肝癌患者术前HBV DNA定量水平与肝移植术后肝癌复发关系的探讨

目的 探讨肝癌肝移植患者术前乙型肝炎病毒(hepatitis B virus,HBV)DNA定量与肝移植术后原发性肝细胞癌(hepatocellular carcinoma,HCC)复发的关系.方法 回顾性分析2004年1月到2008年12月因同时合并HCC和HBV行肝移植手术并长期随访的148例患者,使用Kaplan-Meier生存分析统计患者生存率和无瘤生存率,根掘术后HCC是否复发将患者分成HCC复发组(43例)及未复发组(105例),使用COX多因素回归进行危险因素分析.结果 148例HCC肝移植患者1、3、5年生存率分别为86%,72%,72%,无瘤生存率分别为79%,71%,54%.肝移植术后HCC复发43例,复发率为29.1%(43/148),术后HCC平均复发时间为(13.16±14.17)个月(1～54个月).COX多因素回归分析表明超过米兰标准(HR=9.89;95%CI2.30～42.52;P=0.002)以及术前HBV DNA＞5log10 copies/ml(HR=2.26;95%CI1.01～5.04;P=0.047)是肝移植术后HCC复发的独立危险因素.结论 肝移植术前HBV DNA＞5log10 copies/ml和超过米兰标准是原发性肝癌患者肝移植术后HCC复发的高危因素.     

肝细胞癌伴门静脉癌栓患者手术切除预后评分系统的建立与应用

目的:分析影响可手术的伴有门静脉癌栓的肝细胞癌(PVTT-HCC)患者预后的独立危险因素,并建立预后评分系统。方法:回顾性分析2007年6月至2016年12月在广西医科大学附属肿瘤医院行手术治疗的PVTT-HCC患者临床及随访资料。Kaplan-Meier法及log-rank检验分析患者的生存曲线及组间预后差异。用单因...     

术前乙型肝炎病毒DNA载量对肝细胞癌患者肝切除术后预后的影响

目的:探讨术前血清乙型肝炎病毒(HBV)DNA载量水平对接受根治性肝切除术治疗的原发性肝细胞癌患者预后的影响。方法:回顾性分析2010年1月至2016年12月广西医科大学附属肿瘤医院收治的接受根治性肝切除术治疗的肝细胞癌患者临床资料。根据术前血清HBV DNA载量水平将患者分为对照组(HBV DNA阴性)、低载量组(<...     

肝癌射频消融术后复发危险因素分析及术前预测评分

目的:探讨肝细胞癌(HCC)患者射频消融术(RFA)术后复发的独立危险因素并建立术前预测评分。方法:回顾性分析2016年6月至2019年9月中山大学附属中山医院收治的RFA治疗的168例HCC患者资料,应用X-tile软件确定术前循环肿瘤细胞(CTC)最佳的截断值并进行分组,分析术前不同CTC值与各临床因素之间的关系。...     

肝细胞肝癌术后大量腹水预测评分体系的建立

目的 通过对肝细胞肝癌患者术后大量腹水形成相关因素的分析,建立一套预测术后大量腹水形成的评分体系.方法 回顾性分析2005年1月至2010年1月收治的324例肝细胞肝癌患者的术后腹水发生情况,男性282例,女性42例,年龄17～84岁,中位年龄54岁.根据腹水量的多少,将患者分为两组:大量腹水组(n=78)和少量腹水组(n=246).通过统计学分析筛选出与术后腹水形成密切相关的术前、术中及术后因素,并建立评分系统.结果 单因素分析显示,大量腹水组患者有无肝硬化、凝血功能、血小板计数、血浆白蛋白及天冬氨酸转氨酶等术前指标,以及手术时间、术中出血量、术中输血浆量、术中输红细胞量、半肝(含半肝)以上切除等因素,与少量腹水组相比差异有统计学意义(P＜0.05).多因素回归分析显示,术前血小板计数、天冬氨酸转氨酶、是否行半肝以上(含半肝)切除、术中输注血浆量、术后第1天尿量及术后第1天引流量是术后产生大量腹水的独立相关因素.依据多因素回归分析结果建立的评分系统,预测腹水产生的敏感度为83.3%,特异度为86.2%.结论 肝细胞肝癌术后腹水生成与术前、术中及术后多种因素有关,本研究建立的评分系统可较准确地预测术后大量腹水的生成.     

肝癌患者术前的抑郁情绪与术后复发相关性的临床研究

目的前瞻性地探讨肝细胞癌(Hepatocellular Carcinoma,HCC)患者外科手术前的抑郁状态与治疗后复发的关系。方法纳入2009年1月至2010年1月接受手术的124例HCC患者,术前行近3～5天的抑郁状态进行测定,并采用抑郁自评量表进行评分。以评分数的中位数为界值,分为高抑郁评分组及低抑郁评分组。随访截止至2012年3月。应用Kaplan-Meier生存分析判别术前肝癌患者的抑郁状态与术后复发的关系,并以COX比例风险模型分析肝癌术后复发的独立危险因素。结果肝癌病人术前的抑郁评分(SDS评分)高于国内常模(P=0.007)。高抑郁评分组和低抑郁评分组的术后1、2年复发率分别为:9.5%、11.4%vs 19.1%、37.2%(P=0.036)。进一步行COX比例风险模型多因素分析得出与预后有关因素为:SDS评分高、微血管癌栓侵犯、肿瘤最大径大于5 cm、肿瘤个数多发(P<0.05)。结论肝癌患者术前的抑郁情绪与术后复发密切相关,预防与治疗肝癌患者的抑郁状态是降低肝癌术后复发率的重要途径之一。     

预测肝癌患者术后预后的新型评分系统

目的建立一个基于临床病理特征的预测肝癌术后预后的评分系统。方法回顾性的观察2003年至2009年于东方肝胆外科医院肝外四科行肝癌根治性切除术的793例病例,以死亡及复发作为终点,以Kaplan-meier和COX回归确定肝癌术后预后的独立危险因素。以最小加权法建立肝癌术后预后预测的评分系统,并用一致性指数(C-index)来评价该评分系统的准确性。之后我们根据这一评分系统将患者分为高危、中危和低危三个组,比较这三组人群的生存和复发情况。结果单、多因素分析表明,肝癌术后预后的独立危险因素为肿瘤直径,肿瘤数目,微血管侵犯以及手术切缘情况。用上述4个因素依据各自权重建立新的术后预测评分系统:微血管侵犯(有=2,无=0)+直径(5cm=4,≤5cm=0)+肿瘤数目(多发=2,单发=0)+手术切缘(≤1cm=1,1cm=0)。该评分系统的C-index为0.747(95%CI,0.720~0.774)。应用该评分系统将患者分成三个不同风险组,三组之间生存和复发情况的差异均有统计学意义(P0.001)。结论这一评分系统能够准确预测肝癌患者术后的预后,可进一步为肝癌术后预防复发提供重要参考。     

术前血清ALT水平与HCC患者肝切除术后并发症的关系

对肝切除术后并发症发生的术前评估与防治是目前肝脏外科的热点问题之一。我们通过对一组肝细胞癌 (ＨＣＣ)患者术前肝功能指标的分析 ,探讨与术后并发症发生的关系 ,以寻找简便的术前评价指标。一、材料与方法1990～ 1998年我院收治因ＨＣＣ行各类肝切除术患者 131例 ,男 10 8例 ,女2 3例。年龄 2 0～ 73岁 ,平均 5 1岁。所有病例术前肝功能评估均为Ｃｈｉｌｄ ＰｕｇｈＡ级[1 3 ] ,血清胆红素≤ 2 0 μｍｏｌ/Ｌ。术前测定血清丙氨酸转氨酶 (ＡＬＴ)、天冬氨酸转氨酶 (ＡＳＴ)、前白蛋白 (ＰＡ)和白蛋白 (ＡＬＢ)含量。切除标本常规病理检…     

一种预测肝癌肝移植术后肿瘤复发的术前评分模型

目的 建立一种基于外周血中性粒细胞/淋巴细胞比(NLR)的肝癌肝移植适应证评分模型,评价其预测肝癌肝移植术后肿瘤复发的价值.方法 回顾性分析我院76例有完整随访资料的乙型肝炎相关性肝细胞癌患者临床资料.把肿瘤数目＞3、大血管侵犯和NLR≥2.5三个影响肿瘤复发的术前指标分别赋值1分建立预测复发评分模型,评价该评分模型预测肝癌肝移植术后肿瘤复发的价值.结果 预测复发评分模型ROC曲线下面积(AUC)为0.758.2分和3分的患者肝移植术后肿瘤复发的风险比(HR值)分别是10.038和59.773,10例3分的患者都在6个月内肿瘤复发;0分、1分、2分的患者1年、3年、5年的无瘤生存率分别为95.0％、78.4％、78.4％,76.9％、66.9％、63.2％和51.9％、8.7％、8.7％.无大血管侵犯的55例患者中,5例肿瘤数目＞3且NLR≥2.5的患者都在31个月内肿瘤复发.结论 肿瘤数目＞3且术前NLR≥2.5的患者肝移植术后肝癌复发的风险显著增加.该术前预测复发评分模型可作为肝癌肝移植适应证选择的重要参考.     

乙型肝炎病毒基因型与肝细胞癌发生关系的研究现状

目的总结目前国内外对乙型肝炎病毒X蛋白(HBx)、乙型肝炎病毒(HBV)基因亚型和肝细胞癌三者之间关系的研究现状,并对其在临床工作中的意义进行展望。方法查阅近年来国内外关于HBx、HBV基因亚型和肝细胞癌研究的相关文献并加以综述。结果 HBx和肝细胞癌的发生、发展、迁徙以及转移之间有着密切的关系,HBV基因亚型与肝细胞癌存在一定的关联,但具体机制尚未阐明。结论 HBx和HBV基因亚型在肝细胞癌的发生发展过程中扮演着重要的角色,随着分子机制的不断深入研究,必将推动乙型肝炎、肝硬化和肝细胞癌的诊治工作,为临床工作者提供更为个体化的干预手段。     

肝细胞癌与乙型肝炎病毒基因变异关系研究进展

乙型肝炎病毒(HBV)是肝细胞癌(hepatocellular carcinoma,HCC)的主要病因,研究发现HBV基因变异与HCC的发生过程关系密切.本文从病因学方面对乙型肝炎病毒致肝癌的主要机制作一综述.HBV基因有4个开放读码区(S、C、P、X区),主要通过点突变、插入、截短变异等方式与HCC发生相关.     

Laparoscopic liver resection for hepatitis B and C virus-related hepatocellular carcinoma in patients with Child B or C cirrhosis

Background

The aim of this study was to evaluate the clinical and oncological outcomes after laparoscopic liver resection (LLR) in patients with hepatitis B and C virus-related hepatocellular carcinoma (HCC) with Child B or C cirrhosis.

Methods

Between January 2004 and December 2013, LLR was performed in 232 patients with HCC. Of these, 141 patients also had pathologically proven cirrhosis. Sixteen patients with hepatitis B and C virus-related HCC with Child B or C cirrhosis were included in the study. Thirteen (81.3%) patients had Child B disease and three (18.8%) patients had Child C disease.

Results

The median operation time was 215 min, the median estimated blood loss was 350 mL, and the median hospital stay was eight days. Three patients (18.8%) experienced complications after surgery. There was no postoperative mortality or reoperation. The mean follow-up period was 51.6 months. HCC recurred in eight (50%) patients: seven intrahepatic recurrences and one extrahepatic recurrence. The treatments for recurrence were laparoscopic reoperation in one (6.3%) patient, trans-catheter arterial chemo-embolization (TACE) in one (6.3%) patient, radiofrequency ablation (RFA) in one (6.3%) patient, and combined TACE and RFA in four (25%) patients. The five-year postoperative overall survival (OS) and disease-free survival (DFS) were 84.4% and 41.7%, respectively.

Conclusions

This study demonstrates that LLR can be safely used in patients with hepatitis B and C virus-related HCC and Child B or C cirrhosis, with acceptable survival outcomes.     

年龄-胆红素-国际标准化比率-肌酐评分对乙型肝炎相关慢加急性肝功能衰竭患者短期预后的评估价值

目的探讨年龄-胆红素-国际标准化比率-肌酐(ABIC)评分对乙型肝炎相关慢加急性肝功能衰竭(HBV-ACLF)患者短期预后的评估价值。方法回顾性连续纳入2017年1月至2019年12月于扬州大学医学院附属六合人民医院感染性疾病科住院治疗的HBV-ACLF患者191例,根据住院后90 d的临床转归分为生存组(129例)和死亡组(62例)。收集患者入院24 h内血红蛋白、白细胞、血小板、国际标准化比率(INR)、丙氨酸氨基转移酶(ALT)、白蛋白、总胆红素、γ-谷氨酰转移酶(γ-GT)、血肌酐、尿素氮,分别进行终末期肝病模型(MELD)评分、肝功能评分(CP)、ABIC评分、血清白蛋白-胆红素(ALBI)评分、慢性肝功能衰竭联盟器官功能衰竭(CLIF-C OF)评分。采用Cox回归模型分析HBV-ACLF患者90 d预后的影响因素,绘制受试者工作特征曲线(ROC)判断不同评分模型对90 d预后的评估价值,应用Medcalc软件进行曲线下面积(AUC)两两比较;采用K-M法进行生存分析。结果死亡组患者ABIC评分显著高于生存组[10.6(8.3,12.6)vs.8.5(6.4,10.4),Z=-5.385、P<0.001]。年龄、CP、ABIC、CLIF-C OF评分均为影响HBV-ACLF患者90 d预后的独立危险因素(χ^(2)=6.337、P=0.012,χ^(2)=6.131、P=0.013,χ^(2)=14.531、P<0.001,χ^(2)=7.369、P=0.007)。ABIC评分预测HBV-ACLF患者90 d预后的AUC显著高于MELD、ALBI评分(0.741 vs.0.658:Z=3.869、P<0.001,0.741 vs.0.647:Z=9.453、P<0.001),与CP、CLIF-C OF评分差异无统计学意义(0.741 vs.0.727:Z=1.078、P=0.281,0.741 vs.0.716:Z=1.441、P=0.150)。进一步探讨不同ABIC水平HBV-ACLF患者的预后,结果显示高ABIC(≥9.9)患者90 d生存率为47.6%,显著低于低ABIC(<9.9)患者(77.3%),差异有统计学意义(χ^(2)=19.515、P<0.001)。结论ABIC评分可作为HBVACLF患者短期预后的有效预测指标,ABIC评分大于9.9提示HBV-ACLF患者90 d的死亡风险较高。     

比较亚洲肿瘤峰会标准与LI-RADS对乙型肝炎性小肝癌的诊断价值

目的 对比分析亚洲肿瘤峰会（AOS,2016）标准与肝脏影像报告和数据系统（LI-RADS）对乙型肝炎性小肝细胞癌（sHCC）的诊断效能。方法 对130例疑诊乙型肝炎性sHCC患者（共172个肝结节,直径均≤ 30 mm）进行上腹部CT及MR检查,以病理结果为金标准,分别计算AOS标准及LI-RADS诊断乙型肝炎性sHCC的敏感度及特异度。结果 ①直径≤ 30 mm病灶：AOS标准诊断sHCC的敏感度为55.00%（44/80）,特异度92.39%（85/92）;LI-RADS分级标准的敏感度100%（80/80）,特异度67.39%（62/92）。②直径<20 mm病灶：AOS标准诊断的敏感度为40.00%（10/25）,特异度94.34%（50/53）;LI-RADS分级标准的敏感度100%（25/25）,特异度71.70%（38/53）。结论 对于诊断乙型肝炎性sHCC,LI-RADS标准较AOS标准的敏感度更高,有助于早期诊断及治疗。     

Hepatitis B x antigen and p53 in the development of hepatocellular carcinoma

Hepatitis B virus (HBV) is one of the major etiological agents responsible for the appearance of chronic liver diseases, including hepatocellular carcinoma (HCC). There is increasing evidence that the HBV excoded x antigen (HBxAg) is involved in one or more steps that contribute to multistep hepatocarcinogenesis. Recent work has now defined one of these steps as the physical binding and functional inactivation of the tumor suppressor protein, p53, by HBxAg. The centrality of p53 to genomic stability, cell cycle arrest, induction of apoptosis, and in senescence related pathways, suggests that its disruption by HBxAg will result in genomic instability, loss of cell cycle control, a lower apoptotic rate, and an extension in the life span of HBV-infected cells. It is proposed that HBxAg/p53 complex formation represents one of several steps whereby HBV contributes to the development of HCC. Received for publication on Jan. 6, 1998; accepted on June 10, 1998     

MicroRNA在乙型肝炎病毒相关肝细胞癌侵袭转移中的研究进展

MicroRNA（miRNA）是一种内源性非编码小分子单链RNA,其异常表达与包括肝细胞癌（HCC）在内的多种疾病密切相关。术后复发转移是HCC死亡的主要原因,而乙型肝炎病毒（HBV）感染是HCC发生发展最关键的危险因素。研究证实miRNA在HBV相关HCC中的异常表达与其侵袭转移密切相关,作为重要标志物对于HBV相关HCC预后判断及治疗具有较好的应用前景。     

Hepatectomy for hepatitis B-, hepatitis C-, and dual hepatitis B- and C-related hepatocellular carcinoma in Taiwan

To evaluate the surgical results of patients with hepatitis B-, hepatitis C- and dual hepatitis B- and C-related hepatocellular carcinoma (HCC), we reviewed the clinical records 252 patients (196 men and 56 women) with complete profiles of hepatitis B and hepatitis C infection who had hepatectomies to treat HCC from March, 1992, to August, 1998. The patients were divided into four groups, 30 patients (11.9%) without either hepatitis B surface antigen or anti-hepatitis C antibody (N-HCC group), 133 patients (52.8%) with hepatitis B infection only (B-HCC group), 66 patients (26.2%) with hepatitis C infection only (C-HCC group), and 23 patients (9.1%) with dual hepatitis B and C infection (BC-HCC group). Compared with the patients in the other groups, the patients in the C-HCC group were older and had more severe cirrhotic change of the liver. The surgical complication rates and hospital mortalities in the C-HCC and BC-HCC groups were 30.3% and 12.1% and 30.4% and 17.4%, respectively, which were higher than those in the N-HCC (13.3%, 3.3%) and B-HCC (15.8%, 3.8%) groups. The mean disease-free survivals for the N-HCC, B-HCC, C-HCC, and BC-HCC groups were 31.4, 25.4, 38.9 and 13.8 months, respectively, with the difference between the four groups being significant (P < 0.05). However, the mean overall survival times, 38.3 months for the N-HCC group, 37.2 months for the B-HCC group, 52.1 months for the C-HCC group, and 32.7 months for the BC-HCC group, were not significantly different (P = 0.146). In conclusion, surgical treatments for HCC related to hepatitis C or dual hepatitis B and C infection were associated with a higher surgical complication rate and hospital mortality. Hepatocellular carcinoma related to dual hepatitis B and C infection recurred earlier after hepatectomy, but the overall survival of the four groups was not significantly different. Received for publication on Jan. 17, 2000; accepted on April 1, 2000     

EZH2-regulated immune risk score prognostic model predicts outcome of clear cell renal cell carcinoma

BackgroundThe enhancer of zeste homolog 2 (EZH2) plays an important role in the tumor microenvironment (TME), and EZH2 in shaping the epigenetic landscape of CD8⁺ T cell fate and function, with a particular emphasis on cancer. Here, high EZH2 expression always leads to less CD8⁺ T cell infiltration. However, clear cell renal cell carcinoma (ccRCC) is reportedly a “hot” tumor, with contradictory high EZH2 expression. Our goal was to construct a EZH2-regulated immune risk score prognostic model to predict ccRCC outcomes, and provide a prospect of clinical EZH2 inhibitors in fine-tuning T cell responses with immune therapy.MethodsWe downloaded and analyzed The Cancer Genome Atlas (TCGA), Cancer Cell Line Encyclopedia (CCLE), TISIDB database, and WebGestalt for ccRCC patients, EZH2-related tumor-infiltrating lymphocytes and immunomodulators. R packages “limma”, “BiocManager”, and “preprocessCore”, etc. were downloaded to prepare CIBERSORT files, immune cells heatmap, multivariable Cox model and survival analysis. The EZH2-regulated immune risk model’s prognostic ability was calculated by receiver operating characteristic (ROC) and area under the curve (AUC) analyses in R studio.ResultsEZH2 was highly expressed and related to poor outcome in ccRCC. However, high-expression EZH2 was not related to a “cool” tumor. Of the 49 immunomodulators significantly regulated by EZH2, forest plot showed 26 immunomodulators signatures independently associated with overall survival. The EZH2-regulated immune-risk score prognostic model was an independent prognostic factor (AUC =0.816), especially combined with clinicopathologic parameters in ccRCC overall survival prediction.ConclusionsThe EZH2-regulated immune-risk score prognostic model was an independent prognostic factor, with good accuracy and predictability, and could provide experimental data to the clinical area.     

基于乙肝表面抗原表达的973例早期肝细胞癌预后分析

目的 分析早期肝细胞癌(hepatocellular carcinoma,HCC)患者的病因及临床资料,探索病因和预后之间的关系。方法 回顾性分析2012年1月1日至2019年12月31日于首都医科大学附属北京佑安医院初次接受经肝动脉栓塞化疗(TACE)的973例早期HCC患者的临床及预后资料。描述肝癌患者病因谱,比较具有不同病因的患者的临床资料,并通过Kaplan-Meier曲线和Log-rank检验比较其无复发生存期(recurrence-free survival,RFS)和总生存期(overall survival,OS)的差异。结果 973例早期肝细胞癌患者中乙肝和丙肝病毒感染相关肝癌占97.2%(946/973),非病毒相关肝癌仅占2.8%(27/973)。在乙肝相关肝癌和联合感染相关肝癌患者中,有14.8%(140/946)为HBsAg阴性,联合感染患者中HBsAg阴性情况较乙肝相关肝癌更为常见[80.2%(77/96)和7.9%(63/798)]。截止随访时间2021年7月1日,无肝炎患者(n=63)和单纯乙肝病毒(hepatitis B virus,HBV)感染患者(...