Conclusions In vivo IL-18 expression by ex vivo manipulated cells with IL-18 recombinant adenovirus is able to exert potent antitumor effects by inducing a predominantly T-cell-helper type 1 (Th1) immune response. Intrasplenic transplantation of adenovirus-mediated IL-18 gene-modified hepatocytes could be used as a targeting treatment for implanted liver carcinoma.

Managements of recurrent hepatocellular carcinoma after liver transplantation: A systematic review

AIM: To investigate the efficacy(survival) and safety of treatments for recurrent hepatocellular carcinoma(HCC) in liver transplantation(LT) patients.METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a fulltext evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies.RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo(range 2-132 mo). The majority of patients(67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates(42 and 18 mo, res-pectively). However, Sorafenib, especially when combined with m TOR, was frequently associated with severe side effects that required dose reduction or discontinuation CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.

A national report from China Liver Transplant Registry: steroid avoidance after liver transplantation for hepatocellular carcinoma

Objective:We aimed to evaluate the efficacy and safety of steroid-free immunosuppression after liver transplantation(LT)for hepatocellular carcinoma(HCC).Methods:We retrospectively analyzed HCC recipients without steroids after LT(SF group,n=368)based on the China Liver Transplant Registry(CLTR)database.These recipients were matched 1:2 with patients using steroids(S group,n=736)for the same period after LT for HCC,according to propensity scores.Results:Multivariate analysis indicates that recipients with younger age[odds ratio(OR),1.053;P=0.011],preoperative hepatitis B virus(HBV)DNA≥1,000 copies/mL(OR,2.597;P=0.004)and beyond Milan criteria(OR,4.255;P<0.001)were identified as the risk factors associated with tumor recurrence in steroid avoidance recipients after LT.The patients fulfilling the Milan criteria in the SF group presented higher overall and tumor-free survival rates than those in the S group(P<0.05).Multivariate analysis revealed that recipient beyond Milan criteria was an independent prognostic factor for overall survival(OR,1.690;P<0.001)and tumor-free survival(OR,2.066;P<0.001).The incidences of new-onset diabetes mellitus(21.20% vs.33.29%,P<0.001),new-onset hypertension(10.05%vs.18.61%,P<0.001)and hyperlipidemia(4.08% vs.7.20%,P=0.042)were significantly lower in the SF group.Conclusions:Steroid-free immunosuppression could be safe and feasible for HBV-related HCC patients in LT.Age,HBV DNA level and Milan criteria maybe risk factors associated with tumor recurrence in steroid avoidance recipients.Recipient beyond Milan criteria was an independent prognostic factor and recipient fulfilling Milan criteria can benefit the most from steroid-free immunosuppression.

Liver transplantation for hepatocellular carcinoma: the Hangzhou experience

Over the last 25 years orthotopic liver transplantation (OLT) has been proven a durabletherapy for all forms of end stage

Changes of immune function in patients with liver cirrhosis after splenectomy combined with resection of hepatocellular carcinoma

OBJECTIVE: To study the changes of immune function in liver cirrhosis patients after splenectomycombined with resection of hepatocellular carcinoma (HCC).METHODS: Sixteen patients with HCC associated with liver cirrhosis were divided into two groups:splenectomy combined with hepatectomy (splenectomy group n=7) and hepatectomy (non-splenectomygroup, n=9). T lymphocyte subsets such as CD4, CD8, CD4/CD8 and Th lymphocyte cytokines such asinterferon γ (IFN-γ), IL-2, IL-10 in 7 ml peripheral venous blood before operation and 2 months afteroperation were examined and compared between the two groups.RESULTS: There was no significant difference in pre-operative CD4, CD8, CD4/CD8, IL-2, IFN-γ,IL-10 levels in the two groups. Two months after operation, the levels of CD4 (38.2%±3.7%), CD4/CD8(1.7±0.3), IFN-γ (104.4±14.9 pg/ml), 1L-2 (98.6±18.6 pg/ml) were increased and those of CD8(23.7±3.7 pg/ml), IL-10 (55.5±11.2 pg/ml) levels were decreased in the splenectomy group. Thelevels of CD4 (32.5%±4.0%), CD4/CD8 (1.1±0.1), IFN-γ(70.5±12.6 pg/ml), IL-2(80.9±13.5pg/ml) in the non-splenectomy group were much lower than those in the splenectomy group, but the levelsof CD8 (29.4%±4.0%), IL-10 (89.4±10.0 pg/ml) in the non-splenectomy group were significantlyhigher than those in the splenectomy group (P【0.05).CONCLUSIONS: Splenectomy combined with hepatectomy for HCC patients associated with livercirrhosis does not decrease but promote the recovery of T lymphocyte subsets and Th1/Th2 cytokines fromimbalance and improve anti-tumor immune function of the patients.

Liver transplantation for hepatocellular carcinoma:an update

BACKGROUND: Hepatocellular carcinoma (HCC) is a heterogeneous malignancy with multiple etiologies, high incidence, and high mortality. The standard surgical management for patients with HCC consists of locoregional ablation, surgical resection, or liver transplantation, depending on the background state of the liver. Eighty percent of patients initially presenting with HCC are unresectable, either due to the extent of tumor or the level of underlying hepatic dysfunction. While in patients with no evidence of cirrhosis and good hepatic function resection has been the surgical treatment of choice, it is contraindicated in patients with moderate to severe cirrhosis. Liver transplantation is the optimal surgical treatment. DATA SOURCES: PubMed search of recent articles (from January 2000 to March 2011) was performed looking for relevant articles about hepatocellular carcinoma and its treatment. Additional articles were identified by evaluating references from selected articles. RESULTS: Here we review criteria for transplantation, the types, indications, and role of locoregional therapy in treating the cancer and in downstaging for possible later transplantation. We also summarize the contribution of immunosuppression and adjuvant chemotherapy in the management and prevention of HCC recurrence. Finally we discuss recent advances in imaging, tumor biology, and genomics as we delineate the remaining challenges for the diagnosis and treatment of this disease. CONCLUSIONS: Much can be improved in the diagnosis and treatment of HCC. A great challenge will be to improve patient selection to criteria based on tumor biology. Another will be to incorporate systemic agents post-operatively in patients at high risk for recurrence, paying close attention to efficacy and safety. The future direction of the effort in treating HCC will be to stimulate prospective trials, develop molecular imaging of lymphovascular invasion, to improve recipient selection, and to investigate biomarkers of tumor biology.

Comparison of laparoscopic vs open liver lobectomy(segmentectomy) for hepatocellular carcinoma

AIM:To investigate the effects of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma(HCC) .METHODS:From 2006 to January 2011,laparoscopic hepatectomies were performed on 30 cases of HCC at Northern Jiangsu People's Hospital. During this sametime period,30 patients elected to undergo conventional open hepatectomy over laparoscopic hepatectomy at the time of informed consent. The degree of invasiveness and outcomes of laparoscopic hepatectomy compared to open hepatectomy for HCC were evaluated.RESULTS:Both groups presented with similar bloodloss amounts,operating times and complications. Patients in the laparoscopic hepatectomy group started walking and eating significantly earlier than those inthe open hepatectomy group,and these more rapid recoveries allowed for shorter hospitalizations. There were no significant differences between procedures insurvival rate.CONCLUSION:Laparoscopic hepatectomy is beneficial for patient quality of life if the indications are appropriately based on preoperative liver function and the location and size of the HCC.

Risk factors for fatal recurrence of hepatocellular carcinoma and their role in selecting candidates for liver transplantation

BACKGROUND:With the maturation and popularization of skills in liver transplantation (LT), patients with hepatocellular carcinoma (HCC) have an alternative choice. LT as a curative treatment for HCC provides good liver function and systemic condition to recipients. Preoperative tumor characteristics are critical in selecting optimal candidates for LT to optimize the use of donor livers and to achieve a long-term survival. The present study aimed to elucidate the risk factors of HCC involved in fatal recurrence in the first year after LT and to investigate their utility in selecting suitable candidates for LT. METHODS: From April 2002 to October 2005, 303 patients who had received orthotopic LT for HCC were reviewed. Of these patients, those with diffuse intrahepatic or multiple systemic recurrent lesions who died within 1 year after surgery were investigated as fatal recurrence group (48 patients) and the remaining patients including those who were disease-free without recurrence, those who were alive with recurrence in the first year, or those who died in the first year of other causes, served as control group (255). The two groups were compared by demographics, tumor, and histopathological characteristics for their prognostic significance by logistic regression analysis. RESULTS: Multivariate analysis between the fatal recurrence group and the control group showed that the presence of vascular invasion, a tumor size greater than 6.5 cm, and a preoperative serum alpha-fetoprotein (AFP) level greater than 1000 μg/L were risk factors for fatal recurrence. Increased risk factors reduced the suitability of candidates for LT and diminished survival in the first year. 85.71% of the patients with all three risk factors, 37.84% of those with two factors, 13.64% of those with one factor, and 6.71% of those without risk factors died from tumor recurrence within 1 year after transplantation. CONCLUSIONS: Vascular invasion, tumor size ≥6.5 cm, and preoperative serum AFP level ≥1000 μg/L were significant predictors of fatal recurrence after LT for HCC. Patients with two or more risk factors should not be candidates for LT.

Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma:Report of an initial experience

瞄准：报导收到了 sirolimus 的 36 个病人的初步的结果的回顾的分析(SRL， Rapamune， rapamycin ) 在 248 肝的一个连续的队紧密相联的接枝接受者。方法：被换到的有肝细胞癌(HCC ) 的 36 个肝 transplant 病人从 tacrolimus 的基于 SRL 的免疫力的抑制治疗在这研究被注册。是在常位的肝移植( OLT )前推进了 HCC 被诊断的病人被划分成组 A ( n = 11 )，在 OLT 被分配组织 B 以后，被发现到的那些有 HCC 复发或转移( n = 18 )，并且 calcineurin 禁止者( CNI )引起的发达肾机能不全被分到谁的那些组织 C ( n = 7 )在 OLT 以后。结果：病人被跟随在上面为一 10.4 瞬间中部(范围， 3.8-19.1 瞬间) 在到 SRL 治疗和 12.3 瞬间的变换以后(范围， 5.1-34.4 瞬间) 在 OLT 以后。开发的三个病人在开始 SRL 治疗以后的 2 wk，它是充分在氢化尼松以后颠倒了的温和尖锐细胞的拒绝搏动治疗。在组 A，仅仅 1 个病人被发现有 HCC 复发和转移在 OLT 以后的 12 瞬间。在组 B， 66.7%(12/18 ) 病人们(2 与进步肿瘤， 7 与稳定的肿瘤并且 3 没有肿瘤) 由于在 6.8 瞬间柱子变换和 10.7 瞬间柱子 transplant 的中部的后续的结束为 HCC 复发交谈到 SRL 或切除术仍然是活着的。在组 C，没有 HCC 复发在 7 个病人被表明，并且肾的功能在 SRL 治疗以后变得正常。血小板减少(n = 2 ) ，贫血症(n = 8 ) ，并且口头的 aphthous (n = 7 ) 在我们的队发现是容易可管理的。结论：到基于 SRL 的免疫力的抑制的变换可以禁止 HCC 的复发和转移并且与 HCC 在 OLT 病人改进导致 CNI 的肾机能不全。

Metastasis of primary gallbladder carcinoma in lymph node and liver

AIM: To evaluate the patterns with metastasis of gallbladder carcinoma in lymph nodes and liver.METHODS: A total of 45 patients who had radical surgery were selected. The patterns with metastasis of primary gallbladder carcinoma in lymph nodes and liver were examined histopathologically and classified as TNM staging of the American Joint Committee on Cancer.RESULTS: Of the 45 patients, 29 (64.4%) had a lymph node positive disease and 20 (44.4%) had a direct invasion of the liver. The frequency of involvement of lymph nodes was strongly influenced by the depth of the primary tumor(P = 0.0001). The postoperative survival rate of patients with negative lymph node metastasis was significantly higher than that of patients with positive lymph node metastasis (P = 0.004), but the postoperative survival rate of patients with N1 lymph node metastasis was not significantly different from that of patients with N2 lymph node metastasis (P = 0.3874). The postoperative survival rate of patients without hepatic invasion was significantly better than that of patients with hepatic invasion (P= 0.0177).CONCLUSION: Complete resection of the regional lymph nodes is important in advanced primary gallbladder carcinoma (PGC). The initial sites of liver spread are located mostly in segments Ⅳ and V. It is necessary to achieve negative surgical margins 2 cm from the tumor. In patients with hepatic hilum invasion, extended right hepatectomy with or without bile duct resection or portal vein resection is necessary for curative resection.

AFP level and histologic differentiation predict the survival of patients with liver transplantation for hepatocellular carcinoma

BACKGROUND: In liver transplantation or resection for hepatocellular carcinoma (HCC), patient selection depends on morphological features. In patients with HCC, we performed a clinicopathological analysis of risk factors that affected survival after liver transplantation. METHODS: In 389 liver transplantations performed from 2004 to 2010, 102 were for HCC patients. Data were collected retrospectively from the Organ Transplantation Center Database. Variables were as follows: age, gender, preoperative alpha-fetoprotein (AFP) levels, Child-Pugh and MELD scores, prognostic staging criteria (Milan and UCSF), etiology, number of tumors, the largest tumor size, total tumor size, multifocality, intrahepatic portal vein tumor thrombosis, bilobarity, and histological differentiation. RESULTS: One hundred and two patients were evaluated. The 5-year overall survival rate was 56.5%. According to the UCSF criteria, 63% of the patients were within and 37% were beyond UCSF (P=0.03). Ten patients were excluded (one with fibrolamellary HCC and 9 because of early postoperative death without HCC recurrence), and 92 patients were assessed. The mean age of the patients was 56.5±6.9 years. Sixty-two patients underwent living donor liver transplantations. The mean follow-up time was 29.4±22.6 months. Fifteen patients (16.3%) died in the follow-up period due to HCC recurrence. Univariate analysis showed that AFP level, intrahepatic portal vein tumor thrombosis, histologic differentiation and UCSF criteria were significant factors related to survival and tumor recurrence. The 5-year estimated overall survival rate was 62.2% in allpatients. According to the UCSF criteria, and the 5-year overall survival rate was 66.7% within and 52.7% beyond the criteria (P=0.04). Multivariate analysis showed that AFP level and poor differentiation were independent factors. CONCLUSIONS: For proper patient selection in liver trans- plantation for HCC, prognostic criteria related to tumor biology (especially AFP level and histological differentiation) should be considered. Poor differentiation and higher AFP levels are indicators of poor prognosis after liver transplantation.

Hepatocellular carcinoma in patients with non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is the most common chronic liver disease in the United States and represents an increasingly important etiology of hepatocellular carcinoma(HCC) with annual cumulative incidence rates ranging from 2% to 12% in cohorts of NAFLD cirrhosis. While the risk of progression of NAFLD to HCC remains higher among patients with fibrosis or cirrhosis, an increasing amount of literature describes NAFLD-HCC as a disease that can occur in the absence of cirrhosis. Efforts to characterize the pathogenesis of NAFLD-HCC have suggested mechanisms that strongly associate with states of hyperinsulinemia and chronic inflammation, cellular mechanisms including adaptive immune responses and hepatic progenitor cell populations, and genetic polymorphisms including mutations of PNPLA3. Current literature describes NAFLD-HCC mostly as a disease of late presentation with lower rates of receipt of curative therapy and worse prognosis. However, a growing body of evidence has reported comparable and potentially more favorable disease-free and overall survival rates among patients with NAFLD-HCC after receipt of curative treatment. This review summarizes current evidence of epidemiology, pathophysiology, disease presentation, demand and receipt of curative therapy, post-treatment outcomes, and overall survival of NAFLD-associated HCC.

Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman

A 36-year-old woman was admitted to our department for close examination of a liver tumor that was found during a medical checkup. Abdominal US, CT and MRI showed a tumor in segment 7 (S7) of the liver. Although imaging suggested hepatocellular carcinoma, laboratory tests showed no abnormality in liver function, hepatitis virus markers were negative, and tumor markers including protein induced by vitamin K absence or antagonist Ⅱ (PIVKA-Ⅱ), α-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were all within normal ranges. Upon aspiration biopsy of the liver, the histopathological diagnosis was moderately differentiated hepatocellular carcinoma. Therefore, right hepatectomy was performed. Although a part of the tumor was necrotic, about 60% of the viable part showed a clear-cell variant. Consequently, it was diagnosed as clear-cell hepatocellular carcinoma. It was noted that the background liver tissue was normal. This case is worthy of reporting because development of clear-cell hepatocellular carcinoma in the normal liver of a middle-aged woman is rarely seen.