Clinical evaluation of percutaneous endovascular radiofrequency ablation for portal vein tumor thrombus: experience in 120 patients.

BACKGROUND: Portal vein tumor thrombosis (PVTT) secondary to primary liver carcinoma (PLC) is commonly associated with poor prognosis and poses great challenge. This study was to evaluate the efficacy and safety of percutaneous endovascular radiofrequency ablation (RFA) in treatment of PVTT. METHODS: Consecutive patients who were performed endovascular RFA because of PVTT in single-institution in recent 8 years were retrospectively reviewed, compared with patients who underwent only sequential transcatheter arterial chemoembolization (TACE) during the contemporary period. Patency of portal vein, complications, and overall survival (OS) were investigated. RESULTS: One hundred and 20 patients who underwent endovascular RFA and 96 patients who underwent only sequential TACE were included. No severe complications happened in both groups. Except the higher rates of severe fever and moderate pain in the study group, no difference was found in the incidence of side effects and complications. The effective rate in the study group was (78.3%, 94/120) significantly higher than the comparison group (35.4%, 34/96). The median survival time and 1-3 years cumulative survival rates in the study group were 15.7 months and 42.5%, 21.7%, 2.5%, respectively, and 11.3 months, 21.9%, 9.4%, 0 correspondingly in the comparison group, without significant difference. Type of PVTT and Child-Pugh classification of liver function were independent risk factors, and OS was significantly improved by endovascular RFA and subsequent therapy. CONCLUSION: Endovascular RFA is technically safe and feasible for unresectable PLC and PVTT to improve the prognosis and quality of life.

Increased age, bilirubin, international normalized ratio, and creatinine score to triglyceride ratio are associated with alcohol-associated primary liver carcinoma: a single-centered retrospective study.

BACKGROUND: This study analyzed the clinical features and biomarkers of alcohol-associated liver disease (ALD) to investigate the diagnostic value of age, bilirubin, international normalized ratio (INR), and creatinine (ABIC) score to triglyceride (TG) ratio (ABIC/TG) in ALD-associated primary liver carcinoma (PLC). MATERIALS AND METHODS: Data were collected from 410 participants with ALD, and the epidemiological and clinical records of 266 participants were analyzed. Participants were divided into ALD-without-PLC and ALD-associated-PLC groups. Relationships between clinical characteristics, biomarkers and ALD-associated PLC were estimated. Serum lipid levels and liver function were compared between ALD patients without PLC and patients with ALD-associated PLC. Scoring systems were calculated to investigate ALD severity. The robustness of the relationship was analyzed by the receiver operating characteristic (ROC) curve. RESULTS: Age and dyslipidemia were more strongly associated with ALD-associated PLC than with ALD-without PLC, with AORs of 2.39 and 0.25, respectively, with P less than 0.05. Drinking time and average daily intake, ABIC score, and ABIC/TG ratio were significantly higher in the ALD-associated-PLC group than in the ALD-without-PLC group. The AUC for the ABIC/TG ratio predicting the incidence of PLC was 0.80 (P < 0.01), which was higher than that of the ABIC and TG scores alone; additionally, the specificity and Youden index for the ABIC/TG ratio were also higher, and the cutoff value was 6.99. CONCLUSIONS: In ALD patients, age, drinking time, and average daily intake were risk factors for PLC. Drinking time, average daily intake, TG and ABIC score have diagnostic value for ALD-associated PLC. The ABIC/TG ratio had a higher AUC value and Youden index than the ABIC score and TG level.

Clinical Significance of Acylphosphatase 1 Expression in Combined HCC-iCCA, HCC, and iCCA.

BACKGROUND: Combined hepatocellular and cholangiocarcinoma is a rare primary liver cancer with histological features of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Little is known about the prognostic features and molecular mechanism of cHCC-iCCA. Acylphosphatase 1 is a cytosolic enzyme that produces acetic acid from acetyl phosphate and plays an important role in cancer progression. AIMS: We evaluated the clinical significance of ACYP1 expression in cHCC-iCCA, HCC, and iCCA. METHODS: ACYP1 immunohistochemistry was performed in 39 cases diagnosed with cHCC-iCCA. The prognosis was evaluated in three different cohorts (cHCC-iCCA, HCC, and iCCA). The relationships between ACYP1 expression and cell viability, migration, invasiveness, and apoptosis were examined using siRNA methods in vitro. In vivo subcutaneous tumor volumes and cell apoptosis were evaluated after downregulation of ACYP1 expression. RESULTS: Almost half of the patients with cHCC-iCCA were diagnosed with high ACYP1 expression. In all three cohorts, the cases with high ACYP1 expression had significantly lower overall survival, and high ACYP1 expression was identified as an independent prognostic factor. Downregulation of ACYP1 reduced the proliferative capacity, migration, and invasiveness of both HCC and iCCA cells. Moreover, knockdown of ACYP1 increased the ratio of apoptotic cells and decreased the expression of anti-apoptosis proteins. In vivo tumor growth was significantly inhibited by the transfection of ACYP1 siRNA, and the number of apoptotic cells increased. CONCLUSION: High ACYP1 expression could influence the prognosis of cHCC-iCCA, HCC, and iCCA patients. In vitro ACYP1 expression influences the tumor growth and cell viability in both HCC and iCCA by regulating anti-apoptosis proteins.

Primary liver carcinoma with sarcomatous changes: Analysis of 10 cases.

Primary liver carcinoma with sarcomatous change is a rare malignancy associated with high aggressiveness and poor prognosis. However, the characteristics of these types of tumors are still unknown. The aim of this study was to assess the imaging features, prognostic significance, and clinicopathological characteristics of patients with these tumors. Of 1070 patients who underwent surgical resection of primary liver carcinoma at Toranomon Hospital (Tokyo, Japan) from 2003 to 2017, 10 patients were diagnosed with primary liver carcinoma containing sarcomatous component. This study included all 10 patients. We evaluated the percentage of the sarcomatous component in each tumor. Patients were classified into two groups: the low percentage group (area of sarcomatous changes ≤30%) and high percentage group (area sarcomatous component ≥70%). We also divided patients into two groups based on the combination of the percentage of sarcomatous tissue and tumor size (≥40 mm or <40 mm). The overall survival rate of patients with ≥70% sarcomatous component and ≥40 mm tumor was significantly worse than that of patients with ≤30% sarcomatous tissue or <40 mm tumor size (P = 0.0059). The results confirmed the poor prognosis of patients with sarcomatous changes in primary liver carcinoma, especially those with large sarcomatous component and large tumor size. Radical resection in the early stage is recommended to improve prognosis.

Variant differentiation patterns in primary liver carcinoma.

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are two distinct forms of primary liver carcinoma recognizable at the microscope by their architectural and cytological characteristics, as well as specific immunohistochemical profiles. This straightforward concept however, is increasing imperiled by the recognition of primary liver carcinomas that do not subscribe to a dichotomous paradigm of differentiation, and instead demonstrate biphenotypic differentiation, stem/progenitor cell like features or other variant patterns of differentiation. Appropriate nomenclature, diagnostic criteria, prognostic significance and optimal therapeutic approach for these variant tumors are not completely defined, not leasyt because they are not always identified correctly and when they are, lack of uniform terminology hinders collection of adequate number of cases to facilitate their study. Similar to hepatocellular carcinoma and in contrast with intrahepatic cholangiocarcinoma, primary liver tumors showing biphenotypic differentiation, stem/progenitor cell features or variant differentiation occur mainly, but not always, on a background of chronic liver disease. They are particularly frequent after neo-adjuvant therapy. Whether they represent trans-differentiation of malignant cells, or whether they derive from a stem/progenitor cell that gives rise to divergent differentiation remains yet another area of uncertainty.

Establishment and validation of a nomogram containing cytokeratin fragment antigen 21-1 for the differential diagnosis of intrahepatic cholangiocarcinoma and hepatocellular carcinoma.

Background: Our study aimed to develop a nomogram incorporating cytokeratin fragment antigen 21-1 (CYFRA21-1) to assist in differentiating between patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Methods: A total of 487 patients who were diagnosed with ICC and HCC at Qilu Hospital of Shandong University were included in this study. The patients were divided into a training cohort and a validation cohort based on whether the data collection was retrospective or prospective. Univariate and multivariate analyses were employed to select variables for the nomogram. The discrimination and calibration of the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Decision curve analysis (DCA) was used to assess the nomogram's net benefits at various threshold probabilities. Results: Six variables, including CYFRA21-1, were incorporated to establish the nomogram. Its satisfactory discriminative ability was indicated by the AUC (0.972 for the training cohort, 0.994 for the validation cohort), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) values. The Hosmer-Lemeshow test and the calibration plots demonstrated favorable consistency between the nomogram predictions and the actual observations. Moreover, DCA revealed the clinical utility and superior discriminative ability of the nomogram compared to the model without CYFRA21-1 and the model consisting of the logarithm of alpha-fetoprotein (Log AFP) and the logarithm of carbohydrate antigen 19-9 (Log CA19-9). Additionally, the AUC values suggested that the discriminative ability of Log CYFRA21-1 was greater than that of the other variables used as diagnostic biomarkers. Conclusions: This study developed and validated a nomogram including CYFRA21-1, which can aid clinicians in the differential diagnosis of ICC and HCC patients.

Adjuvant therapy with Huatan Sanjie Granules improves the prognosis of patients with primary liver cancer: a cohort study and the investigation of its mechanism of action based on network pharmacology.

Objective: Nowadays, primary liver carcinoma (PLC) is one of the major contributors to the global cancer burden, and China has the highest morbidity and mortality rates in the world. As a well-known Chinese herbal medicine (CHM) prescription, Huatan Sanjie Granules (HSG) has been used clinically for many years to treat PLC with remarkable efficacy, but the underlying mechanism of action remains unclear. Methods: A clinical cohort study was conducted to observe the overall survival of PLC patients with vs. without oral administration of HSG. Meanwhile, the BATMAN-TCM database was used to retrieve the potential active ingredients in the six herbs of HSG and their corresponding drug targets. PLC-related targets were then screened through the Gene Expression Omnibus (GEO) database. The protein-protein interaction (PPI) network of targets of HSG against PLC was constructed using Cytoscape software. The cell function assays were further carried out for verification. Results: The results of the cohort study showed that the median survival time of PLC patients exposed to HSG was 269 days, which was 23 days longer than that of the control group (HR, 0.62; 95% CI, 0.38-0.99; p = 0.047). In particular, the median survival time of Barcelona Clinic Liver Cancer stage C patients was 411 days in the exposure group, which was 137 days longer than that in the control group (HR, 0.59; 95% CI, 0.35-0.96; p = 0.036). Meanwhile, the enrichment analysis result for the obtained PPI network consisting of 362 potential core therapeutic targets suggest that HSG may inhibit the growth of liver cancer (LC) cells by blocking the PI3K-Akt/MAPK signaling pathways. Furthermore, the above prediction results were verified by a series of in vitro assays. Specifically, we found that the expressions TP53 and YWHA2, the targets of the hepatitis B virus signaling pathway, were significantly affected by HSG. Conclusion: HSG shows promising therapeutic efficacy in the adjuvant treatment of PLC.

Development and validation of a clinicopathological-based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma.

OBJECTIVES: To develop a clinicopathological-based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC). METHODS: A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C-index and receiver operating characteristic curve (AUC). RESULTS: The median follow-up time was 30.3 months (range, 3.2-115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α-fetoprotein (AFP), and international normalized ratio (INR). The 1-, 2-, and 3-year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low-risk group, and 1.7%, 6.3% and 6.3% in the high-risk group, respectively, showing significant statistical difference (P < .001). The nomogram had good calibration and discriminatory abilities in the training set, with C-indexes of 0.722 (95% confidence interval [CI]: 0.661, 0.883) and AUC of 0.850 (95% CI: 0.767, 0.934). External validation with 1000 bootstrapped sample sets showed a good C-index of 0.706 (95% CI: 0.546, 0.866) and AUC of 0.736 (95% CI: 0. 646, 0.827). CONCLUSIONS: The clinicopathological-based nomogram could be used to quantify the probability of seeding risk after PTA in PLC.

Updates in the diagnosis of combined hepatocellular-cholangiocarcinoma.

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver carcinoma showing variable degrees of differentiation toward hepatocellular and cholangiocellular carcinoma. Its great heterogeneity in term of morphology, immunophenotype, molecular, radiological and clinical features represents a challenge still to overcome. The multidisciplinary 2018 International Consensus on the nomenclature of cHCC-CCA allowed to define key issues of this entity. Here we review the historical controversies of cHCC-CCA, resume the key elements of the 2018 consensus, now incorporated in the 2019 WHO classification, and propose a short survival guide to help surgical pathologists facing cHCC-CCA in their routine workup.

Diagnostic value of hepatic artery perfusion fraction combined with TGF-ß in patients with hepatocellular carcinoma.

Diagnostic value of hepatic artery perfusion fraction (HAF) combined with transforming growth factor-ß (TGF-ß) in the diagnosis of primary liver carcinoma (PLC) was evaluated. The clinical data of 128 PLC patients undergoing radical hepatectomy in Affiliated Hospital of Jining Medical University were regarded as the study group. Seventy-four healthy volunteers examined in Affiliated Hospital of Jining Medical University were collected as the control group. Double-antibody sandwich enzyme-linked immunosorbent assay was used to detect the expression level of serum TGF-ß. The upper abdomen of the subjects was scanned by a 64-slice spiral CT, and the perfusion parameters were analyzed and calculated. According to the HAF and the expression level of TGF-ß in the two groups, single and combined detection of TGF-ß and HAF parameters were detected, respectively, by ROC curve. The expression of TGF-ß in serum of the study group was higher than that of the control group (P<0.05). The expression level of serum TGF-ß was closely related to total bilirubin, ascites, TNM stage, prothrombin time and tumor diameter. Blood flow (BF), blood volume (BV), permeability surface (PS), HAF and other perfusion parameters in the study group were higher than those in the control group (P<0.05). The specificity and sensitivity of TGF-ß expression level in diagnosing PLC were 73 and 93%, respectively; the specificity and sensitivity of HAF parameter in diagnosing PLC were 73 and 100%, respectively; the specificity and sensitivity of HAF parameter combined with TGF-ß expression level were 84 and 100%, respectively. TGF-ß is highly expressed in serum of PLC patients; HAF parameter combined with TGF-ß expression level can improve the specificity and has an important value in the diagnosis of PLC, which is worthy of clinical promotion.

Biphenotypic (hepatobiliary) primary liver carcinomas: the work in progress.

Recent WHO classification for combined hepatocellular-cholangiocarcinoma and recognized stem cell subtypes has increased attention to such tumors; however, the resulting burst of reporting and research indicates that this classification, while provocative, is incomplete for description of the full array of primary liver carcinomas with biphenotypic (hepatobiliary) differentiation. We review the history of such lesions and consider the wider array of such tumors previously described. Mixed hepatobiliary phenotypes and immunophenotypes are found in individual tumors at the tissue level - with architectural and cytologic features supportive of both differentiation states - and at the cellular level, with individual cells that display cytology of one cell type, but immunophenotypically showing mixed expression. Pathobiologic and clinical questions to be answered by future research are suggested.

Clinical Observation of S-1 Capsules Combined with Recombinant Human Endostatin in the Treatment of Middle and Advanced Primary Liver Carcinoma / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of S-1 capsules combined with recombinant human end-ostatin in the treatment of middle and advanced primary liver carcinoma. METHODS:Totally 94 patients with middle and advanced primary liver carcinoma in the First College of Clinical Medical Science of China Three Gorges university during Feb. 2012-Dec. 2014 were divided into combination group(48 cases)and control group(46 cases)according to random number table. Both groups were given S-1 capsules 40-60 mg orally within 30 min after breakfast and supper. Combination group additionally received Recom-binant human endostatin injection 150 mg added into 0.9%Sodium chloride injection 210 mL with portable micro pump for continu-ous pump of 120 h. A course involved 14 d treatment and 7 d interval. Short-term objective therapeutic efficacy,clinical benefit re-sponse (CBR) and ADR were evaluated after 2 courses. Disease progression time and average survival period were compared be-tween 2 groups. RESULTS:Objective response rate,disease control rate,disease progression time and average survival period of combination group were 14.6%,66.7%,(5.5 ± 1.3) months,(10.7 ± 3.8) months;those of control group were 8.7%,45.6%, (4.8±1.2)months,(8.9±3.3)months,with statistical significance between 2 groups(P0.05). CONCLUSIONS:S-1 combined with recombinant human end-ostatin show good therapeutic efficacy and tolerance for patients with middle and advanced primary liver carcinoma,and do not in-crease the incidence of ADR.

Meta-analysis of Shenqi Fuzheng Injection Assisting TACE in the Adjuvant Treatment of Primary Liver Carcinoma / 中国药房

OBJECTIVE:To evaluate the effectiveness and safety of Shenqi fuzheng injection assisting TACE in the adjuvant treatment of primary liver carcinoma,and to provide evidence-based reference.METHODS:Retrieved from CJFD,Wanfang database,VIP and PubMed,randomized controlled trials (RCTs) about Shenqi fuzheng injection assisting TACE (trial group) vs.TACE alone (control group) in the treatment of primary liver carcinoma were collected.Meta-analysis was performed by using Stata 12.0 software after data extraction and quality evaluation according to improved Jadad scale.RESULTS:A total of 8 RCTs were included,involving 527 patients.Results of Meta-analysis showed that there was no statistical significance in response rate [RR=1.19,95％CI(0.97,1.46),P=0.091] and clinical benefit rate [RR=1.16,95％CI(0.90,1.48),P=0.251] of 2 groups.The rate of life quality improvement in trial group was significantly higher than control group [RR=2.26,95 ％ CI (1.64,3.10),P=0.001],while the incidence of above middle fever [RR=0.74,95％ CI (0.63,0.88),P=0.001],gastrointestinal reaction [RR=0.52,95％ CI (0.32,0.85),P=0.010] and leucocyte reduction rate [RR=0.75,95％ CI (0.62,0.92),P=0.005],were significantly lower than control group,with statistical significance.CONCLUSIONS:Shenqi fuzheng injection assisting TACE for primary liver carcinoma cannot improve therapeutic efficacy but improve the quality of life and reduce the incidence of gastrointestinal reaction and leucocyte reduction.

Meta-analysis of Shenqi Fuzheng Injection Assisting TACE in the Adjuvant Treatment of Primary Liver Carcinoma / 中国药房

OBJECTIVE:To evaluate the effectiveness and safety of Shenqi fuzheng injection assisting TACE in the adjuvant treatment of primary liver carcinoma,and to provide evidence-based reference.METHODS:Retrieved from CJFD,Wanfang database,VIP and PubMed,randomized controlled trials (RCTs) about Shenqi fuzheng injection assisting TACE (trial group) vs.TACE alone (control group) in the treatment of primary liver carcinoma were collected.Meta-analysis was performed by using Stata 12.0 software after data extraction and quality evaluation according to improved Jadad scale.RESULTS:A total of 8 RCTs were included,involving 527 patients.Results of Meta-analysis showed that there was no statistical significance in response rate [RR=1.19,95％CI(0.97,1.46),P=0.091] and clinical benefit rate [RR=1.16,95％CI(0.90,1.48),P=0.251] of 2 groups.The rate of life quality improvement in trial group was significantly higher than control group [RR=2.26,95 ％ CI (1.64,3.10),P=0.001],while the incidence of above middle fever [RR=0.74,95％ CI (0.63,0.88),P=0.001],gastrointestinal reaction [RR=0.52,95％ CI (0.32,0.85),P=0.010] and leucocyte reduction rate [RR=0.75,95％ CI (0.62,0.92),P=0.005],were significantly lower than control group,with statistical significance.CONCLUSIONS:Shenqi fuzheng injection assisting TACE for primary liver carcinoma cannot improve therapeutic efficacy but improve the quality of life and reduce the incidence of gastrointestinal reaction and leucocyte reduction.

Investigation of primary liver carcinoma in patients with hepatitis B and its influencing factors / 公共卫生与预防医学

Objective To investigate the characteristics of primary liver carcinoma (PLC) in patients with hepatitis B and to analyze the influencing factors. Methods The clinical data of 308 patients with hepatitis B in our hospital from March 2016 to March 2019 were selected to investigate the occurrence of PLC. Univariate analysis and Logistic regression were used to analyze the influencing factors of PLC in patients with hepatitis B. Results The results of this survey showed that 116 of the 308 patients with hepatitis B had PLC (37.66%). The single factor analysis showed that age, diabetes mellitus, family history of PLC, smoking, drinking, eating habits, hepatitis B virus load, e antigen, antiviral therapy, fatty liver and cirrhosis were the influencing factors of PLC in patients with hepatitis B (P 50 years old, diabetes mellitus, family history of PLC, smoking, drinking, poor diet, positive HBV load, positive e antigen, ineffective antiviral therapy, fatty liver and cirrhosis were independent risk factors for PLC in patients with hepatitis B (P < 0.05). Conclusion Patients with hepatitis B were at high risk of PLC. They were affected by various factors. It is important to strengthen the preventative care of patients over 50 years old, with diabetes mellitus, family history of PLC, smoking, drinking, poor diet, hepatitis B virus load positive, e antigen positive, ineffective antiviral therapy, fatty liver, cirrhosis and so on.

Prognostic factors for patients with bone metastasis from primary liver carcinoma:a report of 55 cases / 实用肿瘤学杂志

Objective To improve the clinical diagnosis and prognosis of the treatment of primary liver carcinoma with bone metastasis.Methods A retrospective study on diagnosis and treatment of bone metastasis from 55 cases of primary liver carcinoma was developed.Survival rates were calculated by Kaplan-meier meth-od,univariates analysed by Log-rank and multivariates analysed by Cox regression.Results The 1-,2-and 3-year cumulative survival rates of the cases from primary liver carcinoma were 54.5%,25.5%and 16.4%re-spectively.The mediate survival time was 13 months.And the cases with bone metastasis were 23.6%,10.9%and 1.8%respectively.The mediate survival time was 5.5 months.Factors such as metastasis to other organs,liv-er function,and the combined modality therapy were independent prognostic factors.While number of bone metas-tasis,AFP level and number of liver cancer had no significant relations with the survival rate.Conclusion The prognosis of bone metastasis from primary liver carcinoma is poor.It is important to take emphasis on combined mo-dality therapy,which may be benefit on reducing the symptom,improving the quality and prolong the life span.

Imaging characteristics and intervention therapy for hepatic artery-portal vein shunts in patients with primary liver carcinoma / 中国肿瘤临床

Objective:To investigate the onset of hepatic artery-portal vein shunts (HAPVS) in primary liver cancer (PLC) pa-tients through digital subtraction angiography (DSA) and to devise a suitable strategy for treating both lesions and shunt tracts. In the process, the therapeutic effect on such patients can be enhanced. Methods:A total of 769 PLC patients who accepted transarterial che-moembolization (TACE) were analyzed retrospectively. We examined the image characteristics of 112 cases with HAPVS based on shunt type. For patients with middle or severe fistula, we initially attempted to overpass the fistula. Then, we either embolized the tumor lesions or merely provided chemotherapy to the patients. For patients with mild peripheral fistula, we embolized the tumor and fistula si-multaneously. Then, the accompanying arterial-vein shunt and portal vein tumor thrombus (PVTT) were handled at the same time. Re-sults: DSA findings showed that portal veins were observed in the early stage of angiography. A total of 52 of the 112 cases with HAPVS involved mild shunts, 34 exhibited moderate shunts, and 26 reported severe shunts. Among these cases, 31 involved central-and central peripheral-type artery-portal vein fistula, whereas 81 involved peripheral-type artery-portal vein fistula. Seven cases were examined in combination with hepatic artery-liver vein shunts, and 50 cases were investigated in conjunction with PVTT. Tumor embo-lization was successful in 101 cases (90.1%). Moreover, catheters successfully overpassed shunt tracts and embolized the tumors in 48 cases (42.9%). Shunt tracts were successfully closed in 74 cases (66.1%), and no serious complication was observed. Conclusion:Pe-ripheral-type artery-portal vein fistula and mild-to-moderate shunts were easier to close than central-type artery-portal vein fistula and severe shunts were. Tumor embolization and shunt closure were successful in most patients. Therefore, TACE is a safe and reliable method for treating HAPVS in PLC.

Diagnosis and treatment of early-stage hepatic artery complications after orthotopic liver transplantation / 中华肝胆外科杂志

ObjectiveTo determine the risk factors and the optimal management of hepatic artery complications (HAC) after orthotopic liver transplantation.MethodsThe clinical data of 180 orthotopic liver transplantation patients performed between January 2005 and September 2007 was reviewed.The incidence of HAC between primary liver carcinoma and benign diseases of liver was compared.ResultsTwelve (6.7％) episodes of HAC were identified.3 were hepatic artery thrombosis (HAT) and 9 were hepatic artery stenosis (HAS).The incidence of HAC in patients with primary liver carcinoma (6/39) was higher than benign disease (6/141)(P＜0.05).ConclusionsThe keys to management of HAC after orthotopic liver transplantation are to diagnose the complication in time and to select the proper treatment based on the type of HAC.

Value of MR Imaging with Contrast-Enhanced Multi-Phasic Isotropic Volumetric Interpolated Breath-Hold Examination in Diagnosing Primary Liver Carcinoma / 中国普外基础与临床杂志

Objective To evaluate the value of MR imaging with a contrast enhanced multi phasic isotropic volumetric interpolated breath hold examination (VIBE) in diagnosis of primary liver carcinoma. Methods Thirty two consecutive patients with surgical pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two dimensional (2D) T1WI and T2WI images were acquired before administration of Gd DTPA for contrast enhancement. Then, contrast enhanced multi phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results 33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non enhanced T1WI, enhanced T1WI and enhanced 3D VIBE images ( P

A Case Diagnosed as Primary Progressive Liver Carcinoma with Lung Metastasis Based on diagnostic Imaging and Tumor Markers found to be Responsive to Combined Treatment using Shosaiko-to and IFT / 日本東洋医学雑誌

The subject of this study was a 64-year-old male. He had experienced a sensation of abdominal fullness during treatment for chronic hepatitis C at a neighborhood clinic. He was referred to our hospital for work-up upon discovery of elevated AFP.<br>Examination on admission revealed abdominal swelling, ascites and marked swelling of the liver. The AFP was 11, 535ng/m<i>l</i>. A tumor measuring 9 by 8 centimeters was revealed in the right lobe of the liver on the CT scan, and there were many metastatic lesion 1cm in diameter in both the lung field. Since the liver tumor was considered unresectable, in August 1992, MMC and ADM were administered intraarterially just once at doses of 10 and 20mg, respectively. At the end of August, oral administration of UFT at a dose of 600mg/day was started.<br>The patient was discharged after 3 weeks of treatment, but the administration of 300mg/day of UFT was continued, Since hepatic function tended to be aggravated, administration of Shosaiko-to (EK-9) was commenced at a dose of 6g/day. With the combination therapy, the symptoms were gradually relieved and the subjective symptoms disappeared. In September 1992 (8 months after initiation of Shosaiko-to administration), the shadows due to lung metastasis were absent on the chest x-ray examination, and the CT scan turned negative for the tumor in the right lobe. AFP and PIVKA-II decreased below 11.7ng/m<i>l</i> and 0.06AU/m<i>l</i>, respectively. As of December 1994, the patient is still on combination therapy consisting of Shosaiko-to and UFT. Neither adverse reactions such as weight loss have been induced nor has the tumor returned. The general condition of the patient is good.<br>The results obtained in this case suggest that Shosaiko-to and UFT in combination are effective in treating liver carcinoma.