Transcatheter arterial chemoembolization with tyrosine kinase inhibitor in the 12-year treatment of hepatic metastases from gastrointestinal stromal tumor: a case report.

Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the digestive tract, with surgery and tyrosine kinase inhibitor (TKI) therapy being its main treatment options. However, long-term use of TKIs may lead to drug resistance, which poses a challenge to the long-term survival of patients. We explore a new combination of transcatheter arterial chemoembolization (TACE) with TKI for liver metastasis (LM) of GIST to provide patients with more treatment options and better prognosis. Case Description: This case report describes the application of 6 TACE sessions in the 12-year treatment of multiple LM from small intestinal stromal tumors that were resistant to multiple TKIs. The patient, a 58-year-old male, underwent multiple surgical resections and drug therapies for the LM after a primary small bowel stromal tumor had been identified and resected following an onset symptom of abdominal pain in February 2012. Despite the challenges of drug resistance and economic considerations, 6 TACE sessions effectively controlled the tumor, winning valuable treatment time for the patient. Since the initiation of ripretinib 150 mg once daily in July 2023, the tumor has continued to shrink, with satisfactory drug tolerance. Conclusions: For GIST patients with LM, TACE combined with various TKI drugs could effectively control intrahepatic tumor progression and prolong patient survival. During six TACE sessions, the patient experienced liver tumor rupture and massive bleeding. However, the bleeding was completely stopped by embolization, and the lesion shrank. Our findings provide a new perspective and treatment strategy for the treatment of LM from GIST.

The efficacy and safety of PD-1 inhibitor combined with TACE in the first-line treatment of unresectable hepatocellular carcinoma.

The application of immune checkpoint inhibitors (ICIs) has changed the treatment of advanced hepatocellular carcinoma. Transcatheter arterial chemoembolization (TACE) is a first-line treatment for intermediate hepatocellular carcinoma. Serving as a local treatment modality that can induce immunogenic cell death, the efficacy and safety of combined use with ICI have not been evaluated. Although there have been prospective studies aimed at evaluating the efficacy and safety of ICI combined with TACE in BCLC stage B HCC patients, there are few reports on the evaluation of BCLC stage C patients with distant metastasis or portal vein cancer thrombus. Data of unresectable hepatocellular carcinoma patients received PD-1 inhibitor and TACE were collected in Xijing Hospital from June 2019 to December 2022. The tumor response was evaluated according to the Solid Tumor Modified Response Evaluation Standard (mRECIST), including complete response (CR), partial response (PR), disease stability (SD), disease progression (PD), objective response rate (ORR), and disease control rate (DCR). The progression-free survival (PFS) and overall survival (OS) were used to estimate therapy efficacy. The treatment-related adverse events were evaluated based on National Cancer Institute Common Adverse Event Evaluation Criteria (CTCAE) version 5.0. A total of 42 patients with unresectable hepatocellular carcinoma were included in this study, including 34 males (80.5%) and 8 females (19.5%). The average age is 54.5 years, ranging from 34 to 72. The median follow-up time was 12.3 months, with an ORR of 42.9% and a DCR of 90.5% as of the follow-up time. The median PFS is 7.5 months (95% CI: 5.76-9.23), and the median OS has not yet been reached; 6-month PFS was 62.2%. Safety analysis showed that 41 (97.6%) patients experienced treatment-related adverse reactions, mainly including elevated AST and ALT, fever, elevated bilirubin, hypothyroidism, nausea, abdominal pain, and rash. 40 patients had grade 1/2 adverse reactions, and only one patient had grade 3 adverse reactions, manifested as intolerable rash, nausea, and vomiting. Treatment is terminated when symptomatic treatment and drug suspension cannot be alleviated. In this study, thre patients with unresectable hepatocellular carcinoma were treated with PD-1 inhibitor combined with TACE to achieve good tumor reduction effect and underwent liver cancer resection surgery. For patients with unresectable hepatocellular carcinoma, whether in BCLC stage B or stage C, effective systemic therapy (PD-1 inhibitor) combined with local therapy (TACE) can achieve a high rate of tumor regression and objective response. Some patients may even pursue surgical treatment opportunities, and the treatment-related adverse reactions are controllable, which is expected to provide new options for extending the survival of unresectable hepatocellular carcinoma patients.

Immobilized Drugs on Dual-Mode Imaging Ag2S/BaSO4/PVA Embolic Microspheres for Precise Localization, Rapid Embolization, and Local Antitumor Therapy.

Transcatheter arterial embolization (TAE) in interventional therapy and tumor embolism therapy plays a significant role. The choice of embolic materials that have good biocompatibility is an essential component of TAE. For this study, we produced a multifunctional PVA embolization material that can simultaneously encapsulate Ag2S quantum dots (Ag2S QDs) and BaSO4 nanoparticles (BaSO4 NPs), exhibiting excellent second near-infrared window (NIR-II) fluorescence imaging and X-ray imaging, breaking through the limitations of traditional embolic microsphere X-ray imaging. To improve the therapeutic effectiveness against tumors, we doped the doxorubicin (DOX) antitumor drug into microspheres and combined it with a clotting peptide (RADA16-I) on the surface of microspheres. Thus, it not only embolizes rapidly during hemostasis but also continues to release and accelerate tumor necrosis. In addition, Ag2S/BaSO4/PVA microspheres (Ag2S/BaSO4/PVA Ms) exhibited good blood compatibility and biocompatibility, and the results of embolization experiments on renal arteries in rabbits revealed good embolic effects and bimodal imaging stability. Therefore, they could serve as a promising medication delivery embolic system and an efficient biomaterial for arterial embolization. Our research work achieves the applicability of NIR-II and X-ray dual-mode images for clinical embolization in biomedical imaging.

Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness.

This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.

Heterogeneity of hepatocellular carcinoma that responds differently to combination therapy with TACE and Sorafenib as determined by digital spatial gene expression profiling.

BACKGROUND: The combination of Sorafenib and transcatheter arterial chemoembolization (TACE) exhibits limited efficacy in the treatment of certain advanced hepatocellular carcinomas (HCC), and the molecular mechanisms underlying resistance to this combination remain unclear. OBJECTIVE: This study aims to underscore the distinctive contribution of GeoMx DSP technology in elucidating the molecular intricacies of HCC resistance to the Sorafenib and TACE combination. METHODS: Patients with advanced HCC during the waiting period before liver transplantation were classified into sensitive and resistant groups based on their response to Sorafenib and TACE combination therapy. Employing GeoMx DSP technology for comprehensive gene expression profiling, we identified pivotal molecular targets linked to resistance against combination therapy. RESULTS: The investigation scrutinized intra-tumoral and inter-individual variances, unveiling a spectrum of crucial molecular targets, such as PLG, PLVAP, immunoglobulin genes, ORM1, and NR4A1, among others. Additionally, we explored signaling pathways associated with treatment responsiveness, including the PPAR signaling pathway. Notably, we emphasized the significance of the immune microenvironment characterized by heightened SPP1 expression in HCC resistance to combination therapy. In the resistant group, SPP1+ tumor-associated macrophage (TAM) infiltration was notably pronounced (p = 0.037), while T-cell depletion showed a mitigated presence (p = 0.013). CONCLUSION: The study reveals intra- and inter-individual heterogeneity in HCC that is differentially responsive to the combination of Sorafenib and TACE, highlighting multiple key molecular targets associated with treatment resistance. The immune microenvironment is important, and in particular, SPP1+ TAM infiltration may play a key role. Meanwhile, the introduction of immunotherapy in patients resistant to combination therapy may lead to positive results.

Prognosis comparison between hepatocellular carcinoma patients with microvascular invasion who received hepatectomy alone and those who underwent early PA-TACE: a retrospective cohort study.

Background: Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) can achieve longer overall survival (OS) and disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI). We investigated whether this treatment strategy could benefit these patients by mediating the dysfunctional immunological status. Therefore, a retrospective cohort study was conducted to investigate the effect of early PA-TACE in HCC patients with MVI by measuring the levels of T helper cell 17 (Th17) and regulatory T cell (Treg). Methods: This study retrospectively included 472 patients with HCC undergoing hepatectomy between December 2015 and December 2018, and 115 patients with MVI confirmed by postoperative pathology were enrolled and divided into two groups of TACE group and non-TACE group according to whether TACE was performed. HCC patients with MVI. The proportion of Treg and Th17 cells in peripheral blood was measured one day before and four weeks after TACE. All patients in the two groups were followed up until death or until the study ended in December 2023. The rates of OS and progression-free survival (PFS) in patients with MVI were compared between those who received hepatectomy alone and those who underwent early PA-TACE. Results: Among 115 HCC patients with MVI from 472 patients, the study enrolled 51 patients with PA-TACE into the TACE group and 42 patients without TACE into the non-TACE group. There were no statistical differences in baseline data between the two groups (all P>0.05). The frequency of Treg among CD4+ T cells in HCC patients with PA-TACE was significantly lower than baseline (7.34%±3.61% vs. 5.82%±2.76%, P<0.001), and the frequency of Th17 among CD4+ T cells in these patients was significantly higher than baseline (0.49%±0.28% vs. 0.50%±0.25%, P<0.001). Among all the patients, the median OS was 61.8 months. The OS rate and PFS rate at 12, 36, and 60 months in the TACE group were significantly higher than those in the non-TACE group (all P<0.05). Conclusions: PA-TACE may have roles in improving survival outcomes, and restoring immune homeostasis in HCC patients with MVI after hepatectomy.

A Multicenter International Retrospective Investigation Assessing the Prognostic Role of Inflammation-Based Scores (Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios) in Patients with Intermediate-Stage Hepatocellular Carcinoma (HCC) Undergoing Chemoembolizations of the Liver.

BACKGROUND: The utilization of inflammation-based scores, such as the Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), and Platelet-to-Lymphocyte Ratio (PLR), has garnered attention for their potential as prognostic indicators in various cancers. However, their predictive role in patients with intermediate-stage HCC undergoing transcatheter arterial chemoembolization (TACE) remains an area that requires further investigation, as early recognition of TACE refractoriness holds the potential to guide tailored therapeutic interventions. METHODS: This multicenter international retrospective study analyzed data from patients with intermediate-stage HCC undergoing TACE between 2018 and 2024. Inflammation-based scores (NLR, LMR, PLR) were assessed preoperatively to predict treatment outcomes. RESULTS: Two hundred and fourteen patients were enrolled. Preoperative LMR showed the largest area under the curve for the prediction of 6-months PFS, based on the ROC curve analysis. Both high LMR (≥2.24) and low NLR (<4.72) were associated with improved objective response rates and 6-month progression-free survival. Lymphocyte count emerged as a strong predictor of treatment response in both simple (p < 0.001) and multiple (p < 0.001) logistic regression analyses. CONCLUSIONS: This study highlights the prognostic value of inflammation-based scores, particularly LMR and NLR, in predicting the treatment response and short-term outcomes of patients with intermediate-stage HCC undergoing TACE. Future investigations should focus on validating these scores' clinical applicability and assessing their impact on long-term patient survival and therapeutic decision-making.

Prognostic Role of Lymphocyte-to-Monocyte Ratio (LMR) in Patients with Intermediate-Stage Hepatocellular Carcinoma (HCC) Undergoing Chemoembolizations (DEM-TACE or cTACE) of the Liver: Exploring the Link between Tumor Microenvironment and Interventional Radiology.

Inflammation-based scores are biomarkers of the crosstalk between the tumor microenvironment and the immune response. Investigating the intricate relationship between the tumor stromal microenvironment, biomarkers, and the response to transcatheter arterial chemoembolization (TACE) is essential for early identification of TACE refractoriness or failure, providing insights into tumor biology and facilitating personalized therapeutic interventions. This study addresses a dearth of recent literature exploring the prognostic significance of the preoperative LMR in individuals from western countries diagnosed with stage B hepatocellular carcinoma (HCC) undergoing drug eluting microspheres TACE (DEM-TACE) or conventional TACE (cTACE). This international multi-center retrospective analysis included consecutive patients with stage B HCC who underwent TACE from January 2017 to June 2023. The study evaluated the ability of the preoperative LMR to predict complete response (CR), objective response (OR), sustained response duration (SRD) exceeding 6 months, successful downstaging at 6 months, progression-free survival (PFS) at 6 months, and overall survival (OS) at 6 months. The study population included 109 HCC patients and it was divided into low LMR (LMR < 2.24) and high LMR (LMR ≥ 2.24) groups, according to ROC curve analysis to select the optimal LMR cut-off value. High LMR was associated with lower Hepatitis C prevalence, higher absolute lymphocyte count, and a trend toward lower alpha-fetoprotein. The group with high LMRs exhibited superior CR rates (14.9% vs. 0%), overall OR (43.2% vs. 14.3%), and better PFS at 6 months (75.7% vs. 45.7%). The LMR, specifically categorized as <2.24 and ≥2.24, emerged as a robust predictor for treatment response and short-term outcomes in patients with stage B HCC undergoing DEM- or c-TACE.

Transcatheter Arterial Chemoembolization Imaging Features in MR-Linac Radiation Therapy Planning for the Liver.

For MR-guided radiation therapy treatment planning, an MRI and CT of the intended treatment site are typically acquired. Patients' prior treatments or procedures can cause image artifacts in one or both scans, which may impact treatment planning or the radiation dose calculation. In this case report, a patient with several previous transcatheter arterial chemoembolization (TACE) procedures was planned for radiation therapy on a low-field MR-linac, and the impact of residual iodinated oil on the radiation dose calculation and MR-guided adaptive workflow was evaluated.

Downstaging and laparoscopic hepatectomy plus intraoperative radiofrequency ablation for the treatment of initially unresectable multifocal hepatocellular carcinomas.

Background: Using TKIs plus anti-PD-1 antibodies combined with TACE in the treatment of patients with initially unresectable multiple HCCs has a high tumour response rate, and using laparoscopic hepatectomy (LH) combined with intraoperative RFA for radical treatment of multiple HCCs after successful downstaging treatment has not been reported. Methods: Consecutive patients with multiple HCCs (≤4 lesions) who were downstaged with TKIs plus anti-PD-1 antibodies combined with TACE were analysed. Imaging examinations were performed monthly, and RECIST v1.1 criteria were used to evaluate treatment effect and resectability. Results: Forty-five consecutive patients with multiple HCCs who met the inclusion criteria received downstaging treatment with TKIs plus anti-PD-1 antibodies combined with TACE. Nine patients were successfully downstaged and met the R0 resection criteria, and 8 patients underwent surgery. Among the patients, 5 patients had BCLC stage C, and 3 patients had BCLC stage B. There were 2 lesions in 5 patients, 3 lesions in 2 patients, and 4 lesions in 1 patient. The average size of the main HCC was 8.5 cm (range: 5.4-9.1 cm), and the diameter of the remaining HCCs was 1.6 cm (range: 0.8-2.9 cm). The average time from the start of downstaging therapy to surgery was 81 days (range: 60-210 days). All 8 patients underwent LH of the main HCC, and the remaining HCCs were targeted with RFA. The mean operation time was 220 min (range 150-370 min), the average intraoperative blood loss was 260 ml (range 100-750 ml), there was no case conversion to laparotomy, and the average postoperative hospital stay was 9 days (range 7-25 days). The incidence of postoperative complications was 37.5% and there were no deaths. The average follow-up time was 18.2 months (range 6.1-22.4 months), 5 patients survived tumour-free, 2 patients had tumour recurrence, and 1 patient died. Conclusions: After successful downstaging of multiple HCCs by treatment with TKIs plus anti-PD-1 antibodies and TACE, LH combined with RFA for radical surgery is safe and feasible, and the treatment effect is satisfactory. It is worthy of clinical reference, and its long-term effects require further research for confirmation.

Analysis of the therapeutic efficacy of transcatheter arterial chemoembolization com-bined with systemic treatment in unresectable hepatocellular carcinoma / 中国肿瘤临床

Objective:To investigate the efficacy and safety of different transcatheter arterial chemoembolization(TACE)-based regimens in patients with unresectable hepatocellular carcinoma(uHCC)and explore the optimal timing for combining TACE with tyrosine kinase inhibit-ors(TKIs)and immune checkpoint inhibitors(ICIs).Methods:A retrospective analysis was conducted on data from 555 patients with uHCC who underwent TACE-based treatment between April 2016 and December 2021 in Nanfang Hospital,Southern Medical University.The pa-tients were assigned into the following four groups according to different treatment regimens:TACE group(n=317),TACE combined with TKIs group(TACE+TKIs,n=66),TACE combined with ICIs group(TACE+ICIs,n=33),and TACE combined with TKIs+ICIs group(TACE+TKIs+ICIs,n=139).Subgroup analysis was performed within the TACE+TKIs+ICIs group,with patients being assigned into"pre-TACE"and"post-TACE"groups based on the timing of the combination therapy.Univariate and multivariate Cox regression analyses were conducted to identify pro-gnostic factors influencing overall survival(OS).Results:The TACE+TKIs+ICIs group showed the longest OS(21.9 months,95%confidence in-terval[CI]:17.2-26.6,P=0.030)and progression-free survival(PFS)(8.3 months,95%CI:7.3-9.3,P=0.004)compared to those in the other three groups.In the subgroup analysis,the"post-TACE"group had longer OS than the"pre-TACE"group(26.8 months vs.19.2 months,P = 0.011).The objective response rate(ORR)was 32.8%,41.1%,42.4%,and 52.5%(P=0.001)and the disease control rate(DCR)was 59.6%,71.2%,69.7%,and 82.7%(P<0.001)in the TACE,TACE+TKIs,TACE+ICIs,and TACE+TKIs+ICIs groups,respectively.The adverse events were similar to those reported in previous studies.Cox regression analysis revealed that tumor number,extrahepatic metastasis,and treatment regimen were independent factors influencing OS in patients(all P<0.05).Conclusions:TKIs or ICIs can improve OS and PFS in patients with uHCC receiving TACE,and the combination of TKIs+ICIs with TACE achieves better beneficial outcomes.The greatest OS was observed when the combination therapy TKIs+ICIs was initiated within 3 months after the first TACE procedure.

Research status and progress on surgical treatment of postoperative recurrence of hepatocellular carcinoma / 器官移植

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.

Discussion on the indications and timing of targeted therapy and immunotherapy before and after liver transplantation for hepatocellular carcinoma / 器官移植

Liver transplantation is one of the main treatments of early hepatocellular carcinoma (HCC). The recurrence of HCC after liver transplantation severely affects the long-term survival rate of the recipients. Targeted therapy and immunotherapy play a critical role in HCC downstaging, preventing disease progression, reducing recurrence rate, prolonging the survival and improving the quality of life. However, no consensus has been reached on the application of targeted therapy and immunotherapy in recipients undergoing liver transplantation for HCC, including indications, timing and dosage. In this article, clinical research progresses on the indications and timing of targeted therapy and immunotherapy before and after liver transplantation for HCC were reviewed, aiming to provide reference for prolonging the survival of recipients after liver transplantation for HCC.

Meta-analysis of Oral Chinese Medicine for Adjuvant Treatment of Primary Hepatic Carcinoma and Screening of Basic Chinese Herbs / 中国实验方剂学杂志

Objective:To systematically evaluate the efficacy of oral Chinese herbal prescriptions combined with transcatheter arterial chemoembolization （TACE） against primary hepatic carcinoma （PHC） and screen the basic Chinese herbs，in order to provide certain reference for clinical medication. Method:The randomized controlled trials concerning the treatment of PHC with oral Chinese herbal prescriptions plus TACE were retrieved from CBM，China National Knowledge Infrastructure （CNKI），Chongqing Weipu Database for Chinese Technical Periodicals （VIP），and Wanfang Data Knowledge Service Platform.The quality of the included trials was evaluated by Cochrane handbook，and the Meta-analysis was performed using RevMan 5.3.The enumeration data were expressed by odds ratio （OR），the measurement data by mean difference （MD） or standardized mean difference （SMD），and the effect size by 95% confidence interval （CI）.The data of oral Chinese herbal prescriptions involved in trials were sorted out and subjected to association rule analysis and frequency analysis based on the Traditional Chinese Medicine Inheritance Support System （TCMISS），for exploring the basic Chinese herbs and their dosages against PHC. Result:A total of 75 randomized controlled trials were included，involving 7 406 cases. As revealed by the Meta-analysis，oral Chinese herbal prescriptions combined with TACE was significantly better than TACE alone in improving the short-term curative effect ［OR=2.05，95%CI（1.83，2.29）］，decreasing alpha fetoprotein （AFP） ［MD=-59.02，95%CI（-79.03，-39.01）］，ameliorating liver function ［SMD=-1.23，95%CI（-1.58，-0.88）］，boosting immunity ［SMD=1.08，95%CI（0.84，1.32）］，adjusting Karnofsky Performance Status （KPS） scale score ［OR=2.7，95%CI（1.11，11.02）］，elevating survival rate ［OR=2.31，95%CI（1.96，2.71）］，and reducing adverse reactions ［OR=0.38，95%CI（0.34，0.43）］.Data mining results showed that the basic Chinese herbs against PHC were Bupleuri Radix，Paeoniae Alba Radix，Atractylodis Macrocephalae Rhizoma，Poria，and Glycyrrhizae Radix et Rhizoma，with their clinical dosages listed as follows：6-15 g for Bupleuri Radix，10-15 g for Paeoniae Alba Radix，9-15 g for Atractylodis Macrocephalae Rhizoma，10-15 g for Poria，and 3-10 g for Glycyrrhizae Radix et Rhizoma. Conclusion:The oral Chinese herbal prescriptions combined with TACE produce better effects in treatment of PHC as compared with TACE alone.These five basic Chinese herbs have anti-cancer effect，and their dosages are within the ranges stipulated in 2020 edition of <italic>Chinese Pharmacopoeia.</italic>This Meta-analysis has provided certain reference for clinical medication.

Value of four scoring systems in predicting liver failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma / 中国肿瘤临床

Objective: To investigate the value of the Child-Pugh (CTP), ALBI, MELD, and MELD-Na scores in predicting acute-on-chronic liver failure (ACLF) in patients with hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization (TACE). Methods: Seven hundred and eleven patients with HCC who received their first TACE treatment at Guangxi Medical University Cancer Hospital between October 2013 and October 2015 were retrospectively analyzed. A Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy of the four scoring models in predicting ACLF. Results: The results of the univariate and multivariate analysis showed that the four scoring models could independently predict the occurrence of ACLF after TACE. The ROC curve analysis showed that the area under the ROC curve (AUC) of ALBI was significantly higher than the other three scores (P5.5, ALBI >-2.29, MELD >8.08 and MELD-Na >8.08 was higher than those with scores lower than the cut-off values (P0.001). Conclusions: The child-Pugh, ALBI, MELD, and MELD-Na scores have certain predictive value for ACLF after TACE treatment, with ALBI having the best predictive value.

Effect of TACE combined with sorafenib on angiogenesis of VX2 liver cancer in rabbits / 西安交通大学学报(医学版)

Objective: To investigate the efficacy of antiangiogenesis, mechanism and timing of transcatheter arterial chemoembolization (TACE) combined with sorafenib in treatment of liver cancer in new Zealand rabbits with VX2 liver cancer model. Methods: Thirty New Zealand rabbits with VX2 liver cancer were randomly divided into normal saline control group, single TACE group, single sorafenib group, pre-TACE + sorafenib group and post-TACE + sorafenib group (n=6 in each). Serum VEGF was measured by ELISA 7 days before TACE, 1 day before TACE, 3 days after TACE, 7 days after TACE, and 14 days after TACE. All the rabbits were sacrificed 14 days after operation for MVD immunohistochemical staining, and the tumor growth rate of each group was compared. Results: Compared with that in normal saline control group, serum VEGF in TACE + sorafenib group, TACE + sorafenib group and TACE + sorafenib group increased significantly (P<0.05), but the peak value of VEGF in TACE + sorafenib group was lower than that in TACE group and TACE + sorafenib group(P<0.05). Fourteen days after TACE, the VEGF level in the group + sorafenib was the lowest and that in the group of one drug alone was the highest (P<0.05). In 14 days after TACE + sorafenib group, MVD value was higher than that in saline control group and sorafenib group, but significantly lower than that of single TACE group(P<0.05). The 14 days after TACE + sorafenib group had the smallest tumor growth(P<0.05). Conclusion: TACE combined with sorafenib can significantly inhibit the growth of VX2 liver cancer in rabbits. The effect of TACE combined with sorafenib is better than that of TACE alone or sorafenib alone. However, after TACE the level of VEGF is increased and the level of serum VEGF is decreased by combining sorafenib, which decreases the microvessel density. Moreover, the effect of TACE combined with sorafenib on anti-tumor and anti-angiogenesis is better than that after TACE.

The impact of combined postoperative antiviral therapy with adjuvant transarterial chemoembolization in hepatitis B-related hepatocellular carcinoma patients with high risks of recurrence / 中华肝胆外科杂志

Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence.Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled.These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n =32),the treatment group or the no adjuvant treatment group (n =21,the control group).The recurrence-free survival (RFS) and overall survival (OS) were analyzed.Results There was no significant difference between the two groups in clinical characteristics (P＞0.05).The recurrence-free survival (RFS) (mean±S.D.) was (20.1 ± 1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752).The 1-,2-and 3-year RFS rates of the treatment group and the control group were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％,respectively (P＞0.05).The overall survival (OS) (mean±S.D.) was (26.8± 1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037).The 1-,2-and 3-year RFS rates were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％ in the treatment group and the control group,respectively.The 1-,2-,and 3-year OS rates were 87.5％ vs.66.7％,59.4％ vs.38.1％ and 43.8％ vs.19.0％ in the treatment group and the control group,respectively.Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate,but it improved the OS rate in HCC patients with high risks of recurrence.

The impact of preoperative nutritional support on the clinical outcomes of patients with malnutrition who underwent TACE for hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the impact of preoperative nutritional support on the clinical outcomes in patients with malnutrition who underwent transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma.Methods 46 patients with malnutrition underwent TACE after operation for primary liver cancer were randomly divided into the experimental group (n =23) and the control group (n =23).The patients in the experimental group received preoperative nutritional support,but patients in the control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidences of postoperative complication,the liver function,the lengths of hospital stay,the costs of nutrition support and the costs of hospitalization were compared between the two groups.Results On the day before the operation,on postoperative day 1,day 7,and one month,the levels of serum albumin,and on the postoperative day 7 and one month,the levels of pre-albumin were significantly higher in the experimental group than in the control group,and the differences were significantly different [(38.4 ± 1.5) g/L vs.(32.8±0.8) g/L,(37.6±1.3) g/Lvs.(31.4±0.9) g/L,(39.0±1.6) g/L vs.(32.0±0.7) g/L,(39.8±2.2) g/L vs.(33.0±2.0) g/L,respectively,P＜0.05],[(160.0±14.6) mg/L vs.(131.0 ± 16.5) mg/L,(163.0 ± 17.7) mg/L vs.(135.0 ± 17.1) mg/L,respectively,P ＜0.05].The incidences of complication were significantly lower in the experimental group than that of the control group (52.2％ vs.91.3％,P ＜0.05).The length of hospital stay in the experimental group was shorter than that of the control group [(19.9 ± 2.0) d vs.(24.8 ± 2.7) d,P ＜ 0.05].The cost in the experimental group was significantly lower than that in the control group [(20 108.9 ± 1 142.4) yuan vs.(23 174.1 ± 1 128.5) yuan,P ＜ 0.05].The cost in nutrition support in the experimental group was similar to that of the control group (P ＞ 0.05).Conclusions Preoperative nutritional support was helpful in reducing the incidence of postoperative complications,in shortening the length of hospital stay and in reducing medical costs.Nutritional support improved the nutritional status of the patients with primary hepatocellular carcinoma after surgery and TACE.

Clinical treatment and prognosis of de novo liver cancer following renal transplantation / 中华肝胆外科杂志

Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.

Transcatheter arterial chemoembolization combined with local ablation in treatment of large hepatocellular carcinoma: a review of current status and perspectives / 中华肝胆外科杂志

Large hepatocellular carcinoma,of which diameter is considered to be ≥ 5 cm,has mostly invaded vascular system or been liver function reserve loss when found,resulting in opportunities to surgical therapy are lost.Combined interventional therapy based on transcatheter arterial chemoembolization (TACE) has become one of the main treatments for the surgically unresectable large hepatocellular carcinoma.In particular,TACE combined local ablation has gradually replaced the interventional therapy model of TACE alone.The current combination therapy is mainly sequential combination.With the development of imaging equipment,real-time synchronization is becoming increasingly important and has become one of the current research hotspots.This article focuses on the research status and perspectives of image guidance,local ablation methods,the order of the joint,the number of times and the timing of the joint situation of TACE combined local ablation in treatment of large hepatocellular carcinoma.