DUCK HEPATITIS B VIRUS DNA WITHIN HEPATIC MULTICENTRIC CANCER AND/OR METASTATIC CANCER

Duck hepatitis B vims (DHBV) DNA was detected in different tumorous nodules of ducks with hepatic multicentric cancer or intrahepatic metastasis by Southern blot technique. Among 7 ducks with hepatocellular carcinoma of multiple tumor nodules, the hybridization pattern of Integrated DHBV DNA In different tumorous nodules was identical in 3 cases and different in 2 cases. One case showed a similar hybridization pattern in two tumorous nodules and other one was negative tor DHBV DNA. Integrated DHBV DNA was also identified in a metastatic lung cancer of ducks with hepatocellular carcinoma. The hybridization pattern of metastasis of lungs was as the some as that in primary hepatocellular carcinoma. The same discrete hybridization bands In the different tumorous nodules indicate that these nodules might arise from one transformed cell. The different hybridization patterns In various tumorous nodules show that these tumorous nodules might arise from various transformed cells. The results suggest that the hybridization pattern of different nodules of hepatocellular carcinoma with viral DNA probe could make a cell clone origin marker of tumor nodule to differentiate hepatic multlcentric cancer from Intrahepatic metastatic cancer.

Conversion of Unresectable to Resectable Liver Metastases from Colorectal Carcinoma Using Hepatic Arterial Chronomodulated Chemotherapy: A Case Report and Short Literature Review

Background: The regional chronomodulated hepatic arterial infusion chemotherapy (HAIC) is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, especially for the conversion into resectability. Aim: To demonstrate that chronomodulated HAI triplet chemotherapy according to OPTILIV protocol is well tolerated and displayed high antitumor activity in this heavily-pretreated patient. Case Presentation: A 54 years old patient from Russia was treated for a tumor in the ascending colon presented with 13 hepatic metastases ranging from 0.3 to 2.7 cm in diameter. He underwent a laparoscopic right hemicolectomy, 12 cycles of FOLFIRINOX combined to bevacizumab for the last 5 cycles, resulting in a partial response according to CT scan. It was decided to perform a two-stage hepatectomy at Paul Brousse hospital: left partial hepatectomy allowed the excision of 9 lesions. Radio frequency ablation was performed in 2 nodular lesions. Afterwards, the patient received 5 cycles of chronomodulated triplet chemotherapy into the hepatic artery, according to the OPTILIV protocol design, yet without cetuximab, because of the KRAS mutation in the liver metastases, with a partial re-sponse. The patient could then undergo the second stage of the planned right hepatectomy, which turned out to be an R0 resection followed by receiving three courses of chronomodulated HAIC. Disease progression was documented after 3 months. Chronomodulated FOLFIRI chemotherapy was re-started intravenously, in combination with Aflibercept and it was associated with further disease progression. The genetic analysis of our patient’s cancer revealed a high level of MSI. The patient was included in the Phase 2 CheckMate-142 trial and received nivolumab 3 mg/kg every 2 weeks within 3 months. Treatment was discontinued due to ineffectiveness. Then the patient underwent radiotherapy geared towards reduction of pain. Afterwards, the patient died from the disease progression 2 years after the beginning of treatment. Conclusion: In this article, the authors report a clinical case with chronomodulated HAIC as rescue therapy in a heavily pretreated patient with metastatic colorectal cancer, allowing to achieve an objective response despite prior progression on FOLFIRINOX (the same triplet chemo by IV route). This strategy permitted to overcome drug resistance and to perform further complete resection of the liver me-tastases with prolonged patient survival. Thus, chronomodulated HAI is useful in patients with liver metastases from colorectal cancer and de-serves to be further assessed prospectively in clinical trials chemotherapy.

Target gene prediction and functional analysis of miRNAs differently expressed in colon cancer primary tumors to metastases formed in the liver

Background:Colon cancer is one of the main tumor-related causes of death worldwide and now surgical resection is still the most effective method for the treatment of colon cancer.However,many colon cancers currently lose the opportunity for surgical treatment because of liver metastases.The possible molecular mechanism of liver metastasis of colon cancer can provide ideas for the prevention and treatment of liver metastasis colon cancer.Several studies have recently indicated the regulatory effects of microRNAs(miRNAs)in cancer metastasis.Bioinformatics methods were used to analyze the differentially expressed miRNAs in primary colon cancer tissues and liver metastases.Then the target genes of differentially expressed miRNAs were predicted.By analyzing the biological processes and signaling pathways that the target gene may participate in,we infer the possible molecular mechanisms of liver metastasis of colon cancer and the effects of target genes on prognosis of patients were explored.Methods:The chip data GSE98406 was selected and differentially expressed miRNAs between primary colon cancer and liver metastatic colon cancer were explored by Morpheus.TargetScan and miRanda were used to predict target genes of differentially expressed miRNAs.The gene oncology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed to analyze the biological processes and possible signaling pathways the target genes involved in.Protein-ptotein interaction analysis was performed by String and Cyotscape,the interactions among target genes and hub genes were analyzed.Finally,we explored the effects of differentially expressed miRNAs and their target genes on the prognosis of colon cancer patients.Results:Two differentially expressed miRNAs were screened out,of which miR-122 was upregulated more than 2 folds and miR-143 was downregulated more than twofold in liver metastatic colon cancer.Target genes of miR-122 and miR-143 were mainly involved in energy metabolism.The major signaling pathways involved are epithelial-mesenchymal transition pathways.Ten hub genes were selected by protein interaction analysis.Among them,KRAS,CDK1,CREB1,CS,PC,RAB7A,and CANX were highly expressed in tumor tissues,and CALM1 and MAPK7 were lowly expressed in tumor tissues.The results showed that reduced expression of CS and PC reduced survival of patients with colon cancer.However,the impact of miR-122 and mi-143 on the prognosis of patients with colon cancer is not clear.Conclusion:Differentially expressed miRNAs mainly affect the expression of target genes involved in energy metabolism and cellular transformation in colon cancer.Intracellular metabolic activity is the center of cellular activity,the treatment of metabolic processes in tumor cells may be a new idea for the treatment of tumors.

免疫微环境调控转移性肝癌机制研究进展

转移性肝癌仍是癌症相关死亡的主要原因和挑战。肝脏具有促转移、促侵袭等特性,包含了复杂的免疫系统,该系统对肠肝循环产生的新抗原能够一定程度上抑制免疫。本综述以结直肠癌肝转移为背景,重点讨论转移性癌细胞在肝脏中遇到的免疫微环境,分别从先天性免疫和适应性免疫应答方式阐述免疫微环境在转移性肝癌中的调控,既有利于新型治疗策略的制定,又为临床提供参考。

射频消融治疗肝肿瘤并发症的原因分析及其防治

目的 总结 15 10例次肝癌射频消融治疗并发症的发生原因及其防治对策。方法 对 5 6 3例肝癌患者进行 15 10例次经皮肝穿射频消融治疗 ,通过临床观察 ,分析肝癌射频消融治疗后并发症发生的原因并总结预防处理措施。结果 在15 10例次肝癌射频消融治疗后共发生 14种并发症。最常见的为术后发热、出汗及肝区治疗部位疼痛 ;严重并发症为空腔脏器穿孔 ,腹腔内出血及心血管意外 ,共计 4例 ,其死亡率为 75 %。结论 射频消融治疗中晚期肝癌是新开展的而疗效确切的治疗方法。认真选择适应证 。

转移性肝癌的外科治疗(附208例报告)

目的 探讨转移性肝癌手术治疗效果。方法 回顾性分析我院近7 年来收治的208 例转移性肝癌患者资料,根据治疗方式不同,将其分为切除性手术组(116 例)与非切除性手术组(92 例),比较两组的治疗效果。结果 全组手术无死亡,术后1、3、5年生存率分别为56.3%、23.1%和13.0%。切除性手术组患者1、3、5 年总生存率分别为74.1%、39.7%和23.3%,非切除性手术组患者1、3、5年生存率分别为33.7%、2.2%和0,前者的治疗效果明显好于后者(P<0.05)。结论 切除性手术是转移性肝癌有效的治疗方法,能耐受切除者应力争切除治疗。

三维适形放射治疗肝转移瘤——附10例报告

目的 探讨三维适形放射治疗对肝转移瘤的治疗效果。 方法 1997/ 0 9～ 2 0 0 0 / 0 4采用立体定向适形放射治疗 10例肝转移瘤 (1～ 5个转移灶 )。肿瘤的临床靶体积 (CTV)为 0 .6cm3 ～ 2 32cm3(平均 4 1.9cm3 ) ,计划靶体积 (PTV)周边剂量为每次照射 3.96～ 7.0Gy(平均 5 .2 6Gy) ,PTV中心剂量为每次照射 6 .3～ 10 .88Gy(平均 7.89Gy) ,每天一次 ,每周 5次 ,共 5～ 8次。 结果 病人一般状况的计分标准 (KPS) :术前 2 0～ 90分 (5 4± 2 5 .9分 ) ,术后 30～ 10 0分 (74± 2 3.9分 )。实体瘤疗效标准 :完全缓解(CR) :2例 ;部分缓解 (PR) :4例 ;无变化 (NC) :3例 ;进展 (PD) :1例。

肝癌骨转移的CT影像表现

目的 研究肝癌骨转移的 CT表现 ,提高诊断正确率 ,并评价 CT的诊断价值。材料与方法 回顾性分析 116例肝癌骨转移的 CT影像资料 ,其中有普通 X线脊柱摄影 6 5例 ,MR脊柱扫描 36例。结果 116例中 ,2处或 2处以上的骨转移灶 75例(6 4.6 6 % ) ,骨转移好发部位依次为脊椎、骨盆、肋骨、胸骨、头颅等。主要 CT表现为溶骨性骨质破坏伴软组织肿块。结论 CT能清楚显示转移灶骨破坏范围及对周围组织结构的侵犯情况 ,是诊断骨转移的有效方法 。

伽玛刀治疗大肠癌肝转移近期疗效观察

目的:评价伽玛刀治疗大肠癌肝转移的近期疗效。方法:采用伽玛刀治疗大肠癌肝转移患者30例,根据病变大小和部位选用不同大小的准直器,50%-70%等剂量曲线覆盖整个靶区,单次周边剂量给予3-6Gy,周边总剂量35-50Gy,分割6-12次,每周3-5次。结果:血清CEA由治疗前80.4±10.3ng/L至治疗结束后四周下降为38.4±11.5ng/L(P<0.05),CR 8例,PR 14例,总有效率(CR+PR)为73.3%,肿瘤病灶小于3cm的患者局部控制率较好。随访3个月、6个月、12个月、18个月,生存率分别为96.7%、83.3%、66.7%、43.3%。结论:伽玛刀治疗大肠癌肝转移安全有效,可作为大肠癌肝转移新的治疗手段。

经皮下注射超声造影剂在肝癌前哨淋巴结检测中的价值

目的探讨经皮下注射超声造影剂(SonoVue)在检测兔VX2肝癌前哨淋巴结(sentinel lymph nodes,SLNs)中的应用价值。方法建立兔VX2肝癌模型50只,分别种植在肝左叶(A组)及肝右叶(B组)。经皮下注射SonoVue,肝门部SLNs经超声造影显像,观察SLNs增强特点;经皮下在相同部位注射亚甲蓝(MB);行腹腔探查并清扫淋巴结,统计蓝染淋巴结的数量并送病理检查。结果以蓝染淋巴结为判定SLNs的标准,A、B两组SLNs经皮下超声造影的检出率分别为91.8%(34/37)、88.9%(32/36),两组间比较差异无统计学意义(P>0.05)。以病理结果为标准,经皮下注射超声造影剂判定肝门区前哨淋巴结转移与否的敏感性、特异性、准确性分别为90.5%(38/42)、79.2%(19/24)、86.3%(57/66),与病理结果有良好的一致性(K=0.703,P<0.001)。结论经皮下注射超声造影剂是检测肝癌前哨淋巴结的一种新方法,检测率与肝癌所在位置无关,并将在肝癌前哨淋巴结的识别、诊断中发挥重要作用。

血清TGF-α水平对肝癌临床诊断的意义

目的 :检测血清TGF -α在肝癌临床的应用价值。方法 :采用放射免疫法检测 38例原发性肝癌、16例肝转移癌、2 0例肝硬化及 2 5例正常人的血清TGF -α含量 ,并与AFP值进行比较。数据用x±s表示 ,以正常人x± 2s作为上限计算TGF -α阳性率 ,以 4 0 0 μg/L为上限计算AFP阳性率。 结果 :肝硬化组与正常对照组血清TGF -α比较无显著性差异 (P >0 0 5 )。原发性肝癌组、肝转移组血清TGF -α水平显著高于正常对照组 (分别P <0 0 5、P <0 0 1) ;原发性肝癌Ⅲ期组血清TGF-α水平高于Ⅱ期 ,但无明显差别 (P >0 0 5 ) ;原发性肝癌组肝转移组血清TGF -α水平无显著性差异 (P >0 0 5 ) ;肝转移组血清TGF -α和AFP阳性率分别为 6 8 8%和 0 % ;原发性肝癌组血清TGF -α和AFP阳性率分别为 78 9%和 6 8 4 %。结论 :肝癌患者血清TGF -α明显升高 ,血清TGF -α检测有助于肝癌的诊断、鉴别诊断 ,效果优于AFP 。

彩色多普勒检测转移性肝癌的血流动力学改变

目的 :探讨转移性肝癌 (MHC)的彩色多普勒血流显像 (CDFI)特征。方法 :应用CDFI观察MHC组 6 5例及正常对照组 2 4例 ,测量肝动脉和门静脉内径 ,观察癌灶及肝动脉、门静脉的血流情况 ,检测癌灶内血管及肝动脉的最大血流速度 (Vmax)、阻力指数 (RI)和门静脉的Vmax ,分别对正常组、小肝癌型、结节型及块状型进行对比分析。结果 :癌灶以癌周双重供血为主 ,随着癌灶增大血供增加 ,RI增高 ,三种类型癌灶Vmax均为 30cm/s左右 ,随癌灶增大无明显变化 (P >0 0 5 )。随癌灶增大肝动脉内径、Vmax和RI增加 ,门静脉内径增宽 ,Vmax则逐渐降低。结论 :随着MHC癌灶的增大血供增加 ,但Vmax无明显变化。

应用对比增强和弥散加权MRI鉴别转移性黏液性大肠腺癌和肝脏单纯囊肿的临床价值

目的:探讨应用对比增强和弥散加权MRI鉴别转移性黏液性大肠腺癌和肝脏单纯囊肿的临床价值。方法:选择2010年1月至2018年9月在我院就诊的转移性黏液性大肠腺癌患者43例共107个转移病灶作为研究对象,同时抽取经病理证实的单纯肝囊肿患者31例共78个病灶进行对照研究。所有患者均接受对比增强和弥散加权MRI检查。观察2组患者MRI定性和定量分析资料差异。结果:转移组和单纯囊肿组形态、囊间隔、边缘增强、囊内强化、内容物、T2加权相SI、T1加权相SI、DWI相比较差异有统计学意义(P<0.05)。转移组(≥1cm者共56例)和单纯囊肿组(≥1cm者共37例)病变直径无统计学差异(P>0.05);ADC值、病灶肝ADC比、HBP相SI、HBP相病灶肝SI比相比较差异有统计学意义(P<0.05)。边缘强化(OR=6.082,P=0.001)和囊内强化(OR=9.389,P<0.001)是预测转移性黏液性大肠腺癌的显著自变量。结论:对比增强和弥散加权MRI有助于鉴别转移性黏液性大肠腺癌和肝脏单纯囊肿,边缘增强和囊内增强是鉴别诊断转移性黏液性大肠腺癌的独立MRI征象,对≥1 cm的病灶,定量测量有助于进一步鉴别诊断。

放射介入联合微波消融在转移性肝癌治疗中的应用

目的：探讨采用放射性介入联合微波消融（MWA）治疗转移性肝癌的临床疗效,生存率及安全性评价。方法：选择本院肿瘤外科2010年12月~2011年12月收治的120例转移性肝癌患者,随机分为两组各60例;对照组予超声经皮MWA治疗,联合全身化疗;观察组采用放射介入肝动脉栓塞（TACE）化疗（给予丝裂霉素）治疗,并给予超声经皮MWA治疗;同时给予全身化疗,具体化疗方案与对照组相同。所有患者均于术后2周行彩超、CT或MRI评价消融效果。每3个月复查CT或MRI,比较两组的肿块3个月后的复发率。同时观察患者6个月~3年的生存率。并且观察术后两组的不良反应发生率。结果：经治疗后,观察组的消融效果优于对照组（P〈0.05）;3个月后观察组的肿块复发率低于对照组（P〈0.05）;观察组及对照组的6个月、1年、2年、3年的生存率分别为：91.7%、81.7%、61.7%、20.0%及85.0%、76.7%、53.3%、11.7%,差异均具有统计学意义（P〈0.05）。两组均未见到明显的不良反应发生。结论：采用放射介入联合MWA在转移性肝癌治疗,同时配合全身化疗,临床疗效较高,肿块复发率较低,提高患者6个月、1年、2年、3年的生存率,安全性高。

射频消融治疗小肝癌的疗效观察

目的探讨射频消融对小肝癌（≤5cm）的治疗效果。方法回顾性分析48例小肝癌射频消融治疗患者的临床资料。射频消融治疗术后2周行增强CT，观察灭活效果。随访6个月。7．5年，评价长期疗效。结果术后2周42例患者达到了一次完全灭活，灭活率为87．5％。原发性肝癌患者的1、3、5年生存率分别为88．5％、71．4％、60．0％：转移性肝癌患者生存率分别为75．0％、45．5％、37．5％。两组患者生存率的差异有统计学意义（P=0．002）。结论射频消融治疗能实现小肝癌的有效灭活，尤其对于原发性肝癌疗效较好，具有重要临床应用价值。

经肝动脉栓塞治疗转移性肝癌的方法探讨及疗效分析

目的探讨经肝动脉化疗并栓塞治疗转移性肝癌的方法及效果。方法180例转移性肝癌患者经造影后根据血供情况分别采用单纯灌注化疗(HAI)、化疗并用稠度不同的碘油化疗药乳剂栓塞治疗(TACE),并观察其临床效果。结果临床效果以肝癌和直肠癌肝内转移最佳,有效率分别为87.5%、84.3%。少血管型化疗栓塞组有效率为86.3%,明显高于单纯灌注化疗组的73%(P<0.01)。结论经肝动脉化疗栓塞是治疗转移性肝癌的一种有效方法,对少血供型患者采用稀碘油化疗药乳剂适量栓塞可以明显提高治疗效果。

肺癌肝转移瘤的超声诊断分析

目的 评价超声对肺癌肝转移瘤的诊断价值,进一步提高超声诊断的准确率。方法 回顾200例肺癌肝转移瘤的超声图像并进行分析。结果 200例肝转移瘤中多发病变119例,占59.5％;单发81例,占40.5％。右叶多于左叶,转移瘤大小0.5～9.7cm不等,多数呈圆形或类圆形。高回声型53例,占26.5％;低回声型98例,占49.0％;中等回声及混合回声型分别为32例和17例,占16％和8.5％。结论 肺癌肝转移瘤的超声图像表现呈多样形态,但只要掌握其特点,紧密结合临床大多可明确诊断。

肝脏转移性肿瘤的血管造影表现及临床意义

目的 :分析观察肝脏转移性肿瘤的血管造影形态 ,以便指导对其进行介入治疗。方法 :回顾性分析 2 8例肝脏转移性肿瘤DSA表现 ,原发癌均经病理证实 ,分别为胃癌、胰腺癌、肺癌、大肠癌、食管癌、胆囊癌、恶性胸腺瘤及乳腺癌 ,分别行B超或CT检查肝脏均有实质性占位 ,在介入治疗前常规行腹腔动脉或肝总动脉DSA检查。结果 :本组肝脏转移性肿瘤血供丰富 5例 ,血供中等量 16例 ,血供稀少 7例 ,其血管造影表现为血管增粗、狭窄、扭曲、推移、肿瘤染色、充盈缺损、无门静脉瘤栓亦无动静脉瘘等。结论 :血管造影不仅能反映肝脏转移性肿瘤的血管特征 。

以肝转移为首发表现胃癌的临床及内镜特点

目的 探讨以肝转移癌为首发表现的胃癌的临床及内镜特点。方法 回顾性分析本院 1994年至 1997年 12例胃癌的临床资料。结果 发现这类胃癌的癌灶位于胃体区者多 ;BorrmannⅢ型癌为主 ,且低分化腺癌多 ;血AFP阳性率高 ;误诊率高 ,预后差。结论 以肝转移为首发表现的胃癌不同于一般类型胃癌 ,有其临床及胃镜特点。

彩色多普勒超声在肝脏肿瘤中的诊断价值

目的:探讨彩色多普勒超声在原发性肝癌、转移性肝癌及肝血管瘤鉴别诊断中的临床应用价值。方法:通过112例肝肿瘤患者及38例正常对照组彩色多普勒超声检测参数对比分析,比较原发性肝癌、转移性肝癌及肝血管瘤组间彩色多普勒超声影像学差异及特点。结果:原发性肝癌组肿瘤内部及周边部动脉血供明显丰富(P<0.01),肝动脉直径明显增粗,肝动脉收缩期最大流速和舒张期最小流速明显增高,门静脉血流显著降低,各组阻力指数无显著性差异。结论:彩色多普勒超声检查在原发性肝癌、转移性肝癌及肝血管瘤鉴别诊断中具有重要价值。