Metodologías de Medición de Volumetría Hepática / Methodologies For Measuring Hepatic Volumetry

Lograr determinar el volumen total de un hígado (VHT), o volumetría hepática, pasa a ser de relevancia en diversas situaciones, tales como, vigilancia del progreso de una enfermedad de carácter crónico, planificación de resecciones y trasplantes hepáticos; y observación del clearance hepático de algunos fármacos hepatotropos. La VHT se puede realizar utilizando métodos de segmentación en el curso de una tomografía computarizada (TC), ya sean estos manual, automáticos, y semiautomáticos; mediante resonancia nuclear (RN), utilizando softwares de distintas generaciones (1ª a 4ª). La medición de VHT está indicada en pacientes sometidos a resecciones hepáticas mayores, en el contexto del tratamiento de neoplasias (carcinoma hepatocelular, colangiocarcinoma, metástasis hepáticas o tumores benignos de gran tamaño), abscesos (piogénicos, amebianos), y después de un traumatismo hepático complejo; así como también en la etapa preoperatoria de un trasplante hepático. El objetivo de este manuscrito fue generar un documento de estudio sobre métodos para determinar volumetría hepática.

SUMMARY: Being able to determine the total hepatic volume (THV), or THV, becomes relevant in various situations, such as monitoring the progress of a chronic disease, planning resections and liver transplants; and observation of the hepatic clearance of some hepatotropic drugs. THV can be performed using segmentation methods in the course of a computed tomography (CT), whether manual, automatic, or semi-automated; by nuclear resonance (NR), using software from different generations (1st to 4st). THV measurement is indicated in patients undergoing major liver resections, in the context of treatment of neoplasms (hepatocellular carcinoma, cholangiocarcinoma, liver metastases or large benign tumors), abscesses (pyogenic, amoebic), and after liver trauma complex, as well as in the preoperative stage of a liver transplant. The aim of this manuscript was to generate a study document regarding methods for determine hepatic volumetry.

Economic burden of liver disease in Colombia

Introduction: Liver diseases have a significant impact on global morbidity and mortality rates, primarily attributed to cirrhosis and hepatocellular carcinoma. However, the true extent of their impact on patients, healthcare systems, and countries is often underestimated. Materials and methods: This descriptive, cross-sectional study aimed to determine the economic burden associated with premature deaths caused by cirrhosis and primary liver cancer. The economic assessment was conducted by analyzing potentially productive years of life lost (PPYLL) due to liver diseases in Colombia between 2009 and 2016. Results and conclusions: The total burden of liver disease accounted for 687,861 disability-adjusted life years (DALYs). Men experienced a higher number of years of life lost from mortality (YLL), while women had a greater number of years lived with a disability (YLD). The economic burden of deaths caused by cirrhosis and primary liver cancer exceeded USD 8.6 million, highlighting the urgency to enhance intervention strategies ranging from promotion and prevention to timely diagnosis and treatment.

Introducción: la enfermedad hepática representa una de las principales causas de morbimortalidad a nivel mundial, principalmente por cirrosis y hepatocarcinoma; sin embargo, se subestima su impacto para el paciente, sistema de salud y el país. Materiales y métodos: estudio descriptivo de corte transversal que determinó la carga económica asociada a las muertes prematuras por cirrosis y tumores primarios del hígado, mediante la valoración económica de los años productivos de vida potencialmente perdidos (APVPP) en Colombia y de enfermedad hepática en Colombia entre 2009 y 2016. Resultados y conclusiones: la carga total de enfermedad hepática representó 687,861 años de vida saludable perdidos ajustados por discapacidad (AVAD), los hombres con mayores años de vida perdidos por muerte prematura (APMP) y las mujeres con mayores años vividos con discapacidad (AVD). Las muertes por cirrosis y tumores primarios del hígado representan una carga económica que supera los 8,6 millones de dólares, lo cual refleja la necesidad de fortalecer las estrategias de intervención desde la promoción y prevención hasta el diagnóstico y tratamiento oportuno.

Establishment of a novel co-cultured liver cancer model based on tumor microenvironment / 中华肿瘤杂志

Objective: To construct a new co-cultured liver cancer research model composed of activated hepatic stellate cells (aHSC) and liver cancer cells, explore the efficacy difference between it and traditional model, so as to establish a liver cancer research model in vitro and in vivo that can reflect the real clinical efficacy. Methods: A new co-culture model of liver cancer consisting of aHSC and liver cancer cells was constructed. The differences in efficacy between the new co-culture model and the traditional single cell model were compared by cytotoxicity test, cell migration test, drug retention test and in vivo tumor inhibition test. Western blot was used to detect the drug-resistant protein P-gp and epithelial-mesenchymal transition-related proteins. Masson staining was used to observe the deposition of collagen fibers in tumor tissues of tumor-bearing mice. CD31 immunohistochemical staining was used to observe the microvessel density in tumor tissues of tumor-bearing mice. Results: The cytotoxicity of single cell model and co-culture model was dose-dependent. With the increase of curcumin (CUR) concentration, the cell viability decreased, but the cell viability of single cell model decreased faster than that of co-culture model. When the concentration of CUR was 10 μg/ml, the cell viability of the co-culture model was 62.3% and the migration rate was (28.05±3.68)%, which were higher than those of the single cell model [38.5% and (14.91±5.92)%, both P<0.05]. Western blot analysis showed that the expressions of P-gp and vimentin were up-regulated in the co-culture model, which were 1.55 and 2.04 fold changes of the single cell model, respectively. The expression of E-cadherin was down-regulated, and the expression level of E-cadherin in the single cell model was 1.17 fold changes of the co-culture model. Drug retention experiment showed that the co-culture model could promote drug efflux and reduce drug retention. In vivo tumor inhibition experiment showed that the m-HSC+ H22 co-transplantation model had faster tumor growth and larger tumor volume than those of the H22 single cell transplantation model. After CUR treatment, the tumor growths of m-HSC+ H22 co-transplantation model and H22 single cell transplantation model were inhibited. Masson staining showed that the deposition of collagen fibers in tumor tissues of m-HSC+ H22 co-transplantation model mice was more than that of H22 single cell transplantation model. CD31 immunohistochemical staining showed that the microvessel density in tumor tissue of m-HSC+ H22 co-transplantation model was higher than that of H22 single cell transplantation model. Conclusions: The aHSC+ liver cancer cell co-culture model has strong proliferation and metastasis ability and is easy to be resistant to drugs. It is a new type of liver cancer treatment research model superior to the traditional single cell model.

Thought and practice of long-term management for hepatobiliary and pancreatic malignant tumors / 中华肝胆外科杂志

Radical resection is the only measurement to cure patients of hepatobiliary and pancreatic tumors. The comprehensive application of endoscopy, interventional therapy, radiotherapy and systemic therapy can not only significantly improve the early diagnosis rate of the disease, and successfully transform some borderline resectable tumors into radical resectable states, but also reduce the recurrence rate of tumors after surgery, thus prolonging the survival time of patients. In recent years, the continuous emergence of new systemic therapeutic drugs has brought new opportunities for patients with hepatobiliary and pancreatic malignancies, but the number of doctors participating in diagnosis and treatment has also increased accordingly. Therefore, the contradiction between the division system based on treatment methods and the orderly and standardized treatment is becoming more and more prominent. According to the latest progress of hepatobiliary and pancreatic cancer research at home and abroad, and combined with our clinical experience, we proposed a long-term management concept based on hepatobiliary and pancreatic comprehensive multi-technical team. Based on this concept, we have carried out new thought and practice on the diagnosis and treatment of patients with hepatobiliary and pancreatic malignant tumors.

Prognostic factors of spontaneous rupture hemorrhage in primary liver cancer / 中华肝胆外科杂志

Objective:To explore the independent influencing factors of patients with spontaneous rupture hemorrhage of primary liver cancer (PLC).Methods:A retrospective cohort study was conducted. The clinical data of 128 patients with PLC spontaneous rupture hemorrhage in Ningxia Medical University General Hospital from January 2017 to March 2022 were analyzed, including 108 males and 20 females, aged (53.4±10.6) years. According to different treatment, 128 patients were divided into liver resection group (LR, n=28), interventional group [ n=39, transcatheter arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE)], and conservative group ( n=61). Univariate and multivariate Cox regression was performed to analyze prognostic factors. The LR and TACE groups were subdivided into LR (aLR, n=15), TACE/TAE (aTACE, n=33) and LR+ TACE ( n=19) groups. Kaplan-Meier analysis was performed, and the survival rate was compared by log-rank test. Results:The median survival time of LR group and TACE group was 23 months and 21 months, respectively, with no statistical significance ( P>0.05). The median survival time (38 months) in LR+ TACE group was significantly longer than that in aLR group (10 months) and aTACE group (9 months), and the difference was statistically significant ( P<0.05). Univariate analysis showed that Barcelona Clinical Liver Cancer (BCLC)staging, tumor length ≥10.0 cm, vascular invasion, α-fetoprotein ≥400 μg/L, total bilirubin, prothrombin time and treatment affected overall survival of PLC spontaneous rupture hemorrhage patients (all P<0.05). Multivariate analysis showed that BCLC staging, tumor length ≥10.0 cm, Child-Pugh grade and treatment were independent influencing factors for overall survival of PLC spontaneous rupture hemorrhage patients (all P<0.05). Conclusion:BCLC stage, tumor length ≥10.0 cm, Child-Pugh grade and treatment method are independent predictors of overall survival in patients with spontaneous rupture of PLC. LR combined with TACE therapy can improve the survival and prognosis of patients with spontaneous rupture of primary liver cancer.

Discussion on the surgical technique of laparoscopic anatomical hepatic segmentectomy for hepatocellular carcinoma / 中华肝胆外科杂志

With the continuous development of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma in recent years, laparoscopic anatomical hepatic segmentectomy has become increasingly improved, including anatomical segmentectomy, subsegmentectomy and combined segmentectomy. The above surgical procedures involve a variety of technical means, requiring the surgeon to be familiar with intrahepatic anatomy and possess extensive experience in ultrasound technology and laparoscopic surgery. This article discussed the key techniques of laparoscopic anatomical hepatic segmentectomy for hepatocellular carcinoma based on our clinical practice.

Research progress of liver regeneration after hepatectomy for hepatocellular carcinoma / 中华肝胆外科杂志

Liver is an organ with strong regenerative potential. After trauma, infection, surgery and so on, it will initiate a series of regulation for orderly regeneration to rapidly restore liver function and liver volume and thus maintain normal physiological function. This article summarizes the process of liver regeneration after hepatectomy, the evaluation methods for liver regeneration and the factors affecting liver regeneration, so as to provide references for clinical precision liver surgical treatment.

Integrative treatment for primary liver cancer with tumor thrombosis in hepatic vein or inferior vena cava: a review / 中华肝胆外科杂志

Primary liver cancer is a common malignant tumor. Early liver cancer is suitable for surgical resection, local ablation, liver transplantation and other radical treatment, and the prognosis is better. Patients with advanced liver cancer often have tumor thrombosis in hepatic vein and inferior vena cava. With high rates of recurrence and metastasis, the prognosis is poor. Chinese guidelines recommend multidisciplinary treatment to patients with hepatic vein thrombosis and inferior vena cava thrombosis including local treatment, systematic anti-tumor drug treatment, surgical resection and other treatment. This article reviewed the progress in diagnosis and treatment of primary liver cancer with tumor thrombosis in hepatic vein and inferior vena cava in the past decade.

Efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma.Methods:The clinical data of 58 patients with recurrent hepatocellular carcinoma who underwent surgical treatment from January 2010 to January 2018 at Hunan Provincial People’s Hospital were retrospectively analyzed. There were 50 males and 8 females, ranging in age from 28 to 78 (53.0±10.8) years old. Patients were divided into laparoscopic group ( n=27) and laparotomy group ( n=31) according to different surgical procedures. The differences in operative time, intraoperative blood loss, hospital stay, postoperative anal exhaustion time, postoperative complications and prognosis between the two groups were compared. Results:The intraoperative blood loss of laparoscopy group and laparotomy group were 100.0(50.0, 400.0) ml vs 300.0(100.0, 500.0) ml, the postoperative anal exhaustion time were (2.7±0.6) d vs (3.3±0.6) d, the hospital stay were (14.8±3.8) d vs (21.4±6.3) d, and these differences were statistically significant (all P<0.05). The operative time of the two groups were (243.4±27.2) min vs (217.5±34.7) min, with no statistical significance ( t=0.59, P=0.344). There were no significant differences between the two groups in postoperative complications (bile leakage, abdominal infection, hemorrhage, pleural effusion and hepatic encephalopathy) (all P>0.05); thetumor free survival, 1-year, and 3-year overall survival rates of the two groups were also not significantly different (both P>0.05). Conclusion:Laparoscopic surgery is safe and effective in the treatment of recurrent hepatocellular carcinoma, and its prognosis is similar to laparotomy, its complications are not significantly increased, which is worthy of promotion in clinic.

Mechanism of Bielong Ruangan decoction in treatment of liver cancer based on network pharmacology and molecular docking / 中国医师杂志

Objective:To explore the key targets and mechanism of Bielong Ruangan decoction in the treatment of liver cancer based on network pharmacology and molecular docking.Methods:Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database, PubChem database and PharmMapper database were used to search and screen the chemical components and related targets of Bielong Ruangan decoction and the targets of liver cancer diseases. The network diagram of " Bielong Ruangan decoction-traditional Chinese medicine-active ingredient-predicted target-disease" was constructed; Protein-protein interaction (PPI) network were analyzed through String database; gene ontology (GO) enrichment analysis was performed through WebGestalt database; Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was carried out through KEGG Orthology Based Annotation System (KOBAS) database; Molecular docking of the active components and core target proteins of Bielong Ruangan decoction was carried out by using PyMOL, Auto DockVina and other software.Results:Bielong Ruangan decoction had 67 active components, 154 liver cancer targets and 244 pathways. According to the analysis of network pharmacology, Bielong Ruangan decoction may play an anti-cancer role through key targets such as epidermal growth factor receptor (EGFR), mitogen activated protein kinase 1 (MAPK1), estrogen receptor 1 (ESR1), MAPK8, serine threonine protein kinase 1 (AKT1), MAPK14, cysteine protease 3 (CASP3), cyclin-dependent kinase 2 (CDK2), bone morphogenetic protein 2 (BMP2), aldose reductase (AKR1B1) and other key targets. KEGG enrichment analysis showed that the treatment of liver cancer by Bielong Ruangan decoction involved the regulation of vascular endothelial growth factor (VEGF) signaling pathway, tumor necrosis factor (TNF) signaling pathway, thyroid hormone signaling pathway, T cell receptor signaling pathway and other pathways. The results of molecular docking showed that the binding energy of all compounds to protein was less than -5.6 kcal/mol, indicating that each compound and each protein could bind well.Conclusions:Bielong Ruangan decoction participates in the treatment of liver cancer through " multi-component, multi-target and multi-channel" ways, and plays an anti-cancer role mainly by regulating the proliferation and invasion of tumor cells and tumor inflammatory microenvironment.

Effects of primary location of colorectal cancer on surgical outcome of liver metastases / 中国基层医药

Objective:To analyze the effects of the primary location of colorectal cancer on the surgical outcome of liver metastases.Methods:A cross-sectional study was conducted on 178 patients with liver metastases from colorectal cancer admitted to Binzhou Central Hospital from January 2012 to January 2022. According to whether the patients had recurrence after surgery, they were divided into a recurrence group ( n = 88) and a control group ( n = 90). The general and clinical data were compared between the two groups. Logistic multivariate analysis of the factors with statistical significance was further performed to identify the risk factors of postoperative recurrence of liver metastases from colorectal cancer after surgery. The correlation between the primary location of colorectal cancer and each risk factor was analyzed. The recurrence of colorectal cancer was compared anong patients with different primary locations of colorectal cancer at 12 months after surgery. Results:Primary location at the right colon [55.68% (49/88), lymph node metastasis [92.05% (81/88)], D-dimer ≥ 180 μ g/L, albumin < 29 g/L, ineffective/no neoadjuvant chemotherapy [43.18% (33/38)], and high-risk clinical risk score [53.41% (47/88)] were risk factors for postoperative recurrence of liver metastases from colorectal cancer after surgery ( P = 0.024, 0.019, 0.001, 0.028, < 0.001, 0.001). The primary location of colorectal cancer was positively correlated with lymph node metastasis, D-dimer, and clinical risk score ( P = 0.043, 0.046, 0.030), and negatively correlated with albumin and the efficacy of neoadjuvant chemotherapy ( P = 0.004, 0.033). In 178 patients, the recurrence rate of liver metastases from colorectal cancer at 3 months [53.57% (15/70)], 6 months [55.17% (32/70)], and 12 months [55.68% (49/70)] was significantly higher in the right colon compared with the left colon [32.14% (9/40), 24.14% (14/40), 26.14% (23/40) and the rectum [14.29% (4/68), 20.69% (12/68), 18.18% (16/68)] ( χ2= 4.73, 7.85, 6.27, all P < 0.05). Conclusion:Right colon, lymph node metastasis, D-dimer, albumin, neoadjuvant chemotherapy efficacy, and clinical risk score are the risk factors for postoperative recurrence of liver metastases from colorectal cancer. Patients with the primary location at the right colon have a higher postoperative recurrence rate.

Relationship between peripheral blood lipid level and hepatitis B-related liver cancer / 中国基层医药

Objective:To investigate the relationship between peripheral blood lipid levels and hepatitis B-related liver cancer, and to provide a theoretical basis for the early prevention and treatment of liver cancer.Methods:A total of 188 patients with hepatitis B-related liver cancer who received treatment in The First Hospital of Shanxi Medical University from June 2018 to June 2021 met the inclusion and exclusion criteria and had complete data, were included in this study. They were divided into three groups: chronic hepatitis B group ( n = 72), hepatitis B cirrhosis group ( n = 62), and hepatitis B-related liver cancer group ( n = 54) according to different stages of the disease. All patients' medical records were obtained from the medical data room. Fasting venous blood was collected in all patients on the second day after admission to detect peripheral blood lipid, liver function, and other relevant indicators. General data and biochemical indicators were collected. The Kruskal-Wallis test was performed to compare the measurement data among groups. The chi-squared test was performed to compare the count data among groups. Spearman's correlation (bivariate) was performed. Binary logistic regression was performed to analyze the influential factors of liver cancer. Results:There were significant differences in the levels of total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) among the three groups ( F = 32.14, 27.59, 10.88, 34.09, all P < 0.05). TC and LDL-C levels in the hepatitis B-related liver cancer group were significantly higher than those in the hepatitis B cirrhosis group ( F = -32.31, -50.19, both P < 0.05). There were no significant differences in TG and HDL-C levels between hepatitis B-related liver cancer and hepatitis B cirrhosis groups ( F = -10.69, 4.46, both P > 0.05). TC, TG, HDL-C and LDL-C levels in the hepatitis B cirrhosis group were significantly lower than those in the chronic hepatitis B group ( F = 53.30, 46.98, 24.61, 48.57, all P < 0.05). LDL-C level was positively correlated with the occurrence of liver cancer ( r = 0.20, P < 0.05). HDL-C level was negatively correlated with the occurrence of liver cancer ( r = -0.15, P < 0.05). LDL-C was an independent risk factor for liver cancer ( OR = 3.35, P < 0.05), and HDL-C was a protective factor for liver cancer ( OR = 0.12, P < 0.05). Conclusion:Compared with patients with chronic hepatitis B and hepatitis B cirrhosis, patients with hepatitis B-related liver cancer had abnormal peripheral blood lipid levels, which may be related to the abnormal lipid metabolism of tumor cells. Moreover, peripheral blood lipid levels may affect the occurrence and development of tumor cells.

Role of lipopolysaccharide in the development and progression of liver cancer / 临床肝胆病杂志

Liver cancer is an important public health issue worldwide. With the improvements in high-throughput sequencing and gene editing techniques in recent years, studies have further revealed the biological mechanism of intestinal microflora in the development, progression, and metastasis of liver cancer via the gut-liver axis, and in particular, it has been found that lipopolysaccharide, a component of the outer membrane of gram-negative bacteria, can cause downstream immune cascade reactions. This article reviews the possible mechanism of action of intestinal microflora lipopolysaccharide in the development and progression of liver cancer from the aspects of the association between intestinal environmental changes and liver cancer, immunoregulation by lipopolysaccharide, and preclinical treatment.

Research advances in natural killer cell-based immunotherapy in liver cancer / 临床肝胆病杂志

Natural killer (NK) cells are important immune cells in the human body and are also the main lymphocytes in the liver. They are considered the first defense mechanism against tumor and have a significant impact on the development and progression of liver cancer. The characteristics of NK cells help them become a new choice for immunotherapy, and NK cell-based immunotherapy may succeed in the treatment of liver cancer. This article reviews the biological characteristics of NK cells, their role in the development and progression of liver cancer, and the research advances in related treatment.

Association between immune checkpoint inhibitor antitumor therapy and hepatitis B virus reactivation / 临床肝胆病杂志

In recent years, monotherapy and combination therapy with immune checkpoint inhibitors (ICIs) have achieved good efficacy in a variety of malignancies from solid tumors to lymphomas and have become a standardized and systematic treatment modality for many cancers. However, there is still a lack of studies on the safety of ICIs in hepatitis B virus (HBV)-infected patients with malignancies, and early studies have reported HBV reactivation due to ICI antitumor therapy in clinical practice. With reference to related literature, this article reviews the recent clinical trials and application of ICIs in cancer patients with chronic viral infection and clarifies the efficacy and safety of ICIs in this special population, in order to provide a reference for clinical medication.

Association of folic acid with the development and progression of liver cancer / 临床肝胆病杂志

So far, liver cancer is still a highly malignant tumor with a high incidence rate in China, and it seriously affects the life and health of Chinese people. Previous studies have shown that the development of liver cancer is associated with various factors such as virus, smoking, drinking, and nonalcoholic fatty liver disease. With continuous exploration, more and more studies have pointed out that nutritional factors and living environment are associated with the development and progression of liver cancer. Folic acid is a necessary nutrient for cell growth and reproduction, and its level in human body has an impact on the growth of tumor cells and is closely associated with liver cancer. This article reviews the research advances in the association between folic acid and liver cancer in recent years, so as to provide new reference and basis for the prevention and treatment of liver cancer.

Safety and efficacy of camrelizumab added to second-line therapy after drug-eluting bead transarterial chemoembolization combined with apatinib for unresectable hepatocellular carcinoma / 临床肝胆病杂志

Objective To investigate the safety and efficacy of camrelizumab added to second-line therapy after drug- eluting bead transarterial chemoembolization (DTACE) combined with apatinib for unresectable hepatocellular carcinoma (HCC). Methods A retrospective analysis was performed for 89 HCC patients with camrelizumab added to second-line therapy who attended The First Affiliated Hospital of Zhengzhou University from December 2019 to December 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) after the application of camrelizumab, and the secondary endpoints were objective remission rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs). The Kaplan-Meier method was used to plot survival curves, the Log-rank test was used for stratified analysis of subgroups based on baseline characteristics, and the influencing factors for prognosis were analyzed. Results A total of 89 patients were screened and followed up in this study. The patients were followed up to December 2021, with a median follow-up time of 16 months, a median OS time of 17.0 (95% confidence interval [ CI ]: 15.3-18.7) months, and a median PFS time of 7.0 (95% CI : 6.2-7.8) months. There were significant differences in OS and PFS between the patients with different ECOG-PS scores, liver function Child-Pugh classes, portal vein invasion, patterns of progression, times of DTACE treatment, durations of oral administration of apatinib, and durations of application of camrelizumab (all P 4 months had significant improvements in median OS [21.0 (95% CI : 19.1-22.9) months vs 14.0 (95% CI : 10.4-17.6) months, χ 2 =19.399, P 5 months had significant improvements in median OS [22.0 (95% CI : 20.2-23.8) months vs 13.0 (95% CI : 9.3-16.7) months, χ 2 =22.336, P < 0.001] and PFS [9.0 (95% CI : 7.0-11.0) months vs 5.0 (95% CI : 4.1-5.9) months, χ 2 =26.141, P < 0.001]. Post-embolization syndrome was the adverse event after DTACE and resolved after symptomatic treatment. Adverse reactions related to targeted drugs and immunotherapy all resolved after symptomatic supportive treatment, with no grade ≥4 adverse reactions, and no patients withdrew from target-free therapy due to TRAEs. Conclusion As for DTACE combined with apatinib in the treatment of unresectable HCC, camrelizumab added after progression has a marked therapeutic efficacy with safe and controllable TRAEs.

Expression of peripheral CD100 and its regulation to T lymphocytes function in patients with hepatocellular carcinoma / 临床肝胆病杂志

Objective To investigate the changes of peripheral CD100 in patients with hepatocellular carcinoma (HCC), and to assess the regulatory function of CD100 to T lymphocytes in HCC patients. Methods A prospective study was conducted. Fifty-seven HCC patients and twenty-two controls who were hospitalized in our hospital between April 2020 and July 2021 were enrolled. Anti-coagulant peripheral blood was collected. Plasma and peripheral blood mononuclear cells (PBMC) were isolated. Plasma soluble CD100 (sCD100) level was measured by enzyme-linked immunosorbent assay. Membrane-bound CD100 (mCD100) expression on CD4 + and CD8 + T lymphocytes was measured by flow cytometry. PBMC from HCC patients were stimulated with recombinant human CD100. Cellular proliferation was measured by cell counting kit-8. Different types of T helper cells (Th cells) and cytotoxic T cells (Tc cells) were assessed by flow cytometry. Perforin and granzyme B secretion by alpha fetoprotein (AFP) specific CD8 + T lymphocytes was assessed by enzyme-linked immunospot assay. CD8 + T lymphocytes were purified from HCC patients, and were stimulated with recombinant human CD100. Stimulated CD8 + T lymphocytes were co-cultured with HepG2 cells. AFP specific CD8 + T lymphocytes-induced HepG2 cell death was investigated. Student's t test or paired t test was used for comparison of normally distributed continuous data between two groups. Mann-Whitney U test was used for comparison of abnormally distributed continuous data between two groups. Chi square test was used for comparison of categorial data between two groups. Results Plasma sCD100 level was lower in HCC group when compared with control group ((2.73±0.58)ng/mL vs(3.33±0.84)ng/mL, t =3.584, P 0.05). The percentages of CD4 + IFNγ + Th1 cells, CD4 + IL-17A + Th17 cells, CD4 + IL-22 + Th22 cells, and CD8 + IFNγ + Tc1 cells were notably increased in response to CD100 stimulation when compared with no CD100 stimulation ( t =2.608、5.663、4.113、4605, all P 0.05). Perforin and granzyme B secretion by AFP specific CD8 + T lymphocytes were significantly elevated in response to CD100 stimulation when compared with no CD100 stimulation in HLA-A02 restricted HCC patients ( P < 0.05). AFP specific CD8 + T lymphocytes-induced HepG2 cell death was also increased in response to CD100 stimulation ( t =6.794、2.308, both P < 0.05). Conclusion There was an imbalance between sCD100 and mCD100 on T lymphocytes in HCC patients. Reduced sCD100 level might be insufficient for maintenance of T lymphocytes activity, leading to the immunotolerance in HCC.

The clinical effect of stereotactic radiation therapy combined with sorafenib in the treatment of primary hepatic cancer / 中国医师进修杂志

Objective:To investigate the clinical effect of stereotactic radiation therapy combined with sorafenib in the treatment of primary hepatic cancer (PHC).Methods:Ninety-two PHC patients admitted to Cancer Hospital of China Medical University from January 2017 to May 2018 were selected and divided into the observation group and the control group according to the random number table method, with 46 cases in each group. The control group was treated with stereotactic radiation therapy, and the observation group was treated with sorafenib on the basis of the control group. Clinical efficacy and incidence of adverse reactions in the two groups were compared; the scores of Karnofsky performance scale (KPS) and the levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducing factor (HIF-1α), soluble interleukin-2 receptor (sIL-2R), transforming growth factor (TGF-β1) and alpha-fetoprotein (AFP) before and after the treatment between the two groups were compared. The overall survival (OS) of patients in both groups was recorded after 36 months of follow-up.Results:The total effective rate in the observation group was higher than that in the control group: 84.78%(39/46) vs. 65.22%(30/46), there was statistical difference ( χ2 = 4.70, P<0.05). After the treatment, the score of KPS in the observation group was higher than that in the control group: (85.06 ± 7.19) scores vs. (71.16 ± 7.08) scores; the levels of VEGF, bFGF, HIF-1α, AFP, TGF-β1, sIL-2R in the observation group were lower than those in the control group: (189.52 ± 31.47) ng/L vs. (235.81 ± 35.45) ng/L, (3.89 ± 0.97) ng/L vs. (6.74 ± 1.85) ng/L, (50.17 ± 6.09) ng/L vs. (53.07 ± 6.28) ng/L, (85.76 ± 14.09) μg/L vs. (131.51 ± 18.74) μg/L, (81.07 ± 12.96) μg/L vs. (106.58 ± 15.07) μg/L, (311.58 ± 74.81) kU/L vs. (405.97 ± 85.74) kU/L, there were statistical differences ( P<0.05). The results of 36 months follow-up showed that the 1-year and 3-year OS in the observation group were higher than those in the control group: 69.57% (32/46) vs. 58.70% (27/46), 43.47% (20/46) vs. 28.26 %(13/46), there were significant differences ( χ2 = 4.78, 3.94, P<0.05). Conclusions:Stereotactic radiation therapy combined with sorafenib can effectively improve the efficacy of PHC patients, reduce the expression of VEGF and bFGF, effectively inhibit tumor growth, but also prolong the survival time of patients, with both safety and high effectiveness, and good use value.

Risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma and construction of prediction model / 中华消化外科杂志

Objective:To investigate the risk factors for posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma and construction of prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 116 patients with hepatocellular carcinoma who underwent hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from January 2019 to January 2022 were collected. There were 99 males and 17 females, aged (59±10)years. Observation indicators: (1) occurrence of PHLF; (2) analysis of factors influencing the occurrence of PHLF; (3) construction and evaluation of prediction model for PHLF. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distri-bution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The regression coefficient was used to construct the prediction model. The receiver operating characteristic curve was drawn, and the area under curve (AUC) was used to evaluate the predictive ability of prediction model. Results:(1) Occurrence of PHLF. Of the 116 patients, there were 27 cases with PHLF and 89 cases without PHLF, respectively. Of the 27 patients with PHLF, 13 cases underwent laparoscopic hepatectomy and 14 cases underwent open hepatectomy. (2) Analysis of factors influencing the occurrence of PHLF. Results of multivariate analysis showed preoperative portal vein tumor thrombus and preoperative indocyanine green retention at 15 minutes (ICG R15) ≥10% were independent risk factors influencing the occurrence of PHLF ( odds ratio=13.463, 4.702, 95% confidence interval as 3.140-57.650, 1.600-13.800, P<0.05). (3) Construction and evaluation of prediction model for PHLF. According to the multivariate analysis, preoperative portal vein tumor thrombus and preoperative ICG R15 were included to construct the prediction model for predicting the occurrence of PHLF in patients with hepatocellular carcinoma. The AUC, sensitivity, specificity of prediction model was 0.750 (95% confidence interval as 0.654-0.846, P<0.05), 0.551, 0.852, respectively. Conclusions:Preoperative portal vein tumor thrombus and preoperative ICG R15 ≥10% are independent risk factors influen-cing the occurrence of PHLF. The prediction model based on these two factors has good efficacy in predicting PHLF of patients with hepatocellular carcinoma.