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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.
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Objective To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation. Methods Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model. Results The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001)and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients. Conclusions The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C.
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Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.
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Objective To explore the relationship between the values of total tumor perfusion parameters in primary hepatocellular carcinoma and tumor volume and peritumoral perfusion parameters,and analyze its correlation with liver ChildPugh classification.Methods Forty-seven patients with primary liver cancer in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2015 were selected to perform 320 row volume CT perfusion imaging.The parameters of hepatic artery perfusion(HAP),portal vein perfusion(PVP) and hepatic perfusion index(HAPI) in tumor and peritumoral liver tissues were calculated based on total tumor measurement.The relationship between tumor perfusion parameters and ChildPugh classification of liver function,tumor volume and total tumor perfusion parameters,total tumor perfusion parameters and peritumoral perfusion parameters were analyzed.Results There was no correlation between tumor volume and total tumor perfusion parameters,peritumoral perfusion parameters (P ＞ 0.05),and there was no correlation between total tumor perfusion parameters and peritumoral perfusion parameters(P ＞0.05).There were significant differences between HAP,PVP and HAP of total tumor perfusion in different liver Child-Pugh classifications(P ＜ 0.05).With the increase of Child-Pugh classification of liver function,the HAP and HAPI of tumor gradually increased while PVP gradually decreased (P ＜ 0.05).Conclusions There is no correlation between tumor volume,total tumor perfusion parameters and peritumoral perfusion parameters.There is also no correlation between total tumor perfusion parameters and peritumoral perfusion parameters.There are significant differences in perfusion parameters between different Child-Pugh classifications of liver function,and the perfusion parameters obtained by the total tumor measurement can be used as the imaging indexes to reflect liver reserve function.
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Objective To understand the relationship between the changes of coagulation function ,platelet parameters and retic‐ulocyte parameters with the Child‐Pugh grade in the patients with liver cirrhosis .Methods The coagulation function index (PT , APTT ,Fig ,TT) ,platelet parameters(PLT ,MPV ,PDW ,PCT) and reticulocyte parameters(RET# ,RET% ,IRF) were detected in 163 patients with liver cirrhosis and 50 healthy controls by using the automatic hematological analyzer and the automatic blood co‐agulation analyzer .Then the changes of coagulation function ,platelet parameters and reticulocyte parameters were compared be‐tween the liver cirrhotic group and the control groups ,and among different Child‐Pugh grade groups .Results Compared with the control group ,Fig in the liver cirrhosis group was declined ,PT ,APTT and TT were prolonged ,PLT and PCT was decreased ,while MPV and PDW were elevated ,RET count ,RET% and IRF were increased ,the difference between the two groups were statistically significant(P<0 .05);Fig was gradually declined with the Child‐Pugh grade elevation ,PT ,APTT and TT were prolonged ,PLT and PCT was decreased ,while MPV and PDW were increased with the Child‐Pugh grade elevation ,and RET count ,RET% and IRF were increased (P<0 .05) .Conclusion The blood coagulation disturbance and abnormality of platelet parameters and reticulocyte parameters exist in the patients with liver cirrhosis .The changes of coagulation function ,platelet parameters and reticulocyte param‐eters are closely related to the Child‐Pugh classificatione ,which are the important indicators for judging the liver damage ,bleeding tendency and bone marrow hematopoietic function in the patients with liver cirrhosis .
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Objective To assess the use of human albumin (ALB) after hepatectomy in hepatocellular carcinoma patients in our hospital .Methods 150 hospital medical records from June 2012 to June 2013 were analyzed ,which used the human ser-um albumin during the perioperative period of hepatectomy at hepatocellular carcinoma (preoperative Child-Pugh A or B) retro-spectively ,the rationality of human blood albumin use was evaluated .Results Among the 150 medical records ,the total appli-cation amount of albumin was 11 212 .5 g (897 bottles) ,the total cost was 527 ,744 yuan ,nearly 20 percent of total drug costs ,accounting for nearly 10% of the total cost of hospitalization .By using human serum albumin after surgery ,the patients'liver function was significantly improved (P<0 .05) ,there was a positive correlation between the Child-Pugh score and dosage of human albumin (P<0 .05) .Conclusion The use of human serum albumin was rational during the perioperative period of hepatectomy in hepatocellular carcinoma patients in our hospital ,which had achieved the desired therapeutic effect .
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Objective To observe the correlation between vitamin D and liver cirrhosis classification in hepatic diabetes.Methods Thirty-eight patients with hepatic diabetes,48 patients with type 2 diabetes and 30 cases of healthy controls were collected.The level of serum 25-(OH)D3 was determined,and the Child-Pugh score was calculated.The correlation between pathogenesis and pathogenetic condition of hepatic diabetes was analyzed.Results The levels of serum 25-(OH)D3 in hepatic diabetes patients,type 2 diabetes patients and healthy controls were (38.23 ± 12.47),(63.33 ± 13.58) and (86.14 ± 16.25) μ mol/L,and there was statistical difference (P ＜ 0.05).There was negative correlation in hepatic diabetes between serum 25-(OH)D3 level and liver cirrhosis Child-Pugh score (r =-0.363,P ＜ 0.05).Conclusion Low level of vitamin D may be one of the pathogenesis of hepatic diabetes.
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Objective To investigate the relationship of the nutritional status with liver function and clinical outcomes of liver cancer patients treated with surgery.Methods Altogether 112 hospitalized patients undergoing surgical treatments for liver cancer were enrolled from October 2011 to October 2013.Their general clinical data were collected,including creatinine-height index (CHI),arm circumference,grip strenghth,albumin,prealbumin,and transferrin.The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA).The liver function was assessed with Child-Pugh classification.Postoperative infectious complications and the hospital stays were recorded to assess the clinical outcomes.The correlation between nutritional status and liver function,and that between nutritional status and clinical outcomes were analyzed.Results Among the 112 patients,70 (62.5％) were in normal nutritional status,34 (30.4％) were with moderate malnutrition,and 8 (7.1％) were with severe malnutrition according to PG-SGA scores.PG-SGA assessment showed strong consistence with CHI nutritional assessment (κ =0.760,P =0.000),and moderate consistence with arm circumference assessment (κ =0.564,P =0.000),and grip strength assessment (κ =0.523,P =0.000).The live function classified by Child-Pugh was found highly correlated with PG-SGA assessment (rs =0.829,P =0.000).Postoperative infectious complications and hospital stays were both positively correlated with PG-SGA assessment (r =0.349,P =0.000 ; r =0.624,P =0.000).Conclusions PD-SGA combining with CHI can be used for the nutritional status assessment of liver cancer patients undergoing surgical treatments.The nutritional status of the patients has positive correlation with live function,infectious complications,and postoperative hospital stays.
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Objective: To establish a scoring formula of liver injury (SFLI) using matter-element analysis, so as to provide evidence for preoperative assessment and treatment of patients with liver cirrho sis diseases. Methods: The preoperative serum biochemical indicators of liver cirrhosis patients were collected, including albumin (ALB), prealbumin (PA), total bilirubin (TBIL), serum creatine (SCr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GT), alkaline phosphatase (ALP), prothrombin time (PT), prothromb in time-international normalized ratio (PT-INR),activated partialthromboplastin time (APTT), and thrombin time (TT). The matter-element analysis was used to establish SFLI, and the results were compared with those of Child liver function system to create SFLI scores. Results: An SFLI was successfully established. The scores of cirrhosis extents were expressed as the R value, which gradually decreased with the aggravation of cirrhosis. R = 1 represented the normal liver tissue; 0. 770≤R
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BACKGROUNDS/AIMS: Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. METHODS: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrast- enhanced echocardiography. Significant shunt was defined as a shunt of grade >or= 2. RESULTS: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p < 0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. CONCLUSION: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Echocardiography , English Abstract , Hepatopulmonary Syndrome/etiology , Liver Cirrhosis/physiopathology , Liver Transplantation , Pulmonary Circulation , Risk FactorsABSTRACT
Objective To study the practical value of serum prealbumin and butyrylcholinesterase in Child-Pugh classification of liver cirrhosis. Methods 66 serum samples of patients with liver cirrhosis and 50 serum samples of the healthy subjects were collected for detecting prealbumin (PA) level and butyrylcholinesterase (BuChE) activity, as well as hepatic functional indices(serum albumin, total bilirubin and alanine aminotransferase). The patients were classified according to the Child-Pugh score. Results Compared with healthy subjects, the content of PA and the activity of BuChE significantly decreased in the patients with liver cirrhosis. According to the Child-Pugh classification, PA content and BuChE activity in different grades of liver cirrhosis varied obviously. Conclusion The content of serum PA and the activity of serum BuChE had an important guiding significance in diagnosing the extent of liver cirrhosis, which can serve as effective indices for diagnosis of patients'condition and prognostic evaluation of liver cirrhosis.
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Objective To investigate the feasibility of L-[1- 13 C]phenylalanine breath test to assess liver function and determine the effective parameters of the test for quantitative assessment of liver function in adult. Methods Twelve healthy volunteers served as control group, and 26 liver cirrhotic patients with hepatitis B were divided into three groups, 10 patients in Child-Pugh classification A, 8 in B and 8 in C, An oral dose of 100 mg of nonradiative tracer L-[1- 13 C]phenylalanine were administered to all the subjects. Breath samples were taken before and different intervals within 360 min after administration. 13 CO_2 enrichment was measured by isotope ratio mass spectrometer. Results After the oral administration of L-[1- 13 C] phenylalanine, 13 C excretion reached a peak within 10-30 min. The parameters of 13 CO_2 excretion rate at 30 min ( 13 CO_2ER_ 30 ) , 13 C cumulative excretion of 60 min ( 13 C_ cum60 ), 75 min( 13 C_ cum75 ), 90 min( 13 C_ cum90 ) and 13 CO_2 half excretion time ( t _ 1/2 ) were shown sensitive, which could differentiate significantly the groups( P
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700 mL/min).Conclusion The CLh-s could be correlated with operation complications,and be considered as an effective supplement to evaluate hepatic functional reserve when combined with ICGR15 and Child-Pugh classification. It could be used to evaluate liver functional reserve more effectively and reliably.