Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
Soluble interleukin-2 recepter(sIL-2R）levels, NK activity and T lymphocyte subpopulation in peripheral blood were determined in 34 cases of primary liver cancer (PLC). The results showed that the mean level of sIL-2R and CD8 in the patients with primary liver cancer were higher than that in health subjects (Plt;0.01or Plt;0.05), NK activity and T lymphocyte subpopulation (CD3,CD4,CD4/CD8) in the patients with primary liver cancer were much lower than that in health subjects (Plt;0.01), sIL-2R levels in stage II, III patients with primary liver cancer were significantly higher than that in stage I (Plt;0.01). The 6-month mortality rate in 3 groups of patients with sIL-2R level ≥1000u/ml, 500-1000u/ml, andlt;500u/ml were 80.0%, 29.4%and 0 respectively. sIL-2R levels were also decreased (Plt;0.05) in patient with primary liver cancer 4 weeks after immune therapy, but the cell-mediated immunity was increased. It suggests that sIL-2R level determination in peripheral blood is a new biological marker for the assessment of the stage, the response to medical intervention, the prognosis and cell-mediated immunity in primary liver cancer.
Objective To state operative details of lip-shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC).Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip-shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge-shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1-,3-,5-year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface.Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.
The serum level of testosterone (T), estradiol (E2) and progesterone (P) in 86 cases with primary liver cancer (PLC) (male：76 cases; female：10 cases) was determined by RIA method. The result showed that for male cases, serum level of T and ratio of T/E２ in operation group and nonoperation group was significantly higher than that in benign hepatic diseases group (BHD group) and normal control group (NC group), but the value of E２ obviously lower than the later two groups. After tumor resection, the level of E2 increased, while serum level of T and value of T/E２ decreased, which had no significant difference as contrasted with BHD group and NC group. The serum level of T,E2 in female PLC group made no difference to BHD group and NC group, but the value of T/E2 much higher than NC group. No obvious changes of the serum level of progesterone can be observed in both male and female cases. Our research showed that high serum testosterone level and low estradiol level may be concerned with PLC. The possibility and importance of sex hormone imbalance on initializing and developing of PLC is suggested.
Objective To improve the prognosis of primary liver cancer with portal vein tumor thrombus （PVTT）， the progress of treatment for primary liver cancer with PVTT was reviewed. Methods The therapeutic approach and its efficacy for primary liver cancer with PVTT were summarized by literature search within recent years. Results PVTT is a common complication of primary liver cancer， the therapeutic approach are surgical resection， transcatheter arterial chemoembolization (TACE), intraportal venous therapy， radiotherapy， ablation therapy, molecular targeted therapy， etc. The excision rate for primary liver cancer with PVTT is low， the treatment is difficult and the outcome is dismal. It remains a poor prognosis at present， and the therapeutic effect need to be promoted. Conclusions The main treatment for primary liver cancer with PVTT should be surgical excision combine with other multidisciplinary comprehensive treatment to improve the survival in patients with PVTT， moreover， the therapeutic approach should be individualized and sequentially according to the patient’s condition and the type of PVTT.
Objective To systematically evaluate AFP as the diagnostic standard for Chinese primary liver cancer (PLC). Methods A comprehensive electronic search and additional manual tracking were performed to retrieve relevant studies on AFP in diagnosis of Chinese PLC. All studies were divided into three groups according to the cutoff value of AFP: 20 or 25 ?g/L, 200 ?g/L, 400 ?g/L (Groups 1, 2, and 3, respectively). The data about the accuracy of the included studies were extracted for further heterogeneity studies; statistical pooling and SROC (summary receiver operating characteristics) were analyzed using MetaDisc 1.4 software. Results Twenty studies which were selected from 1,062 references met the inclusion criteria. Heterogeneity (except for threshold effect) was found within the three groups. A Meta-analysis was performed using the random effect model. Compared with the other two groups, the specificity of Group 3 (AFP 400 ?g/L) was the highest (0.977, 95%CI 0.967 to 0.985) and sensitivity was the lowest (0.422, 95%CI 0.403 to 0.441). The values of LR+ and dOR were lower than those of Group 2 (AFP 200?g/L) (17.691: 19.669; 32.820: 53.599, respectively). Area under curve (AUC) of SROC and Q index of Group 3 were also lower than those of Group 2 (0.6575: 0.832 3; 0.633 8: 0.782 2, respectively). Conclusion Four-hundred ?g/L of AFP as the diagnostic standard for PLC is not good enough, and we suggest that 200 ?g/L may be better than 400 ?g/L for PLC diagnosis.
ObjectiveTo study the clinical role of spleen/remnant liver volume ratio in evaluating liver reserve function after surgical treatment for liver cancer. MethodsTo calculate the ratio of spleen volume/remnant liver volume after tumor excision with imaging method and immersion method; to analyze the relationships between spleen/remnant liver volume ratio and liver function score after operation as well as hospital stay. ResultsLiver function ChildPugh score was related mainly with spleen/remnant liver volume ratio (t=7.831, P=0.000), which was proved by multiple regression analysis. The median hospital stay of the group with spleen/remnant liver ratio ≤0.9 was 14 d （12-16 d）, which was less than that (22 d, 15-29 d) of the other group with the ratio gt;0.9 (P=0.000). ConclusionsSpleen/remnant liver volume ratio can predict effectively recovery ability of patients after operation for liver cancer， and assess correctly the reserve function of liver. When the ratio is less than or equal 0.9, the operation is safe.
Objective To study the effects of pcDNA3/AFP/TK/Angio fusion gene targeting therapy for human primary liver cancer in nude mice implanted with SMMC-7721. Methods Human liver cancer cell line SMMC-7721 was implanted subcutaneously in nude mice to establish experiment model. Animals bearing liver cancer were randomly divided into five groups: control group， vector group， GCV (ganciclovir) group， pcDNA3/TK/Angio group; pcDNA3/AFP/TK/Angio group. Different plasmids were directly injected into tumors and GCV was intraperitoneally administrated simultaneously according to different groups. The growth of tumors was observed and the pathology was examined as well. Serum AFP level was measured by radioimmunology, the ultrastructural change of tumor cells was studied by using electron microscopy, the expressions of MVD and VEGF were respectively detected with immunohistochemistry and the cell apoptosis in situ was detected by TUNEL. Results The success rate to establish subcutaneous implanted liver cancer model in nude mice was 100%. The tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/TK/Angio group and pcDNA3/AFP/TK/Angio group were lower than those in control group, vector group and GCV group (P＜0.05) and more apoptosis cells could be observed. While the tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/AFP/TK/Angio group was lower than those in pcDNA3/TK/Angio group (P＜0.05); and apoptosis index was higher than that of the latter (P＜0.05).Conclusion pcDNA3/AFP/TK/Angio fusion gene inhibits the growth of tumor remarkably and becomes a promising new biological agent to treat human primary liver cancer.
31 case of advanced primary liver cancer were treated by using IL-2 and LAK cells in which 15 cases were combined with surgery (group A) and 16 cases were combined with chemotherpy (Group B). 7～14 months follow-up showed: In group A there was no recurence and metastasis, and the cell-mediated immunity was obviously improved. In group B, the average life time was more than 5.84 months, the tumor average diameter dicreased in 10 cases ,and the cee-mediated immunity was also improved. The role of immunotherapy combined with surgery or chemotherapy was discussed.
ObjectivesTo classify the high risk population for primary liver cancer (PLC) in rural China.MethodsBetween June 2011 and June 2013, hepatitis B surface antigen (HBsAg) carriers were identified in clinical laboratory of Qidong People’s Hospital and surveyed by questionnaires. Cox proportional hazard regression model was introduced to demonstrate independent risk factors associated with PLC occurrence. Moreover, receiver characteristic operating (ROC) curve was utilized to evaluate discrimination power of risk factor panel for PLC risk classification.ResultsA total of 1 296 HBsAg carriers were enrolled, among which 686 participants were male with an average age of 45.73±11.58 years, and 610 participants were female with an average age of 45.67±12.33 years. After a mean follow up period of 5.5 years, 43 incident PLC cases were confirmed, which generated a PLC incidence of 60.5 millions person years. Multi-univariate Cox model showed that increase of age (HR=1.055, 95%CI 1.029 to 1.083, P<0.000 1), male (HR=3.263, 95%CI 1.567 to 6.796,P=0.001 6), having family history of PLC (HR=2.315, 95%CI 1.260 to 4.252, P=0.006 8), HBeAg positivity (HR=2.367, 95%CI 1.267 to 4.419, P=0.006 9) and GGT abnormality (HR=2.721, 95%CI 1.457 to 5.083, P=0.001 7) were the independent risk factors of PLC.ConclusionRoutine host, viral and liver biochemical parameters which are readily accessible in daily clinical practice can be utilized in identification of the targeted population for prevention of PLC in rural China.