Effects of parenteral nutrition without and with growth hormone on growth hormone/insulin-like growth factor-1 axis after hepatectomy in hepatocellular carcinoma with liver cirrhosis.

BACKGROUND: Complex alterations in the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis are thought to play an important role in the protein catabolism that complicates major surgical procedures. The aim of this study was to evaluate the potential roles of recombinant human growth hormone (rhGH) therapy after hepatectomy in hepatocellular carcinoma (HCC) with liver cirrhosis, and to investigate whether postoperative administration of rhGH increases the risk of tumor recurrences. METHODS: Twenty-four patients with HCC in the setting of cirrhosis who underwent hepatectomy were randomly divided into 2 groups: parenteral nutrition (PN) group (n = 12) and rhGH + parenteral nutrition group (n = 12). Liver function, serum GH, IGF-1, and IGF binding protein-3 (IGFBP-3) were measured before operation, at postoperative days (POD) 1 and 6. IGF-1 and IGFBP-3 mRNA in liver tissue was measured by reverse transcriptase polymerase chain reaction. Liver Ki67 immunohistochemistry staining was studied. At the same time, 12 patients with cholelithiasis or liver hemangioma who underwent operation were segregated as a normal control. RESULTS: On POD 6, compared with the PN group, serum prealbumin, GH, IGF-1, IGFBP-3, hepatic IGF-1 mRNA, IGFBP-3 mRNA, and liver Ki67 LI were higher in rhGH + PN group. The 6- and 12-month tumor-free survival rates, a median tumor-free survival time, were not different between the PN and rhGH + PN group. CONCLUSIONS: rhGH + PN can ameliorate changes in the GH/IGF-1 axis after hepatectomy for HCC in the setting of cirrhosis.

Expression of albumin, IGF-1, IGFBP-3 in tumor tissues and adjacent non-tumor tissues of hepatocellular carcinoma patients with cirrhosis.

AIM: To explore the expression of albumin (ALB), insulin-like growth factor (IGF)-1, and insulin-like growth factor binding protein (IGFBP)-3 in tumor tissues and adjacent non-tumor tissues of hepatocellular carcinoma (HCC) patients with cirrhosis. METHODS: Twenty-four HCC patients with cirrhosis who underwent hepatectomy were studied. ALB mRNA, IGF-1 mRNA, and IGFBP-3 mRNA in liver tissues (including tumor tissues and adjacent non-tumor tissues) were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Liver Ki67 immunohistochemistry staining was studied. At the same time, 12 patients with cholelithiasis or liver angioma who underwent operation were segregated as normal control. RESULTS: In HCC patients with cirrhosis, hepatic ALB mRNA, IGF-1 mRNA, and IGFBP-3 mRNA of tumor tissues or adjacent non-tumor tissues were lower than the normal liver tissues, while in tumor tissues, hepatic ALB mRNA and IGFBP-3 mRNA were lower, hepatic IGF-1 mRNA was higher than in adjacent non-tumor tissues. Liver Ki67 labeling index (Ki67 LI) in tumor tissues or adjacent non-tumor tissues were higher than that in the normal liver tissues, while in tumor tissues it was higher than that in adjacent non-tumor tissues. CONCLUSION: Imbalance of IGF-1 and IGFBP-3 may play a role in hepatocarcinogenesis and tumor development of liver cirrhosis patients.

Surgical treatment of hepatocellular carcinoma with bile duct tumor thrombi.

AIM: To study the surgical treatment effect and outcome of hepatocellular carcinoma (HCC) with bile duct tumor thrombi (BDTT). METHODS: Fifty-three consecutive HCC patients with BDTT admitted in our department from July 1984 to December 2002 were reviewed retrospectively. The clinical data, diagnostic methods, surgical procedures and outcome of these patients were collected and analyzed. RESULTS: One patient rejected surgical treatment, 6 cases underwent percutaneous transhepatic cholangial drainage (PTCD) for unresectable primary disease, and the other 46 cases underwent surgical operation. The postoperative mortality was 17.6%, and the morbidity was 32.6%. Serum total bilirubin levels of these patients with obstructive jaundice decreased gradually after surgery. The survival time of six cases who underwent PTCD ranged from 2 to 7 mo (median survival of 3.7 mo). The survival time of the patients who received surgery was as follows: 2 mo for one patient who underwent laparotomy, 5-46 mo (median survival of 23.5 mo, which was the longest survival in comparison with patients who underwent other procedures, P = 0.0024) for 17 cases who underwent hepatectomy, 5-17 mo (median survival of 10.0 mo) for 5 cases who underwent HACE, 3-9 mo (median survival of 6.1 mo) for 11 cases who underwent simple thrombectomy and biliary drainage, and 3-8 mo (median survival of 4.3 mo) for four cases who underwent simple biliary drainage. CONCLUSION: Jaundice caused by BDTT in HCC patients is not a contraindication for surgery. Only curative resection can result in long-term survival. Early diagnosis and surgical treatment are the key points to prolong the survival of patients.

[Effects of amino acid solution and recombinant human growth hormone on growth hormone/insulin like growth factor-1 axis in rats with liver cirrhosis].

OBJECTIVE: To explore the effects of amino acid solution and recombinant human growth hormone on growth hormone/insulin like growth factor-1 (GH/IGF-1) axis after partial hepatectomy in rats with liver cirrhosis. METHODS: Six normal rats severed as normal group, while 30 rats with liver cirrhosis were randomly divided into preoperation group, 1 day postoperative group, 8.5% Novamin PN for 5 days postoperative group, 10% Hepa PN for 5 days postoperative group and rhGH + 10% Hepa PN for 5 days postoperative group. Liver function, blood glucose and serum GH, IGF-1, IGFBP-3 were determined. ALB mRNA, IGF-1 mRNA and IGFBP-3 mRNA levels in liver tissues were detected by RT-PCR. Liver Ki67 immunohistochemistry staining was studied. RESULTS: Compared with the 8.5% Novamine PN group, serum ALT [(103 +/- 23) IU/L vs (154 +/- 45) IU/L], ALP [(571 +/- 92) IU/L vs (972 +/- 252) IU/L], GH [(1.55 +/- 0.12) ng/ml vs (1.81 +/- 0.11) ng/ml] level were lower (P < 0.05), serum IGF-1 [(966 +/- 55) ng/ml vs (813 +/- 43) ng/ml] and IGFBP-3 [(8.1 +/- 0.3) ng/ml vs (6.9 +/- 0.2) ng/ml] level and the expression of hepatic ALB mRNA (1.24 +/- 0.06 vs 1.02 +/- 0.09), IGF-1 mRNA (0.85 +/- 0.00 vs 0.60 +/- 0.03), IGFBP-3 mRNA (0.69 +/- 0.02 vs 0.58 +/- 0.09) were higher in the 10% Hepa PN group (P < 0.05), but there was no difference in liver Ki67 labeling index [(4.8 +/- 0.3)% vs (4.4 +/- 0.4%)] (P > 0.05). Compared with the 10% Hepa PN group, serum ALP [(434 +/- 41) IU/L vs (571 +/- 92) IU/L] was much lower (P < 0.05), serum ALB [(37.0 +/- 1.8) g/L vs (32.8 +/- 1.2) g/L], blood glucose [(7.6 +/- 1.3) mmol/L vs (4.9 +/- 0.7) mmol/L], GH [(3.00 +/- 0.61) ng/ml vs (1.55 +/- 0.12) ng/ml], IGF-1 [(1100 +/- 32) ng/ml vs (966 +/- 55) ng/ml], IGFBP-3 [(9.3 +/- 0.2) ng/ml vs (8.1 +/- 0.3) ng/ml] level, the expression of hepatic ALB mRNA (1.35 +/- 0.04 vs 1.24 +/- 0.06), IGF-1 mRNA (0.97 +/- 0.00 vs 0.85 +/- 0.00) and liver Ki67 labeling index [(5.4 +/- 0.3)% vs (4.8 +/- 0.3%)] were higher (P < 0.05) in the rhGH + 10% Hepa PN group. CONCLUSIONS: Amino acid solution and recombinant human growth hormone can influence the GH/IGF-1 axis in rats with liver cirrhosis. It may be helpful in selecting and evaluating nutrient by measuring the serum IGF-1 and IGFBP-3 level.

Effects of recombinant human growth hormone on remnant liver after hepatectomy in hepatocellular carcinoma with cirrhosis.

AIM: To explore the effects of recombinant human growth hormone (rhGH) on the remnant liver after hepatectomy in hepatocellular carcinoma with liver cirrhosis. METHODS: Twenty-four patients with hepatocellular carcinoma who underwent hepatectomy were randomly divided into 2 groups: parenteral nutrition (PN) group (n=12) and rhGH+PN group (n=12). Liver function, blood glucose, AFP, serum prealbumin and transferrin were detected before operation, at post-operative d 1 and d 6. Albumin (ALB) mRNA in liver biopsy specimens was detected by RT-PCR at post-operative d 6. Liver Ki67 immunohistochemical staining was studied. RESULTS: On post-operative d 6, compared with PN group, the levels of blood glucose, serum prealbumin, transferrin, the expression of hepatic ALB mRNA and liver Ki67 labeling index were higher in rhGH+PN group. CONCLUSION: rhGH can improve protein synthesis and liver regeneration after hepatectomy in hepatocellular carcinoma with liver cirrhosis.

[Application of Onodera prognostic nutrition index in prognostic evaluation of elderly patients with colorectal cancer].

OBJECTIVE: To study the applied valuation of Onodera prognostic nutrition index (Onodera index) in elderly patients with colorectal cancer. METHODS: Onodera indexes of 163 elderly patients with colorectal cancer were calculated and these patients were divided into better-nourished group (Onodera index ≥45) and under-nourished group (Onodera index <45). Correlations of Onodera index with general data, operation type, postoperative complication, recovery of gastrointestinal function, clinicopathological feature and prognosis were analyzed. Cox proportional hazards model was also established to identify the independent prognostic factors for prognosis of elderly patients with colorectal cancer. RESULTS: Patients in better-nourished group had significantly higher radical resection rate [90.9% (70/77) vs. 62.8% (54/86), P<0.01], lower postoperative complication rate [17.1% (12/70) vs. 53.7% (29/54), P<0.01] and earlier postoperative defecation [(3.09±1.14) d vs. (3.43±1.98) d, P<0.05] than those in under-nourished group. Onodera index was found to be related to age, tumor location, tumor size, and operation type (all P<0.05). Better-nourished group had significantly better survival than worse-nourished group (5-year survival rate: 64% vs. 24%, P<0.01). Onodera index was identified as an independent prognostic factor for elderly patients with colorectal cancer (RR=0.888, 95%CI:0.800-0.985, P=0.025). CONCLUSION: Onodera index is a valuable clinical marker in preoperative estimation as well as prognosis prediction for elderly patients with colorectal cancer.

[Effect of branched-chain amino acid-rich parenteral nutrition on protein metabolism after partial hepatectomy in rats with liver cirrhosis].

OBJECTIVE: To observe the effect of parenteral nutrition (PN) with branched-chain amino acid supplementation on protein metabolism after partial hepatectomy in rats with liver cirrhosis. METHODS: Eighteen rats with liver cirrhosis were randomly divided into pre-operation group (n=6), post-operation 8.5% Novamin PN group (n=6) and post-operation 10% Hepa PN group (n=6), with 6 normal rats severing as the normal control group. Five days after the operation, serum albumin (ALB), insulin-like growth factor I (IGF-1) and plasma amino acid spectrum were measured, and ALB mRNA level in the liver was assayed using RT-PCR. RESULTS: Postoperative serum ALB was similar between 10% Hepa PN and 8.5% Novamine PN groups, but the rats in the latter group showed significantly increased serum IGF-1 level, Fischer ratio and hepatic ALB mRNA expression (P<0.05). CONCLUSION: Administration of PN with branched-chain amino acid supplementation can ameliorate plasma amino acid spectrum and increase protein synthesis in rats with liver cirrhosis after partial hepatectomy.

A study of the ameliorating effects of carnitine on hepatic steatosis induced by total parenteral nutrition in rats.

AIM:To investigate the effects of carnitine on ameliorating hepatic steatosis induced by total parenteral nutrition (TPN) in animal model.METHODS: Eighteen normal Wistar rats and 19 cirrhotic Wistar rats induced by carbon tetrachloride were randomly divided into three groups, i.e., free access to food and drink (group A), TPN (group B) and TPN+carnitine (group C) for one week, respectively. Hepatic function, histology and its fat content were determined on the 7th day.RESULTS: Hepatic triglyceride (TG) and cholesterol (CHO) contents were significantly higher in groups B and C than in group A,and significantly lower in group C than in group B in both normal and cirrhotic rats (all P < 0.05). Histopathological examinations revealed that hepatic steatosis was more severe in group B than in group C in both normal and cirrhotic rats.CONCLUSION:Carnitine can ameliorate hepatic steatosis associated with TPN in both non-cirrhotic and cirrhotic rats.