Objective To probe into the significance of tuftsin in patients with liver cancer. MethodsThe serum tuftsin level of 12 patients with liver cancer before and after the resection，20 cirrhostic and 20 normal controls were measured by radioimmunoassay (RIA). ResultsTuftsin level in preoperative group （449±106） ng/ml was much lower than that in postoperative group (588±129) ng/ml，cirrhotics group (580±187) ng/ml and control group (703±128) ng/ml (P＜0.01). The tuftsin level in postoperative group was also quite lower than that in control group (P＜0.01). Conclusion We should try our best to excise the liver cancer so that a higher tuftsin level might be obtained which can activate NK cell and T cell.
Objective To Investigate the indications, surgical technique and perioperative management of orthotopic liver transplantation.Methods Orthotopic liver transplantation was successfully performed on a unresectable liver cancer on caudate lobe, 2 cases with Caroli’s disease and 7 cases with advanced liver cirrohosis. A 11 year’s old girl with Caroli’s disease was performed on one reduced size liver transplantation (RSLT). Results The recovery of liver graft function was good after the operation in those patients without perioperative death. The case of liver cancer died of recurrent cancer on the 139th postoperative day, 1 case died of severe fungus infection and one died of gastric stress ulcer perforation, other 7 cases recovered well without complications. Conclusion The results suggest that unresectable central liver cancer, terminal liver cirrohosis or benign liver diseases combined with severe liver disfunction are good indications for liver transplantation. Good surgical technique and perioperative management are key points to succucess of the liver transplantation.
ObjectiveTo understand the role of metformin on reducing incidence of type 2 diabetes mellitus (T2MD) patients complicated with liver cancer. MethodThe related literatures of metformin treated patients with T2MD complicated with liver cancer at home and abroad in recent years were reviewed. ResultsA large number of epidemiological and clinical data showed that the metformin might prevent the occurrence of the T2MD patients complicated with liver cancer, its mechanism was mainly inhibited the proliferation of hepatoma cells through the ATM-LKB1-AMPK-mTOR pathway, PI3K/Akt/mTOR pathway, or miRNA. The current controversy was the authenticity of the data, the influencing factors included the aging problem and characteristics of metformin user. The prospective study design rigorous remained to be clarified. ConclusionMetformin could reduce the incidence of T2MD patients complicated with liver cancer, and could inhibit the growth of liver cancer cells, which provides a new way of thinking for the comprehensive treatment of liver cancer.
ObjectivesTo evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis.MethodsWe searched PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the meta-analysis, it was estimated as 0.71 (95%CI 0.70 to 0.72), 0.57 (95%CI 0.56 to 0.59) and 0.43 (95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92 (95%CI 0.92 to 0.93), 0.95 (95%CI 0.94 to 0.96) and 0.95 (95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65 (95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39 (95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35 (95%CI 0.31 to 0.39), 0.38 (95%CI 0.29 to 0.52) and 0.49 (95%CI 0.39 to 0.62); the diagnosis odds ratio was 17.23 (95%CI 12.26 to 24.20), 33.79 (95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53) for AFP alone with cut-off of 20, 200 and 400 ng/mL, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65 (95%CI 0.62 to 0.69), 0.97 (95%CI 0.97 to 0.97), 16.48 (95%CI 9.55 to 28.42), 0.27 (95%CI 0.18 to 0.42) and 64.54 (95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96 (95%CI 0.94 to 0.98), 0.96 (95%CI 0.96 to 0.96), 10.76 (95%CI 2.62 to 44.27), 0.07 (95%CI 0.02 to 0.22) and 160.59 (95%CI 31.61 to 816.03) for the combined strategy.ConclusionFor liver cancer screening technologies, the overall accuracy of serum AFP test alone is the optimum at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.
Objective To review the advances of target gene therapy of liver cancer. MethodsWe analyze and compare the tissuespecific carrier system or cellspecific gene expressing system from current researches of liver cancer gene therapy. ResultsArtificial synthetic DNA transfer system and modified viral vectors could efficiently transfect target cells and get highlevel expression. The ciselements of alpha fetal protein or albumin gene have been often adopted in the regulation of therapeutic gene and have shown their effectiveness. Some other gene therapy strategies also promised a good future. Conclusion Searching for more specific and universal liver cancer antigens is the key to improve the target gene therapy efficiency. The individual situation is the basis to select the best transfer system or regulatory elements in the future.
ObjectiveTo systematically evaluate the dose-response relationship between coffee consumption and liver cancer risk. MethodsThe PubMed, Web of Science, Cochrane Library, EMbase, CNKI, VIP, WanFang Data, and CBM databases were searched from inception to December 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 17.0 software. ResultsFifteen studies (11 cohort studies and 4 case-control studies) involving 557 259 participants were included. The results of meta-analysis showed that coffee consumption was significantly negatively associated with the risk of liver cancer (RR=0.39, 95%CI 0.27 to 0.57, P<0.01). The dose-response meta-analysis showed a non-linear dose-response relationship between coffee consumption and the risk of liver cancer (P<0.01). Compared with people who did not drink coffee, people who drank 1 cup of coffee a day had a 25% lower risk of liver cancer (RR=0.75, 95%CI 0.67 to 0.83), and people who drank 2 cups of coffee a day had a 38% lower risk of liver cancer (RR=0.62, 95%CI 0.56 to 0.70). The risk of liver cancer decreased by 45% (RR=0.55, 95%CI 0.48 to 0.62) for 3 cups of coffee and by 51% (RR=0.49, 95%CI 0.43 to 0.56) for 4 cups of coffee. ConclusionCurrent evidence suggests that there is a nonlinear dose-response relationship between coffee consumption and the risk of liver cancer. These results indicate that habitual coffee consumption is a protective factor for liver cancer. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．
Objective To investigate the clinical outlook of hepatic stem cells and its relations with liver cancer. Methods The literatures of recent years on the studies of hepatic stem cells were reviewed. Results Liver cancer may consist of cells of various differentiation grades and it may result from the perodifferentiated hepatic stem cells or abnormal differentiated cells. Conclusion The hypothesis of hepatic stem cells has been identified extensively. Further study maybe helpful for revealing the origin, carcinogenesis of hepatic cancer, and may also be useful for the understanding of the mechanism of metastasis.
Objective To explore the diagnosis and treatment for spontaneous rhexis hemorrhage of liver cancer. Methods Clinical data of thirty patients who suffered from spontaneous rhexis hemorrhage of liver cancer from January 1995 to March 2009 were collected and analyzed retrospectively. Results Twenty-six cases were stanched by surgical therapy, in which 14 cases underwent liver cancer resection, 10 cases underwent bleeding transfixion and hepatic artery ligation (or intubation), and 2 cases underwent omentum stuff transfixion. Four cases died one week after surgery, one died after 15 d, 9 cases died 1 to 3 months after operation, 5 cases survived after 4 to 6 months, 3 cases survived after 7 to 12 months, and in 4 cases survival time was longer than 12 months (in which one patient’s survival time was 16 months, one was 5 years and two patients were still alive with survival time of 3 and 13 years respectively). Four patiens went through the non-surgical therapy and survival time was 3 to 14 d. Conclusion The spontaneous rhexis hemorrhage of the liver cancer is not the telephase of the liver cancer. Early diagnosis and operation can stanch bleeding effectively. The surgical therapy is better than the non-surgical therapy. Resection of liver neoplasms in time can raise long-term survival time.
Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.