Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
ObjectiveTo summarize the research progress on the pathogenesis of ischemic bile duct injury after transcatheter arterial chemoembolization (TACE).MethodThe recent studies on the incidence, pathological features and related mechanisms of ischemic bile duct injury and ischemic bile duct injury after TACE were reviewed.ResultsThe incidence of ischemic bile duct injury after liver TACE fluctuated greatly and was related to different chemoembolization methods. At present, the causes of ischemic bile duct injury were attributed to the bile duct ischemia caused by embolization and the toxic effects of chemotherapeutic drugs. The destruction of protective mechanism of bile duct epithelium and the expression of transforming growth factor-β might play an important role in ischemic bile duct injury.ConclusionsAfter liver TACE, in addition to the direct injury of bile duct caused by the toxic effects of ischemia and chemotherapy drugs, the damage of bile duct epithelial protection mechanism caused by ischemia and chemotherapy drugs makes the toxic effects of bile acids play a very important role in the ischemic bile duct injury. However, there is still no direct evidence of bile duct epithelial protection mechanism in ischemic bile duct injury after liver TACE. Further clarifying the role of bile duct epithelial protection mechanism in ischemic bile duct injury after liver TACE will be helpful to explore its prevention and treatment measures, and provide new insights for the further studies in future.
ObjectiveTo evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. MethodsThe relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. ResultsBy searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
ObjectiveTo discuss the clinical value of internal radiation therapy with hepatic intraarterial iodine131 labeled material for the treatment of hepatocellular carcinoma (HCC). MethodsThis summarized paper was made on literature review. ResultsIodine131lipiodol and several reported iodine131labeled antibodies to HCC associated antigens were concentrated in the foci of HCC with a high tumortonormaltissue absorbed dose ratios. No severe side effects occurred. It was used in various kinds of HCC patients, and mostly showed a significant tumor response. Survival rate of HCC patients was raised in several clinical trials.Conclusion Internal radiotherapy with hepatic intraarterial iodine131 labeled material may be considered as an effective method to treat HCC.
【Abstract】ObjectiveTo study the effect of preoperative gastric arterial chemoembolization on apoptosis of lymph node metastasis of gastric cancer. MethodsForty patients with gastric cancer and lymph node metastasis underwent curative resection, among which there were 20 patients who received the preoperative gastric arterial chemoembolization, and they constituted the treatment group. The rest of the patients were included in the control group. The expressions of p53, CD95 and bcl-2 were examined by immunohistochemistry and apoptosis in the lymph node metastasis was examined by in situ terminal transferasemediated dUTP nick end labeling （TUNEL）. ResultsThe expression intensity of p53 and CD95 in lymph node metastasis of treatment group increased more significantly than that of control group, whereas the expression intensity of bcl-2 decreased in treatment group. There was a significantly positive correlation between the expressions of p53 and CD95 and the apoptosis.ConclusionPreoperative gastric arterial chemoembolization may affect the expressions of p53, CD95 and bcl-2 and may induce the apoptosis of lymph node metastasis. It may be helpful to improve the effect of curative resection of gastric cancer.
【Abstract】Objective To investigate the change of vascular endothelial growth factor (VEGF) expression in HepG2 cells under hypoxia. Methods HepG2 cells were cultured under hypoxia（hypoxia group） and normal condition (control group). VEGF expression of HepG2 cells was examined by immunohistochemical staining. The growth of HepG2 cells was examined by MTT colorimetry and cell count. VEGF level in the culture medium was measured by ELISA.Results After 48 h and 72 h of culture, the growth rate of HepG2 cells in hypoxia group was lower than that in control group (P＜0.05). The cell count in hypoxia group (2.51×104/μl and 2.69×104/μl, respectively) was much lower than that in control group(3.01×104/μl and 3.52×104/μl) after 48h and 72h of culture (P＜0.05). In hypoxia group, VEGF level in the culture medium after 24 h and 48 h was higher than that in control group (P＜0.05, P＜0.01). Conclusion Hypoxia may enhance the VEGF expression in HepG2 cells and this could be the reason of high expression of VEGF after transcatheterized hepatic arterial chemoembolization.
Objective To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma. Methods Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient. Results ① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group. Conclusion Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.
Objective To investigate the growth of tumors and the natural life length of the rats after the adriamycinethylcellulose microspheres(ADM-EC mc) were injected in the rats bearing transplantable liver cancer through their hepatic arteries.Methods ADM-EC mc were infused into the proper hepatic arteries of the Wistar rats (W256). All of the rats were divided randomly into five groups, group 1: control, group 2: normal saline, group 3: conventional ADM, group 4: placebo ethylcellulose microspheres, and group 5: ADM-EC mc. Results As compared with other four groups, the ADM-EC mc (group 5) showed the best inhibition of the growth of tumors and the longest mean life length of the rats. Conclusion Hepatic arterial infusion of ADM-EC mc can inhibit the growth of the tumor, aggravate the necrosis, and improve the effects of the chemotherapy of liver cancer.
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H2O (1 cm H2O=0.098 kPa) before the surgery to (25.62±2.13) cm H2O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.