[Lymphoepithelioma-like hepatic carcinoma: the current status and progress].

Lymphoepithelioma-like hepatic carcinoma (LELC) is a rare distinctive variant of liver cancer with unique epidemiological and pathological characteristics, characterized by dense lymphocyte infiltration.It can be divided into lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) and lymphoepithelioma-like cholangiocarcinoma (LEL-CC). The diagnosis is mainly based on pathology, and the treatment is mainly surgery. The prognosis of LELC is good, which may be related to a large number of lymphocyte infiltration. The data of LELC is very limited, only a few case reports and small retrospective studies, which needs further exploration and research. Up to now, 67 cases of LEL-HCC and 34 cases of LEL-CC have been reported. The purpose of this review is to provide a comprehensive overview of the current research situation on LELC in terms of epidemiology, clinical treatment, pathology and research prospects.

[Discussion on diagnosis and treatment of hepatobiliary malignancies during the outbreak of COVID-19].

Objective: From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.

[Clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma].

Objective: To investigate the clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Methods: A total of 379 HCC patients who received partial hepatectomy from January 2010 to December 2013 in Department of Hepatobiliary Surgery of Cancer Hospital, Chinese Academy of Medical Sciences were selected. Based on the nutritional method, all of the enrolled patients were divided into two group: 142 patients who received early enteral nutrition (EEN) combined with parenteral nutrition (PN) were identified as EEN+ PN group; 237 patients who received total parenteral nutrition (TPN) were identified as TPN group. These two groups were even divided into two subgroups, centrally located HCC (cl-HCC) and non-centrally located HCC (ncl-HCC). The clinical effectiveness of different groups was assessed and compared. Results: The age, gender, body mass index (BMI), the maximum diameter of the tumor, the amount of operative bleeding and postoperative infective rate did not show statistically significant differences between EEN+ PN group and TPN group (P>0.05). On the seventh postoperative day (7(th) POD), aspartate transaminase (AST) of EEN+ PN group and TPN group were (41.6±2.0) IU/L and (50.4±3.2) IU/L respectively, and the difference was statistically significant (P<0.05). Alkaline phosphatase (ALP) of these two groups were (80.8±2.4) IU/L and (90.2±2.3) IU/L, respectively, and the difference was statistically significant (P<0.05). Total bilirubin (TBIL) of these two groups were (15.8±0.7) µmol/L and (19.1±0.7) µmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, AST in cl-HCC subgroups of EEN+ PN group and TPN group were (39.6±2.6) IU/L and (61.0±7.0) IU/L, respectively, and the difference was statistically significant (P<0.05). TBIL in cl-HCC subgroups of these two groups were (14.4±0.9) µmol/L and (20.7±1.3) µmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, ALP in ncl-HCC subgroups of these two groups were (79.3±3.0) IU/L and (89.9±3.1) IU/L, respectively, and the difference was statistically significant (P<0.05). The total length of stay (t-LOS) of these two groups were (15.8±0.4) days and (17.1±0.4) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) of these two groups were (8.6±0.2) days and (10.1±0.3) days, respectively, and the difference was statistically significant (P<0.05). Total length of stay (t-LOS) in ncl-HCC subgroups of these two groups were (15.1±0.5) days and (16.6±0.3) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in ncl-HCC subgroups of these two groups were (8.4±0.2) days and (9.5±0.2) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in cl-HCC subgroups of these two groups were (8.7±0.2) days and (11.0±0.8) days, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses of these two groups were (20 855.0±549.8) yuan and (23 373.0±715.5) yuan, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses in cl-HCC subgroups of these two groups were (21 012.0±748.5) yuan and (24 697.0±1 409.0) yuan, respectively, and the difference was statistically significant (P<0.05). Conclusion: EEN+ PN can improve the liver function, shorten the postoperative hospitalization time and reduce the postoperative hospitalization expenses of HCC patients in need of nutritional support.

[A prospective pilot study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas].

Objective: To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications. Methods: A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared. Results: No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05). Conclusion: The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible. Trial registration: National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.

[Analysis of clinicopathological features and prognosis of 98 cases of small hepatocellular carcinoma].

Objective: To analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma. Methods: The clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively. Results: All of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival (OS) period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival (PFS) period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS (P<0.05), and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS (P<0.05). The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma (P=0.003) and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period (P<0.05). Conclusions: The treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.

[Effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellular carcinoma].

Objective: To investigate the effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellular carcinoma (HCC) patients. Methods: A total of 339 patients with primary HCC who underwent curative hepatectomy between January 2003 and December 2010 at the Cancer Hospital, Chinese Academy of Medical Sciences were enrolled. The clinical data of the patients were retrospectively analyzed. These patients were divided into non-transfusion, fresh frozen plasma (FFP) transfusion only and concentrated red cells (CRC) transfusion groups. Disease-free survival and overall survival were estimated using the Kaplan-Meier method, and Cox regression was performed to identify clinicopathological factors related with survival. Results: Among the 339 patients, the 1-, 3- and 5-year disease-free survival rates were 63.1%, 35.4% and 22.4%, respectively, and the median disease-free survival was 22 months. While the 1-, 3- and 5-year overall survival rates were 90.5%, 69.5% and 56.4%, respectively, and the median overall survival was 72 months. The median disease-free survivals of the non-transfusion (n=181), FFP transfusion only (n=48) and CRC transfusion (n=110) groups were 28, 22 and 12 months, respectively, while the median overall survivals of the three groups were 99, 63 and 40 months respectively. Significant differences in the disease-free and overall survivals were observed among the three groups (both P<0.01). Multivariate Cox regression analyses showed that FFP transfusion only (HR=1.658, P=0.026), CRC transfusion (HR=1.470, P=0.030), serum alpha-fetoprotein>400 µg/L (HR=1.686, P=0.002), albumin<35 g/L (HR=1.782, P=0.047), tumor capsule (HR=0.597, P=0.012), tumor necrosis (HR=1.820, P=0.001) and the TNM stage Ⅲ or above (HR=2.537, P=0.000) were independent predictors of overall survival after hepatectomy. Conclusion: Both perioperative FFP only transfusion and CRC transfusion may have detrimental effect on the long-term prognosis of HCC.

[Analysis of the survival of 123 patients with intrahepatic cholangiocarcinoma after surgical resection].

OBJECTIVE: To investigate the prognostic factors for patients with intrahepatic cholangiocarcinoma after surgical resection. METHODS: The clinicopathological and follow-up data of 123 patients with intrahepatic cholangiocarcinoma who underwent surgical resection in Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and June 2015 were collected and reviewed, and their survival and prognosis were analyzed with the Kaplan-Meier method and Cox regression model. RESULTS: The median follow-up time was 22 months and median recurrence-free survival time was 8.97 months. The 1-, 2- and 3-year recurrence rates were 58.6%, 68.9% and 76.5%, respectively. Cox multivariate regression analysis showed that preoperative rise in CEA, lymph node metastasis, multiple lesions, extrahepatic invasion, and combination of tumor necrosis were significant adverse prognostic factors affecting the postoperative recurrence-free survival in patients with intrahepatic cholangiocarcinoma after surgical resection (P<0.05 for all). The median overall survival time was 21.17 months, and the 1-, 3- and 5-year overall survival rates were 76.6%, 33.2% and 26.1%, respectively. The Cox multivariate regression analysis showed that preoperative rise in CEA, lymph node metastasis, multiple lesions, and extrahepatic invasion were significant adverse prognostic factors affecting the postoperative overall survival in patients with intrahepatic cholangiocarcinoma after surgical resection(P<0.05 for all). CONCLUSION: Preoperative rise in CEA, lymph node metastasis, multiple lesions and extrahepatic invasion are significant adverse prognostic factors for patients with intrahepatic cholangiocarcinoma after surgical resection.