中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2015 No. 6

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Editorial
Current challenges to primary liver cancer research
Ye ShengLong
2015, 31(6): 819-823. DOI: 10.3969/j.issn.1001-5256.2015.06.001
Abstract:
Primary liver cancer is a common malignancy with increasing incidence and mortality. Remarkable progress has been made in the clinical research on liver cancer,but challenges to further improvement are still rigorous. This article reviews the progress and difficulties of primary liver cancer study from the following aspects: molecular classification and stem cell biology,pathological and clinical diagnosis,clinical staging,surgical treatment,loco- regional treatment,molecular targeted therapy,systemic chemotherapy,management of portal vein tumor thrombus,antiviral therapy,diagnosis and treatment of intrahepatic cholangiocarcinoma,and multimodality treatment. The future strategies to further improve primary liver cancer study are also investigated.
Therapeutic guidelines
Policybrief: Guidelines for the prevention, care, and treatment of chronic hepatitis B virus infection(march 2015)
World Health Organization
2015, 31(6): 824-828. DOI: 10.3969/j.issn.1001-5256.2015.06.002
Abstract:
Explanation of the “Guidelines for the prevention,care and treatment of persons with chronic hepatitis B infection 2015”: non-invasive assessment of liver fibrosis,treatment strategy and implementation of national programs
Hu XiaoYun, Liu ZhiHong, Sun Jian
2015, 31(6): 829-832. DOI: 10.3969/j.issn.1001-5256.2015.06.003
Abstract(141) PDF (207KB)(1261)
Abstract:
Updated key points and clinical pathway for NCCN Clinical Practice Guidelines in Oncology: hepatobiliary cancers(Version 2. 2015)
Zhu Peng, Xu Zong, Wang YuMing
2015, 31(6): 840-849. DOI: 10.3969/j.issn.1001-5256.2015.06.005
Abstract:
Interpretation of key points in Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma: The Japan Society of Hepatology 2013 update (3rd JSH-HCC Guidelines)
Wu YinLian, Lin Su, Dong Jing, Jiang JiaJi
2015, 31(6): 850-851. DOI: 10.3969/j.issn.1001-5256.2015.06.006
Abstract:
UK guidelines on the management of variceal haemorrhage in cirrhotic patients (2015): an excerpt of recommendations
Deng Han, Qi XingShun, Guo XiaoZhong
2015, 31(6): 852-854. DOI: 10.3969/j.issn.1001-5256.2015.06.007
Abstract:
Discussions by experts
Significance of predictive models / risk calculators for HBV-related hepatocellular carcinoma
Dong Jing, Jiang JiaJi
2015, 31(6): 855-858. DOI: 10.3969/j.issn.1001-5256.2015.06.008
Abstract:
Hepatitis B virus( HBV)- related hepatocellular carcinoma( HCC) is a major public health problem in Southeast Asia. In recent years,researchers from Hong Kong and Taiwan have reported predictive models or risk calculators for HBV- associated HCC by studying its natural history,which,to some extent,predicts the possibility of HCC development. Generally,risk factors of each model involve age,sex,HBV DNA level,and liver cirrhosis. This article discusses the evolution and clinical significance of currently used predictive models for HBV- associated HCC and assesses the advantages and limits of risk calculators. Updated REACH- B model and LSM- HCC model show better negative predictive values and have better performance in predicting the outcomes of patients with chronic hepatitis B( CHB). These models can be applied to stratified screening of HCC and,meanwhile,become an assessment tool for the management of CHB patients.
Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus
Jia WeiDong, Liu WenBin
2015, 31(6): 859-862. DOI: 10.3969/j.issn.1001-5256.2015.06.009
Abstract:
Portal vein tumor thrombus( PVTT) is one of the important biological characteristics of hepatocellular carcinoma( HCC),and also a serious complication and a metastatic mode. Surgical treatment is still the most effective therapy for HCC with PVTT. This article describes the history and present situation of surgical treatment of HCC with PVTT,the anatomical basis for PVTT formation,classification of PVTT,indications for surgery,selection of surgical approaches,and evaluation of the surgical outcome of PVTT. Individualized multidisciplinary treatment should be developed based on evidence- based medicine,which might be the right direction for the treatment of HCC with PVTT.
Comprehensive interventional treatment of hepatocellular carcinoma with portal vein tumor thrombosis
Zhu XiaoLi
2015, 31(6): 863-869. DOI: 10.3969/j.issn.1001-5256.2015.06.010
Abstract:
Portal vein tumor thrombosis( PVTT) often occurs in advanced hepatocellular carcinoma( HCC) patients. PVTT may cause tumor dissemination,liver failure,and portal hypertension,thus leading to intractable ascites,variceal rupture,and hepatic encephalopathy,which will result in a poor prognosis. According to the Barcelona Clinic Liver Cancer Staging System,sorafenib is recommended as the first- line treatment for advanced HCC with PVTT,but its application in China has been limited due to its mild efficacy and high price.Nowadays,interventional treatment is widely used in the treatment of advanced HCC with PVTT due to the advantages of minimal invasiveness and repeatability and shows good efficacy. At present,the main methods of interventional treatment include hepatic arterial infusion chemotherapy,transcatheter arterial chemoembolization( TACE),TACE combined with sorafenib,TACE combined with ablation,TACE combined with three- dimensional conformal radiotherapy,TACE combined with portal vein stent placement,endovascular implantation of iodine- 125 seeds strand,and transjugular intrahepatic portosystemic shunt. It is pointed out that multimodality treatment is expected to achieve good efficacy in the treatment of advanced HCC with PVTT.
A novel approach for treating hepatocellular carcinoma: epigenetic therapy
Li Qiang, Chen Liang, Huang YuXian
2015, 31(6): 870-875. DOI: 10.3969/j.issn.1001-5256.2015.06.011
Abstract:
Recent studies have shown that the pathophysiology of hepatocellular carcinoma( HCC) involves epigenetic alterations in DNA methylation,histone modifications,and microRNAs. In this review,we describe the general characteristics of epigenetic machinery in HCC as well as the current advances in epigenetic therapy for HCC. It is pointed out that epigenetic therapy has good prospects in the treatment of HCC,but there is still a long way before clinical application.
Hepatic stellate cells,Toll-like receptor 4 signaling pathway,and inflammatory fibrotic microenvironment in the development of hepatocellular carcinoma
Wu YuJing, Guo JinSheng
2015, 31(6): 876-879. DOI: 10.3969/j.issn.1001-5256.2015.06.012
Abstract:
The development of hepatocellular carcinoma( HCC) is closely related to the precancerous microenvironment of inflammation and fibrosis. The activated hepatic stellate cells( HSCs) are the major source of extracellular matrix in the development of liver fibrosis and the key effective cells of hepatic inflammatory responses. HSCs have an intact Toll- like receptor 4( TLR4) signaling pathway,which mediates important biological properties of HSCs such as fibrogenesis,inflammatory phenotype,and immunoregulatory function. The TLR4 signaling pathway is involved in the development and progression of chronic liver diseases,and mediates liver fibrogenesis and HCC. HSCs produce several cytokines and growth factors by TLR4 signaling pathway,which has been confirmed to be related to the development of HCC.
Original articles_Liver neoplasms
Efficacy of transcatheter arterial chemoembolization alone or combined with microwave ablation in treatment of primary large liver cancer: a comparative analysis
Chang Peng, Zhang HongYi, Xiao Mei
2015, 31(6): 880-885. DOI: 10.3969/j.issn.1001-5256.2015.06.013
Abstract:

Objective To retrospectively analyze the short- term efficacy and long- term survival rates of transcatheter arterial chemoembolization( TACE) combined with percutaneous microwave coagulation therapy( PMCT) versus TACE monotherapy in the treatment of large primary hepatic carcinoma. Methods Sixty- seven patients with unresectable large primary hepatic carcinoma( > 5. 0 cm) who were admitted to our hospital from February 2011 to May 2014 were enrolled as subjects. Among these patients,34 patients received TACE monotherapy and 33 patients received TACE combined with PMCT. At one month after treatment,the abdomen was re- examined using contrast-enhanced computed tomography or magnetic resonance imaging,and liver function and alpha- fetoprotein( AFP) level were measured. The follow- up period varied from 3 to 36 months. Comparison of short- term outcomes,AFP level,and long- term survival rates were performed between the two groups. Comparison of continuous data was made by t test,and comparison of categorical data by χ2test and Fisher's test. Results The complete ablation rate and the response rate were significantly higher in the combination therapy group than in the TACE monotherapy group( 54. 5% vs 20. 6%,P = 0. 004; 97% vs 64. 7%,P = 0. 001). The AFP level after treatment with combination therapy was significantly lower than that before treatment with combination therapy and that after treatment with TACE monotherapy( P < 0. 001; P <0. 001). Patients in both groups had varying degrees of liver dysfunction and elevated aminotransferase,but with no severe complications such as bleeding,gastrostoma,colon fistula,bile duct injury,and needle tract metastasis,as well as deaths. The median survival time in the combination therapy group and the TACE monotherapy group was 13 months and 9 months,respectively,and the mean survival time was14. 00 ± 1. 63 months and 10. 83 ± 1. 19 months,respectively. The 1-,2-,and 3- year overall survival rates in the combination therapy group were significantly higher than those in the TACE monotherapy group( 63. 6% vs 28. 4%; 15. 2% vs 5. 9%; 4. 5% vs 0%; P =0. 044). Conclusion TACE combined with PMCT is a safe and effective therapy regimen,which achieves better treatment outcomes in local tumor control,substantially lower AFP level,and longer survival time than TACE monotherapy.

Efficacy and prognostic factors of intensity-modulated radiotherapy for large primary hepatocellular carcinoma
Fang ZiYan, Jin Shuai, Li Gong
2015, 31(6): 886-890. DOI: 10.3969/j.issn.1001-5256.2015.06.014
Abstract:

Objective To investigate the efficacy of intensity- modulated radiotherapy( IMRT) in treating large primary hepatocellular carcinoma( LHCC) which is unsuitable for surgery or has poor response to radiofrequency ablation,interventional therapy,and other local treatments,and to identify the prognostic factors for survival. Methods We retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short- term efficacy and prognosis were observed and analyzed. The Kaplan- Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. Results The complete remission,partial remission,stable disease,and disease progression rates were 3. 57%,32. 14%,53. 57%,and 10. 72%,respectively. The overall median progression- free survival( PFS) time was 6. 43 months,and the median overall survival( OS) time was 11. 43 months. The 1- and 2- year survival rates were 46. 79% and 25. 23%,respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition,the independent prognostic factors for OS included tumor response rate,tumor diameter,and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort,radiation- induced liver damage,and myelosuppression. Conclusion IMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.

Therapeutic effect and prognostic analysis of intensity-modulated radiotherapy for primary hepatocellular carcinoma with portal vein and / or inferior vena cava tumor thrombus
Huang Long, Qi Liang, Li Gong
2015, 31(6): 891-894. DOI: 10.3969/j.issn.1001-5256.2015.06.015
Abstract:

Objective To determine the efficacy and prognostic factors of intensity- modulated radiotherapy( IMRT) for primary hepatocellular carcinoma( HCC) with portal vein and / or inferior vena cava tumor thrombus. Methods Twenty- three HCC patients with portal vein and / or inferior vena cava tumor thrombus received IMRT with an 8 MV linear accelerator at the Cancer Center of General Hospital of Armed Police Forces,Anhui Medical University,from April 2008 to August 2011. A single dose of 3 to 6 Gy was delivered at five fractions per week,with a total dose of 56 to 96 Gy and a median dose of 60 Gy. Survival time was recorded,and adverse reactions were evaluated. Survival rate calculation and survival analysis were performed using the Kaplan- Meier method. Comparison of categorical between two groups was made by chi- square test. Results One patient did not complete radiotherapy due to upper gastrointestinal bleeding. Of 22 patients who completed IMRT,4 achieved complete remission and 10 achieved partial remission,with an overall response rate of 63. 7%. Our analysis showed that the type of tumor thrombus and tumor size were associated with tumor response rate and were significant prognostic factors( P< 0. 05). The median survival time was 13. 4 months. The 1-,2-,and 3- year survival rates were 59%,27%,and 18%,respectively. The 22 patients who completed radiotherapy did not experience acute radiation injury or late adverse outcomes such as radiation- induced liver disease. Conclusion This study suggests IMRT is a safe and effective treatment option for HCC patients with portal vein and / or inferior vena cava tumor thrombus.

Efficacy of sorafenib combined with capecitabine in Hui versus Han residents with advanced hepatocellular carcinoma in Sanya,Hainan,China: a comparative analysis
Chen Long, Liang Dong, Hou BenXin, Feng Jun, Lin YongPing, Lu ZhiCheng
2015, 31(6): 895-898. DOI: 10.3969/j.issn.1001-5256.2015.06.016
Abstract:

Objective To compare the clinical efficacy of sorafenib combined with capecitabine in Hui versus Han residents with advanced hepatocellular carcinoma( HCC) in Sanya,Hainan,China. Methods A total of 96 Hui and Han residents with advanced HCC took oral capecitabine 1500 mg / m2 twice daily for 14 days followed by a 7- day withdrawal,which was repeated at least twice; besides,sorafenib was given orally at a dose of 400 mg twice daily until tumor progression occurred. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chi- square test. Results In the two groups of Hui and Han patients,the rates of alpha- fetoprotein reduction were 60. 9% and 40. 0%,respectively( χ2= 4. 173,P = 0. 041); the rates of serum ferritin reduction were 50. 0% and 30. 0%,respectively( χ2= 4. 007,P = 0. 027); the rates of tumor regression were 54. 3% and 34. 0% as shown by CT( χ2= 4. 030,P = 0. 045); the response rates were 32. 6% and 14. 0%,respectively( χ2= 4. 697,P = 0. 030). Survival analysis suggested the combination of sorafenib and capecitabine had provided a significantly higher overall survival rate in Hui patients than in Han patients( P< 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion In Sanya,a combination of sorafenib and capecitabine has better efficacy in Hui patients with advanced HCC than in Han patients,and the former have a higher overall survival rate.

Ultrasound-guided percutaneous cinobufagin injection for treatment of portal vein tumor thrombus in primary liver cancer patients
Ji JianFeng, Deng XiaoLi, Xiao QiuJin, Yang Xue
2015, 31(6): 899-902. DOI: 10.3969/j.issn.1001-5256.2015.06.017
Abstract:

Objective To evaluate the clinical value of ultrasound- guided percutaneous cinobufagin injection for the treatment of portal vein tumor thrombus( PVTT) in primary liver cancer( PLC) patients. Methods A total of 25 PLC patients with PVTT who were admitted to our hospital from January 2009 to March 2012 were recruited in this study. These patients underwent ultrasound- guided percutaneous cinobufagin injection three times a week,and each course of treatment was 4- 5 weeks. After treatment,the clinical efficacy and survival rates were determined,and the changes in levels of alpha fetoprotein( AFP) and alanine aminotransferase( ALT) were evaluated. Results Seventeen patients showed varying degrees of improvement after treatment,with an overall response rate of 68%. In addition,the levels of AFP and ALT were significantly reduced after treatment( P < 0. 05). The survival rates at 3,6,12,and 24 months after treatment were88%,76%,60%,and 32%,respectively. Conclusion Ultrasound- guided percutaneous cinobufagin injection has good efficacy in the treatment of PVTT in PLC patients and shows a good clinical value.

Relationship between tumor location and pain level in CT-guided percutaneous microwave ablation of hepatocellular carcinoma
Li JingHua, Cui ShiChang, Sun Jian, Fang Da, Du Ning, Zheng JiaSheng, Cui XiongWei
2015, 31(6): 903-906. DOI: 10.3969/j.issn.1001-5256.2015.06.018
Abstract:

Objective To investigate the relationship between tumor location and pain level in computed tomography( CT)- guided percutaneous microwave ablation( MWA) of hepatocellular carcinoma( HCC) under local anesthesia. Methods A total of 42 tumors in 35 HCC patients were given CT- guided percutaneous MWA under local anesthesia after transcatheter hepatic arterial chemoembolization. The 35 patients were divided into two groups based on the distance from the tumor to the Glisson's capsule and / or the branch of the portal vein. Group A( 19 tumors out of 16 patients) had a distance of ≤5 mm from the tumor to the Glisson's capsule and / or the branch of the portal vein,and group B( 23 tumors out of 19 patients) had a distance of > 5 mm from the tumor to both the Glisson's capsule and the branch of the portal vein. The pain levels of the two groups were evaluated by visual analogue scale( VAS). The tumor size,baseline VAS score,intraoperative VAS score( the highest VAS score during MWA),relative VAS score( intraoperative VAS score minus baseline VAS score),the highest tolerated MWA power,ablation time,and meperidine hydrochloride dose were recorded and compared between the two groups. The comparison was made by Mann- Whitney U test. Results The 16 cases in group A had significantly higher intraoperative VAS score and relative VAS score than the 19 cases in group B( 3. 25 ± 0. 68 vs 2. 74 ± 0. 73,P = 0. 042; 3. 00 ± 0. 52 vs 2. 47 ± 0. 61,P = 0. 009). It showed that the patients whose tumor was close to the Glisson' s capsule had a greater pain level than the patients whose tumor was away from the Glisson's capsule. The dose of meperidine hydrochloride in group A was significantly higher than that in group B( 78. 1 ± 20. 2 mg vs 64. 5± 17. 3 mg,P = 0. 039). After treatment with high dose of meperidine hydrochloride,groups A and B showed no significant differences in the highest tolerated MWA power and ablation time( 73. 8 ± 15. 4 W vs 75. 8 ± 17. 7 W,P > 0. 05; 6. 6 ± 1. 8 min vs 6. 4 ± 2. 1 min,P >0. 05). Conclusion The patients who have a longer distance between the tumor and the Glisson's capsule and the branch of the portal vein suffer greater pain in MWA therapy. Additional meperidine hydrochloride can help complete the MWA treatment.

Clinical characteristics of patients with HBs Ag( + ) versus HBs Ag(-) / HBc Ab( + ) primary hepatic carcinoma treated by hepatectomy: a comparative analysis
Yang KeLi, Yang Zhan, Guan YuJuan, Ying RuoSu, Li JianPing
2015, 31(6): 907-909. DOI: 10.3969/j.issn.1001-5256.2015.06.019
Abstract:

Objective To explore the differences in clinical characteristics between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) primary hepatic carcinoma( PHC) treated by hepatectomy. Methods Forty- three HBs Ag( +) and 18 HBs Ag(-) /HBc Ab( +)patients who underwent liver resection against PHC from October 2009 to November 2014 in Guangzhou 8th People's Hospital were selected for the study. The clinical data of the subjects,including sex,age,histological differentiation,intravascular tumor thrombi,and hepatic cirrhosis,were compared,using t test for continuous data,chi- square test for categorical data,and Mann- Whitney U test for non- parametric data. Results No significant differences existed between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) PHC in terms of the age of onset( 50. 77 ± 12. 93 years vs 54. 28 ± 9. 89 years,t =- 1. 031,P > 0. 05),the incidence of cholangiocarcinoma( 2. 3% vs16. 7%,χ2= 2. 24,P > 0. 05),the incidence of hepatic cirrhosis( 62. 8% vs 44. 4%,χ2= 1. 746,P > 0. 05),alpha- fetoprotein level( 3638 ± 7869 ng/ml vs 3577 ± 9628 ng/ml,t = 0. 026,P > 0. 05),histological differentiation( Z =- 1. 085,P > 0. 05),and the rate of intravascular tumor thrombi( 34. 9% vs 22. 2%,χ2= 0. 949,P > 0. 05). Conclusion There are no significant differences in the age of onset and progression of disease between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) PHC treated by hepatectomy. However,given the possibility of occult hepatitis B virus infection,it is necessary to monitor hepatic carcinoma even post HBs Ag seroconversion

Usage analysis of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy
Huang DongHai, Shi JianShe, Zhang ChengHua
2015, 31(6): 910-914. DOI: 10.3969/j.issn.1001-5256.2015.06.020
Abstract:

Objective To analyze the usage of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy.Methods A total of 121 patients with liver cancer and liver cirrhosis who received hepatectomy in our hospital from January 2012 to January2014 were divided into control group( n = 60) and observation group( n = 61). Both groups received human serum albumin in addition to the routine treatment for liver protection. The observation group was given intravenous drip of 5% human serum albumin within 48 h after surgery. The plasma albumin concentrations of patients were measured at 48 h after surgery,and if the concentration was < 35 g / L,the patients would be given 20% human serum albumin until the concentration was ≥35 g / L. The control group was given intravenous drip of 20%human serum albumin within 48 h after surgery until the plasma albumin concentration was ≥35 g / L. The amounts of used human serum albumin and plasma were recorded for both groups. The urine volume,abdominal drainage volume,central venous pressure( CVP),mean arterial pressure( MAP),and thromboelastogram( TEG) R and K values were measured at 1,3,7,and 10 days after surgery. The liver function indices before and after surgery and the indocyanine green retention rate at 15 minutes( ICG R15) at 7 days after surgery were measured. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chisquare test. Results( 1) There were no significant differences in age,sex,Child- Pugh classification,surgical approach,intraoperative blood loss,occlusion time of the first porta hepatis,and operation time between the two groups( P > 0. 05). But there were significant differences in the amounts of used human serum albumin and plasma and the length of hospital stay between the two groups( P < 0. 05).( 2) There were significant differences in daily urine volume,CVP,MAP,abdominal drainage volume,and interstitial fluid volume at 1 and 3 days after surgery between the two groups( P < 0. 05),but there were no significant differences in the above indices at 7 days after surgery between the two groups( P > 0. 05). There were no significant differences in alanine aminotransferase,aspartate aminotransferase,total bilirubin,and TEG R and K values at 1 and 3 days after surgery between the two groups( P > 0. 05),but significant differences were observed in the above indices at 7 days after surgery( P < 0. 05).( 3) There was a significant difference in ICGR15 at 7 days after surgery between the observation group and the control group( 16. 59% ± 4. 4% vs 13. 21% ± 4. 2%,t = 5. 23,P = 0. 000). Conclusion The isotonic albumin and hypertonic albumin used in different periods after surgery have a better clinical effect than hypertonic albumin alone.

Clinical analysis of blood amino acids and trace elements in patients with hepatocellular carcinoma
Zhao YuPing, Han XiuQing, Xue ShuBao, Xiao FengYan, Gao CuiHong, Zhao LiMei
2015, 31(6): 915-917. DOI: 10.3969/j.issn.1001-5256.2015.06.021
Abstract:

Objective To investigate the characteristics of trace elements and amino acid metabolism in the blood of patients with hepatocellular carcinoma( HCC) and to guide clinical treatment. Methods This study included 125 untreated patients with primary HCC in Tangshan Maternal and Child Health Hospital and Tangshan Guzhi District Hospital from March to November,2013,as well as 50 healthy controls who underwent physical examination in Tangshan Maternal and Child Health Hospital. Blood trace elements were measured by atomic absorption spectrophotometry,and the levels of amino acids were determined by an amino acid analyzer. Comparison of continuous data was made by t test. Results Compared with the controls,the HCC patients had a significantly higher Cu level( t = 6. 30,P < 0. 05) and significantly lower Zn,Fe,and Mg levels( t = 10. 15,3. 98,and 2. 25,all P < 0. 05). The HCC patients showed significant increases in tyrosine,phenylalanine,and methionine levels( t = 10. 10,13. 46,and 2. 34,all P < 0. 05) and significant decreases in valine,isoleucine,leucine,and arginine levels( t = 3. 65,2. 98,5. 67,and 8. 35,all P < 0. 05). Conclusion HCC patients show changes in various amino acids and trace elements in blood. Measurement of trace elements and amino acids is of certain significance for evaluating HCC patients' condition and guiding clinical treatment.

Therapeutic comparison between radiofrequency ablation and percutaneous ethanol injection in treatment of primary liver cancer: a meta-analysis
Yin Yu, Ni CaiFang, Li Zhi, Tang Jie
2015, 31(6): 918-921. DOI: 10.3969/j.issn.1001-5256.2015.06.022
Abstract:

Objective To compare the efficacy of radiofrequency ablation( RFA) versus percutaneous ethanol injection( PEI) in the treatment of primary liver cancer( PLC). Methods A search of Pub Med,EMBASE,CKNI,VIP,and Wanfang Data identified all randomized controlled trials( RCTs) related to therapeutic comparison between RFA and PEI in patients with PLC. Quality of each study was assessed,meta- analysis was performed with Review Manager 5. 0 software,and the results were analyzed with fixed effect model and random effect model. Results Seven RCTs were included in this study. The results of meta- analysis indicated that,compared with the PEI group,the RFA group had a significantly higher tumor necrosis rate( P = 0. 008,OR = 2. 66,95% CI: 1. 29- 5. 48). The 1-,2-,and 3- year survival rates and 1- and 3- year tumor- free survival rates of the RFA group were significantly higher than those of the PEI group( P <0. 05). The RFA group had significantly lower 1-,2-,and 3- year local recurrence rates in comparison with the PEI group( P < 0. 05).There was no significant difference in 2- year tumor- free survival rate between the two groups( P = 0. 06). Conclusion The efficacy of RFA is superior to that of PEI,which is of clinical significance to guide the selection of methods for PLC treatment.

Efficacy and safety of octreotide in treatment of hepatocellular carcinoma: a meta-analysis
Zhang YuHuai, Luo ZhangJiang
2015, 31(6): 922-926. DOI: 10.3969/j.issn.1001-5256.2015.06.023
Abstract:

Objective To systematically evaluate the efficacy and safety of octreotide in the treatment of hepatocellular carcinoma( HCC).Methods Online databases including Pub Med,Cochrane Library,Embase,China National Knowledge Internet,Wanfang Data,and China Science and Technology Journal Database were comprehensively searched for relevant randomized controlled trials( RCTs) of octreotide in the treatment of HCC. The quality of included studies was assessed using the method recommended by the Cochrane handbook for systematic review. A meta- analysis was performed by using Rev Man 5. 3. 4 software. Results Eleven RCTs were included,which involved 909 cases( treatment group,452 cases; control group,457 cases). As for clinical efficacy,octreotide significantly increased the response rate( RR =2. 30,95% CI: 1. 25 ~ 4. 22,P = 0. 007) and decreased the progression rate( RR = 0. 78,95% CI: 0. 59 ~ 1. 04,P = 0. 09),but there was no significant difference in disease control rate and progression rate between the two groups( P > 0. 05). The overall survival rate and6- month,1- year,and 2- year survival rates in the treatment group were not significantly higher than those of the control group( all P >0. 05). As regards to safety,severe adverse events in the treatment group were significantly reduced( RR = 0. 72,95% CI: 0. 54 ~ 0. 98,P= 0. 03),but there were no significant differences in diarrhea,nausea / vomiting,liver function abnormality,and blood glucose fluctuation between the two groups( all P > 0. 05). Conclusion For HCC patients,octreotide can significantly increase the clinical response rate incidence of grade 3 /4 adverse events,but it does not lead to significant improvement in disease progression and survival rate.

Preoperative neutrophil-lymphocyte ratio is an independent prognostic factor for hepatocellular carcinoma after radical resection
Zhang TingTing, Zhao XiangQian, Liu Zhe, Jiao ShunChang, Bai Li
2015, 31(6): 927-931. DOI: 10.3969/j.issn.1001-5256.2015.06.024
Abstract:

Objective To evaluate the effect and predictive value of preoperative neutrophil- lymphocyte ratio( NLR) on the prognosis of patients undergoing radical resection for hepatocellular carcinoma( HCC). Methods The clinical data of 245 patients who received radical resection for HCC in our hospital from 2004 to 2009 were retrospectively analyzed. The effects of clinicopathological parameters including NLR on overall survival( OS) time were assessed by univariate analysis using the log- rank test. The significant variables were further analyzed by multivariate analysis using the Cox regression model. Results Using NLR = 1. 5,2,and 3 as cut- off points,the patients were divided into four groups. The median OS time in groups with NLR < 1. 5,1. 5≤NLR < 2,2≤NLR < 3,and NLR≥3 was 39. 6,38. 3,25. 4,and 19. 9 months,respectively( P = 0. 003). Multivariate analysis showed that preoperative NLR,levels of alpha- fetoprotein and alanine aminotransferase in peripheral blood,number of tumor nodules,maximum size of tumor,and portal vein tumor thrombus were independent prognostic factors for HCC( P < 0. 05). Conclusion Preoperative NLR in peripheral blood is a novel prognostic biomarker for HCC after radical resection.

Angiogenesis-related factors in various clinical stages of hepatitis B-related hepatocellular carcinoma
Han Zhen, Sun HuanQin, Jiang Na, Liu Ning, Xu Jie, Sun JianPing, Zhang YongHong
2015, 31(6): 932-935. DOI: 10.3969/j.issn.1001-5256.2015.06.025
Abstract:

Objective To investigate the expression levels of angiogenesis- related factors in various clinical stages of hepatitis B- related hepatocellular carcinoma( HCC) and their clinical significance. Methods Seventy patients with hepatitis B- related HCC who were admitted to our hospital from 2011 to 2013 were enrolled as subjects and divided into four groups according to the HCC staging criteria: very early HCC group( n = 18),early HCC group( n = 17),advanced HCC group( n = 18),and end- stage HCC group( n = 17). Eighteen healthy volunteers were used as controls. The Luminex 200 liquid suspension array system was used to determine the expression levels of vascular endothelial growth factor( VEGF),vascular endothelial growth factor receptors( VEGFR- 1 and VEGFR- 2),and hepatocyte growth factor( HGF) in each clinical stage of hepatitis B- related HCC. Comparison of continuous data between two groups was made by t test. Results Compared with the control group,the very early HCC group had significantly higher levels of VEGF and HGF( t = 2. 69,P = 0. 008; t =2. 18,P = 0. 002). The early HCC group had significantly higher levels of VEGF,VEGFR- 1,and HGF than the control group( t = 1. 73,P = 0. 01; t = 2. 03,P = 0. 009; t = 2. 54,P = 0. 008). The levels of VEGF,VEGFR- 1,and HGF were significantly higher in the advanced HCC group than in the control group( t = 1. 64,P = 0. 01; t = 4. 38,P = 0. 007; t = 4. 02,P = 0. 005). In the end- stage HCC group,the levels of VEGF,VEGFR- 1,VEGFR- 2,and HGF were significantly higher than those in the control group( t = 4. 37,P =0. 007; t = 20. 24,P = 0. 009; t = 2. 21,P = 0. 01; t = 3. 06,P = 0. 003). Conclusion The levels of angiogenesis- related factors,VEGF and HGF,have already been substantially increased in the very early HCC,which induces a substantial upregulation of expression of VEGFR- 1 and VEGFR- 2 along with the progression of HCC.

Correlation between interleukin-6 and primary hepatocellular carcinoma: a meta-analysis
Li Xia, Shi YongYu
2015, 31(6): 936-942. DOI: 10.3969/j.issn.1001-5256.2015.06.026
Abstract:

Objective To evaluate the correlation between interleukin( IL) 6 and primary hepatocellular carcinoma( HCC). Methods Case- control studies that included quantitative data on plasma or serum IL- 6 levels of patients with HCC were identified from Pub Med,ISI Web of Knowledge,CBM,and CNKI. A meta- analysis was performed to quantitatively and comprehensively analyze data. Results Twenty- five studies were included and the meta- analysis was conducted separately for 3 groups: HCC vs controls,HCC vs liver cirrhosis,and HCC vs hepatitis. The serum IL- 6 levels of patients with HCC were significantly higher than those of healthy controls( 25 studies,standardized mean difference( SMD) 5. 02,95% CI: 4. 13- 5. 91,Z = 11. 05,P < 0. 000 1),patients with liver cirrhosis( 15 studies,SMD =2. 36,95% CI: 1. 54- 3. 19,Z = 5. 60,P < 0. 000 1),and patients with hepatitis( 7 studies,SMD = 2. 63,95% CI: 1. 24- 4. 03,Z =3. 69,P = 0. 000 2). Conclusion The inflammatory mediator,IL- 6,may play an important role in the development and progression of HCC.

Effects of PARP-1 inhibitors AG-014699 and AZD2281 on proliferation and apoptosis of human hepatoma cell line HepG2
Du SenRong, Mao XiaoRong, Xiao Ping, Chen Hong
2015, 31(6): 943-946. DOI: 10.3969/j.issn.1001-5256.2015.06.027
Abstract:

Objective To observe the inhibitory and pro- apoptotic effects of two poly( ADP- ribose) polymerase( PARP- 1) inhibitors,AG- 014699 and AZD2281,on human hepatoma Hep G2 cells and preliminarily explore the mechanism by which AG- 014699 induces Hep G2 cell apoptosis,and to provide a new therapeutic target for hepatoma. Methods The effects of different concentrations of AG-014699 and AZD2281 on Hep G2 cell proliferation were determined by MTT assay. The cell apoptosis rate was measured by flow cytometry.The expression levels of caspase- 3 and caspase- 8 were measured by Western Blot. Inter- group comparison was made by t test. Results Both AG- 014699 and AZD2281 suppressed Hep G2 cell proliferation in a time- and dose- dependent manner. However,the sensitivity of Hep G2 cells to the two PARP- 1 inhibitors was different. The half- maximal inhibitory concentrations of AG- 014699 and AZD2281 at48 h determined by MTT assay were about 20 μmol / L and 400 μmol / L,respectively. Flow cytometry and Western blot were not used to evaluate the apoptosis of Hep G2 cells exposed to AZD2281 to which these cells were not sensitive. Hep G2 cell apoptosis could be induced by10,30,and 50 μmol / L AG- 014699,and the highest apoptosis rate at 48 h was significantly higher than that of the control group( 31. 00% ± 2. 13% vs 0. 9% ± 0. 013%,P < 0. 01). Compared with those in the control group,the protein levels of caspase- 3 and caspase- 8 in Hep G2 cells after 48- h exposure to 30,and 50 μmol / L AG- 014699 increased. Conclusion The two PARP- 1 inhibitors AG- 014699 and AZD2281 can inhibit the proliferation of Hep G2 cells,which showed different sensitivities to the two inhibitors. AG-014699 can induce Hep G2 cell apoptosis by up- regulating the protein expression of caspase- 3 and caspase- 8.

Original articles_Liver fibrosis and liver cirrhosis
Mirabilite umbilical compress in treatment of ascites in liver cirrhosis: a meta-analysis
Zhang WenWen, Qi XingShun, Guo XiaoZhong
2015, 31(6): 947-950. DOI: 10.3969/j.issn.1001-5256.2015.06.028
Abstract:
Objective To systematically evaluate the efficacy of mirabilite umbilical compress in the treatment of ascites in liver cirrhosis.Methods The literature on the treatment of cirrhotic ascites with mirabilite umbilical compress was searched in CNKI,VIP,Wanfang Data,and Pub Med databases. A meta- analysis was carried out using the random effect model. The continuous and categorical data were expressed as aas standard mean difference( SMD) and odds ratio( OR),respectively. Results A total of 11 randomized controlled trials were included. The mirabilite umbilical compress treatment group showed a significantly higher response rate of ascites( OR = 3. 19,P < 0. 0001) and significantly reduced abdominal circumference( SMD = 1. 69,P < 0. 0001) and body weight( SMD = 2. 77,P < 0. 0001) compared with the control group. After mirabilite umbilical compress treatment,alanine transaminase level was significantly decreased( SMD = 1. 92,P =0. 0009),albumin level was significantly increased( SMD =- 1. 78,P = 0. 0006),while aspartate aminotransferase and total bilirubin levels showed no significant changes( SMD = 3. 39,P = 0. 25). Conclusion Mirabilite umbilical compress is effective in the treatment of ascites in liver cirrhosis,yet its efficacy in improving liver function remains uncertain.
Original articles_Biliary diseases
Effects of conventional versus laparoscopic surgery in treatment of congenital bile duct dilatation: a comparative analysis
Chen HouBin, Huang Wei
2015, 31(6): 951-954. DOI: 10.3969/j.issn.1001-5256.2015.06.029
Abstract:
Objective To compare the clinical effects of conventional versus laparoscopic surgery in adults with congenital bile duct dilatation. Methods A retrospective analysis was performed on the clinical data of 37 patients with congenital bile duct dilation who were treated in our hospital from February 2011 to February 2013. All the 37 cases underwent bile duct cyst resection and common hepatic duct- jejunal Roux- en- Y anastomosis; 20 of them( study group) underwent laparoscopic surgery,while the other 17 cases( control group) underwent open surgery. The mean operative time,mean intraoperative blood loss,mean length of hospital stay after surgery,mean time to first flatus after surgery,and postoperative complications were compared between the two groups. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chi- square test. Results Compared with the control group,the study group had a significantly longer operative time( P < 0. 05) but significantly less mean intraoperative blood loss,mean length of hospital stay after surgery,and mean time to first flatus after surgery( P < 0. 05). The incidence of postoperative complications showed no significant difference between the two groups( P > 0. 05). Conclusion Compared with conventional surgery,laparoscopic bile duct cyst resection and common hepatic duct- jejunal Roux- en- Y anastomosis is less invasive and safer and leads to faster recovery in adults with congenital bile duct dilation,and it is worthy of clinical application.
Original articles_Others
Investigation of impairment of liver function in local residents of Miaofeng Village,Wushan County,China
Yang ZhongXia, Mao XiaoRong, Yuan Hong
2015, 31(6): 955-957. DOI: 10.3969/j.issn.1001-5256.2015.06.030
Abstract:

Objective To assess the impairment of liver function and investigate possible causes in local residents in Miaofeng Village,Mali Town,Wushan County,Gansu Province,China,and to provide a basis for the etiological study of idiopathic liver damage. Methods The residents in Miaofeng Village were screened for liver function and an epidemiological study was conducted. Serological testing was performed for those with abnormal screening results. Trace elements in drinking water and soil such as arsenic,chromium,and selenium were also tested. Results Of all residents,23. 8% and 10. 7% showed abnormal levels of alanine aminotransferase and aspartate aminotransferase,respectively. Positivity of HBs Ag was detected in 11 cases,fatty liver was identified in 3 cases,and absence of selenium in soil was also confirmed. Conclusion A proportion of local residents in Miaofeng Village have impaired liver function and the absence of selenium in soil may be a contributing factor to this phenomenon.

Case reports
Diagnosis and treatment of hepatocellular carcinoma after 8-year treatment of decompensated HBV-related liver cirrhosis: a report of one case
Hao Juan, Xing Feng, Zhao ZhiMin, Guo ShaoWen, Liu ChengHai
2015, 31(6): 958-960. DOI: 10.3969/j.issn.1001-5256.2015.06.031
Abstract:
A case of hepatic epithelioid hemangioendothelioma
Wang FengJiao, Liu KaiYan, Qi Yue, Cai YanJun, Li WanYu
2015, 31(6): 961-962. DOI: 10.3969/j.issn.1001-5256.2015.06.032
Abstract:
Systemic sclerosis with gallbladder stone disease: a report of one case
Dai ShuLong, Yang ShiYong, Yang KunXing
2015, 31(6): 963-964. DOI: 10.3969/j.issn.1001-5256.2015.06.033
Abstract:
Reviews
Progress in comprehensive treatment of primary liver cancer
Zhu PuLi, Yin Chao, Feng JianLong
2015, 31(6): 965-968. DOI: 10.3969/j.issn.1001-5256.2015.06.034
Abstract:
The therapeutic methods for the treatment of primary liver cancer is in abundant supply,yet the prognosis far from satisfactory.The article mainly introduces the progress in hepatectomy,liver transplantation,ablation therapy,interventional therapy,radiotherapy,drug therapy,and biological immunity in the treatment of primary liver cancer,and it also briefs us on the multidisciplinary and comprehensive treatment of primary liver cancer,believing that comprehensive treatment is the key to improving the overall response of primary liver cancer by giving full play to the superiority of each treatment and achieving the optimal therapeutic effect.
The progress of Fibro Scan technique for diagnosis of hepatocellular carcinoma value
Li Mi, Nie QingHe
2015, 31(6): 969-973. DOI: 10.3969/j.issn.1001-5256.2015.06.035
Abstract:
Hepatocellular carcinoma( HCC) is one of the most common cancer worldwide,it considers that HCC arises in a background of cirrhosis or chronic infection with hepatitis virus. Liver stiffness assessed by transient elastography is described as a potential risk factor for HCC in cirrhosis. The technique and factors,clinical applications are presented. In addition,it discusses the diagnostic value of Fibro Scan and its performance for predicting the prognosis of HCC. It raises that Fibro Scan measurement is associated with risk of HCC,in the near future,the transient elastography method will decrease the need for liver biopsy in many patients with HCC.
New progress in treatment of hepatocellular carcinoma with portal vein tumor thrombus
Chen Peng, Li Fei
2015, 31(6): 974-976. DOI: 10.3969/j.issn.1001-5256.2015.06.036
Abstract:
Portal vein tumor thrombus( PVTT) is one of the common manifestations in patients with advanced hepatocellular carcinoma( HCC). It is the decisive factor leading to severe complications and causes extremely poor prognosis. With the development of molecular biology and imaging techniques,both single and combined therapy modalities,including surgical resection,embolization and chemotherapy,radiation therapy,a variety of ablation therapies,and molecular targeted therapy,have achieved substantial progress. However,there are no guidelines for reasonable and effective treatments. In this paper,new progress in the treatment of HCC with PVTT in recent years is summarized to provide a standardized approach for future treatment options.
Diagnosis and treatment of hepatocellular carcinoma from a new perspective of miRNAs
Li Qiang, Zhuo QiBin, Huang YuXian, Chen Liang
2015, 31(6): 977-981. DOI: 10.3969/j.issn.1001-5256.2015.06.037
Abstract:
The hepatocellular carcinoma( HCC) diagnosed by serum biomarkers is usually at late stages,and the five- year survival rate of HCC is extremely low. Therefore,it is necessary to develop an efficient and noninvasive biomarker that can detect HCC at an early stage and to explore a new strategy for the treatment of HCC. Abundant evidence has shown that microRNAs( miRNA) s is involved in the development and progression of HCC,and it can be a sensitive biomarker for the detection of HCC and a new target for the treatment of HCC. The article introduces the application of miRNAs in the diagnosis and treatment of HCC,and believes that the diagnosis and treatment strategy for HCC based on miRNAs has great potential in clinical application,yet remains to be studied.
Research progress in c-Met and hepatocellular carcinoma
Wang ZhangQing, Guo WeiWei, Liu Zheng
2015, 31(6): 982-984. DOI: 10.3969/j.issn.1001-5256.2015.06.038
Abstract:
c- Met plays a pivotal role in the development and progression of hepatocellular carcinoma( HCC),which can lead to proliferation,survival,cytoskeleton reorganization,separation and diffusion,and angiogenesis of tumor cells. Moreover,c- Met is an important prognostic factor for HCC. In HCC,c- Met acts as an activator of a series of signaling pathways,including PI3 K / AKT / m TOR,ERK /MAPK,and Rac- Pak. In recent years,it has been reported that small- molecule kinase inhibitors can abolish phosphorylation at the intracellular carboxyl terminal of c- Met,and then inhibit the recruitment of signal convertors and downstream signaling pathways,which finally achieve anti- tumor activities. Based on the carcinogenic activity of c- Met in HCC,this paper points out that selective inhibitors of c- Met hold promise for targeted therapies for HCC.
Clinical research progress in Erlotinib treatment for hepatocellular carcinoma
Gao Fan, Qi XingShun
2015, 31(6): 985-988. DOI: 10.3969/j.issn.1001-5256.2015.06.039
Abstract:
Erlotinib achieves antitumor activity by selective inhibition of the epidermal growth factor receptor. This paper summarizes the results of phase Ⅱ- Ⅲ clinical trials of erlotinib in the treatment of hepatocellular carcinoma( HCC). Two phase Ⅱ clinical trials demonstrated the modest antitumor activity of erlotinib alone in patients with HCC. Additionally,two phase Ⅱ clinical trials conducted in the USA showed the excellent efficacy of erlotinib combined with bevacizumab for HCC,but with an increased risk of variceal bleeding. By contrast,two phase Ⅱ clinical trials conducted in Asia showed the poor efficacy of erlotinib combined with bevacizumab for HCC. Recently,a randomized controlled phase Ⅲ trial failed to confirm any substantial improvement in overall survival time in HCC patients treated with sorafenib combined with erlotinib compared with sorafenib alone. Future studies should identify the candidates for erlotinib among patients with HCC based on the clinical and molecular prognostic biomarkers.
PI3K / Akt / mTOR signaling pathway and malignant hepatobiliary tumors
Chen XuXiao, Chen YongJun
2015, 31(6): 989-991. DOI: 10.3969/j.issn.1001-5256.2015.06.040
Abstract:
Phosphoinositide- 3 kinase / protein kinase- B / mammalian target of rapamycin( PI3 K / Akt / m TOR) signaling pathway is involved in many important biological processes such as cell metabolism,growth,proliferation,and angiogenesis. And its high- level activation is closely related to the development and progression of many malignant tumors. In this paper,m TOR and PI3 K / Akt / m TOR signaling pathway are introduced,and their action mechanisms in the development and progression of hepatocellular carcinoma,cholangiocellular carcinoma,cholangiocarcinoma,and gallbladder carcinoma are expounded,and then the role of m TOR inhibitors in the treatment of malignant hepatobiliary tumors is briefly described. It is thought that the PI3 K / Akt / m TOR signaling pathway provides new therapeutic targets for malignant hepatobiliary tumors in advanced stage and the constant development of new m TOR inhibitors provides some new hope for the patients with malignant hepatobiliary tumors in advanced stage.
Prevention and treatment of liver fibrosis by regulating liver regeneration
Li HanMin
2015, 31(6): 992-995. DOI: 10.3969/j.issn.1001-5256.2015.06.041
Abstract:
Liver fibrosis is regarded as a form or status of liver regeneration disorder. Therefore,from a new perspective of regulating liver regeneration,we put forward a new strategy for the prevention and treatment of liver fibrosis. This strategy not only focuses on confrontational reverse regulation,but also emphasizes positive induction. Moreover,this strategy applies an integrated method of promotion and inhibition,which improves liver injury and regeneration and corrects the abnormal liver regeneration and the normal liver regeneration disorder. Furthermore,this strategy also advocates the combination of prevention and treatment,which prevents the occurrence of liver fibrosis or a disorder of liver regeneration and treats the rapid progression of liver fibrosis. The imbalance between epithelial- mesenchymal transition( EMT) and mesenchymal- epithelial transition( MET) is involved in the CCl4- induced liver fibrosis in rats. Diwu Yanggan capsules can delay the progression of liver fibrosis and attenuate the degree of fibrosis,which is associated with the regulation of liver regeneration by modulating the imbalance between EMT and MET( inhibiting EMT and / or promoting MET).
Application of hepatobiliary-specific MRI contrast agent Gd-EOB-DTPA in preoperative evaluation of hepatobiliary patients
Jiang JiaYun, Li XueSong, Ma KuanSheng
2015, 31(6): 996-999. DOI: 10.3969/j.issn.1001-5256.2015.06.042
Abstract:
Gd- EOB- DTPA,a newly applicable hepatocyte- specific contrast agent,is excreted through the biliary tract and the kidney,showing the characteristics of nonspecific extracellular contrast agent and hepatocyte- specific contrast agent. It can provide both dynamic and hepatobiliary images and has been rapidly accepted by clinicians for the diagnosis of liver lesions and preoperative evaluation. Gd- EOB-DTPA can fulfill hepatic perfusion imaging,cholangiography,detection and characterization of focal liver lesions,and evaluation of liver function within the same examination in a relatively short time window. A large number of domestic and foreign studies have confirmed that hepatobiliary- specific contrast- enhanced MRI is significantly superior to MRI scan,contrast- enhanced CT,and ultrasound in diagnosing hepatocellular carcinoma,especially small hepatocellular carcinoma. The features of Gd- EOB- DTPA and its current status and prospect of application in the preoperative evaluation of hepatocellular carcinoma are reviewed in this article.