The Value of Interferon Combined with Hepatic Artery Chemoembolization and Portal Vein Chemotherapy in Preventing a Recurrence after Radical Resection for Hepatocellular Carcinoma

OBJECTIVE The change of cell immune function after hepatectomy of patients suffering from hepatocellular carcinoma (HCC) is usually neglected. The aim of this study was to explore the change of T cell subsets in HCC patients after hepatectomy, and to study the value of treatment with interferon (INF)combined with hepatic artery chemoembolization (HACE) and portal vein chemotherapy (PVC) to prevent recurrence after radical resection of HCC.METHODS Seventy-five HCC patients were treated with PVC and HACE at the 2nd week and 4th week after radical tumor resection. In the 2nd week after surgery, 33 pationts received INF treatment for one week. Seventy-two patients were followed up over three years. The effect of INF combined with HACE and PVC on the postoperative recurrence rate was compared with that of HACE and PVC treatment. Changes of T cell subsets in the peripheral blood were examined with labeled monoclonal antibodies before and after hepatectomy or with use of interferon. Forty cholecystolithiasis patients who received a cholecystectomy were used as controls.RESULTS CD3^ and CD4^ cells in the peripheral blood were reduced in patients with HCC. After hepatectomy, they declined further with a decrease in the CD4^ /CD8^ ratio. The values returned to pre-operative level at the 4th week after surgery. The CD3^ and CD4^ cells and the CD4^ /CD8^ ratio increased remarkably following the use of INF. The 1-, 2- and 3-year recurrent rates of patients treated with HACE, PVC and INF in combination were 0%, 6.2% and 15.6%, respectively, while those treated only with HACE and PVC were 5.0%, 12.5% and 27.5%, respectively.CONCLUSION Patients with HCC suffer from a marked immunosuppression, which become ever more severe after hepatectomy. The combined use of HACE, PVC and INF is superior in decreasing the recurrent rate to the combination of only HACE and PVC.     

Diabetes mellitus and postoperative blood glucose value help predict posthepatectomy liver failure in patients with hepatocellular carcinoma

BackgroundMany complications after hepatectomy can lead to perioperative death, among which posthepatectomy liver failure (PHLF) is the leading one. Existing studies suggest that one of the most important risk factors for PHLF is cirrhosis. Hepatitis B virus (HBV) infection is an important factor in the occurrence of cirrhosis, and the exact relationship between HBV infection and PHLF is not obvious. Diabetes mellitus and postoperative blood glucose are closely associated with liver regeneration, but its exact relationship with PHLF remains unclear.MethodsWe collected clinical indicators from 920 adult patients treated at the Liver Surgery and Transplantation Center of West China Hospital of Sichuan University from April 2009 and April 2019. We conducted a univariate analysis find out the risk factors of PHLF, follow by a multivariate analysis to ascertain the independent risk factors. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficiency of each risk factor.ResultsFollowing hepatectomy, 205 (22.2%) of patients were diagnosed with PHLF. Several variables were confirmed to related with PHLF significantly: diabetes [P<0.01, odds ratio (OR) =10.845, 95% confidence interval (CI): 5.450–21.579], HBV (P<0.01, OR =0.345, 95% CI: 0.187–0.635), blood glucose on the first postoperative day (post-BG1) (P=0.027, OR =1.059, 95% CI: 1.006–1.115), blood glucose on the third postoperative day (post-BG3) (P=0.021, OR =1.085, 95% CI: 1.012–1.162), blood glucose on the fifth postoperative day (post-BG5) (P=0.014, OR =1.119, 95% CI: 1.023–1.225), postoperative total bilirubin (post-TB) (P<0.01, OR =1.160, 95% CI: 1.133–1.187), and liver cirrhosis (P<0.01, OR =0.982, 95% CI: 0.561–1.717) identified to be independent risk factors of PHLF.ConclusionsDiabetes, HBV, post-BG1, post-BG3, and post-BG5 are related to the development of PHLF, and diabetes and post-BG can be used as predictors of the development of PHLF in patients with hepatocellular carcinoma (HCC).     

Microwave ablation in treating intrahepatic recurrence of hepatocellular carcinoma after liver transplantation: An analysis of 11 cases

Abstract

Purpose: This study was designed to evaluate the efficacy and safety of microwave ablation (MWA) in the treatment of intrahepatic recurrence of hepatocellular carcinoma (HCC) after liver transplantation. Materials and methods: Between October 2008 and August 2014, a total of 11 cases with 19 lesions were enrolled. All the subjects had confirmed HCC recurrence after liver transplantation by at least two types of enhanced imaging. Real-time monitoring and small ethanol doses were used as an additional technique to assist with ablation. Contrast imaging was performed to evaluate the technique efficacy. The technique efficacy rate, local tumour progression rate, 3, 6, 9, 12, 18 and 24 months survival rates, and the incidence of complications were comprehensively analysed. Results: The follow-up period ranged from 5–33 months. All tumours achieved full ablation. The first MWA technique efficacy rate was 84.2% (16/19), while the second technique efficacy rate was 100%. Local tumour progression was identified in three cases (15.8%) at 1, 3 and 7 months after MWA. The 3, 6, 9, 12, 18 and 24 months accumulative survival rates were 90.9%, 81.8%, 71.6%, 51.5%, 30.7% and 15.3%, respectively, the average survival time was 17.3 months (3.5–33 months). Mild side effects included five patients (45.4%) with fevers, three with (27.3%) nausea and vomiting, five (45.4%) with local pain, and eight (72.7%) with increased blood transaminase levels; no serious complications occurred. Conclusion: MWA treatment is a promising technique for intrahepatic recurrence after liver transplantation without serious complications or side effects.     

Decreasing disparity in liver transplantation among white and Asian patients with hepatocellular carcinoma : California, 1998-2005

BACKGROUND.

A preliminary study using national cancer surveillance data from 1998 through 2002 suggested that there were significant differences between non‐Hispanic whites (‘whites’) and Asian/Pacific Islanders (APIs) in the use of liver transplantation as a treatment for hepatocellular carcinoma (HCC).

METHODS.

The objective of the current study was to examine whether differences in liver transplantation between whites and APIs with HCC were changing over time. By using a population‐based, statewide cancer registry, data were obtained on all HCC cases diagnosed in California between 1998 and 2005, and the study was limited to white and API patients with nonmetastatic HCC who had tumors that measured ≤5 cm in greatest dimension (n = 1728 patients).

RESULTS.

From 1998 through 2003 (n = 1051 patients), the odds of undergoing liver transplantation were 2.56 times greater for white patients than for API patients (95% confidence interval [CI], 1.72–3.80 times higher), even after adjusting for age, sex, marital status, year of diagnosis, TNM stage, and tumor grade. In contrast, during 2004 and 2005 (n = 677 patients), there were no significant differences in the odds of undergoing liver transplantation. Between 2002 and 2004, changes in liver transplantation policy assigned priority points to patients with HCC (initially to stage I and II, then to stage II only). After the policy changes, API patients with HCC experienced a significant increase in stage II diagnoses, whereas white patients did not.

CONCLUSIONS.

In California, there was a large and significant disparity in the rate of liver transplantation among white and API patients with HCC from 1998 through 2003 but not during 2004 and 2005. Changes in liver transplantation policy from 2002 through 2004 may have played a role in decreasing this difference. Cancer 2008. © 2008 American Cancer Society.     

肝细胞移植治疗大鼠急性肝衰竭的疗效观察

目的观察肝细胞移植治疗大鼠急性肝衰竭的疗效, 探讨原代肝细胞提取方法, 观察体外培养的大鼠肝细胞生存情况。方法 利用胶原酶消化法分离大鼠肝细胞, 用D-氨基半乳糖(D-GalactosamineN, D-GalN)制作大鼠急性肝功能衰竭模型, 并以此模型为基础行大鼠同种异体肝细胞移植实验。结果 分离的肝脏实质细胞(Hepatocyte)的存活率在87%-95%。平均每只大鼠肝脏可分离出7.8×10⁷个肝脏实质细胞。肝细胞移植组大鼠7天的存活率为54.2%(13/24), 对照组8.3%(2/24), 移植组大鼠存活率与非移植组大鼠存活率之间具有显著性差异(P＜0.005)。结论 经腹腔移植同种异体肝细胞可明显改善D-GalN诱导的急性肝衰竭大鼠的存活率, 腹腔肝细胞移植是治疗急性肝衰竭安全有效的方法。     

Persistent disparities in liver transplantation for patients with hepatocellular carcinoma in the United States, 1998 through 2007

BACKGROUND:

Prior studies have demonstrated that among patients with hepatocellular carcinoma (HCC), African Americans (AAs) and Asian/Pacific Islanders (APIs) are substantially less likely to undergo liver transplantation (LT) compared with whites. The authors examined whether disparities in the receipt of LT among LT‐eligible HCC patients changed over a 10‐year time period, and whether the disparities might be explained by sociodemographic or clinical factors.

METHODS:

The National Cancer Data Base, a national hospital‐based cancer registry, was used to study 7707 adults with small (≤ 5 cm), nonmetastatic HCC diagnosed between 1998 and 2007. Racial/ethnic patterns in the use of LT were compared during 2 periods of 5 years each: 1998 through 2002 (n = 2412 patients) and 2003 through 2007 (n = 5295 patients). Data regarding comorbid medical conditions were only available during the later time period.

RESULTS:

Large and persistent racial/ethnic differences in the probability of receiving LT were observed. Compared with whites, hazard ratios (HRs) and associated 95% confidence intervals (95% CIs) for receiving LT from 1998 through 2002 were 0.64 (95% CI, 0.46‐0.89) for AA patients, 1.01 (95% CI, 0.79‐1.29) for Hispanic patients, and 0.52 (95% CI, 0.39‐0.68) for API patients. Analogous results for 2003 through 2007 were 0.64 (95% CI, 0.54‐0.76) for AA patients, 0.86 (95% CI, 0.75‐0.99) for Hispanic patients, and 0.58 (95% CI, 0.49‐0.69) for API patients. AA patients were less likely than whites to undergo any form of surgery, and API patients were more likely than whites to undergo surgical resection. Adjustment for sociodemographic and clinical factors produced only small changes in these HRs.

CONCLUSIONS:

Between 1998 and 2007, there were large and persistent racial/ethnic disparities noted in the receipt of LT among patients with HCC. These disparities were not explained by sociodemographic or clinical factors. Cancer 2011;. © 2011 American Cancer Society.     

Magnitude of change in alpha-fetoprotein in response to transarterial chemoembolization predicts survival in patients undergoing liver transplantation for hepatocellular carcinoma

Background

Downsizing strategies are often attempted for patients with hepatocellular carcinoma (hcc) before liver transplantation (lt). The objective of the present study was to determine clinical predictors of favourable survival outcomes after transarterial chemoembolization (tace) before lt for hcc outside the Milan criteria, so as to better select candidates for this strategy.

Methods

In this retrospective study, patients with hcc tumours either beyond Milan criteria (single lesion > 5 cm, 3 lesions with 1 or more > 3 cm) or at the upper limit of Milan criteria (single lesions between 4.1 cm and 5.0 cm), with a predicted waiting time of more than 3 months, received carboplatin-based tace treatments. Exclusion criteria for tace included Child–Pugh C cirrhosis or the presence of portal vein invasion or extrahepatic disease on imaging. Only patients without tumour progression after tace underwent lt.

Results

Of 160 hcc patients who received liver grafts between 1997 and 2010, 35 were treated with tace preoperatively. The median of the sum of tumour diameters was 6.7 cm (range: 4.8–8.5 cm), which decreased with tace to 5.0 cm (range: 3.3–7.0 cm) at transplantation (p < 0.0004). The percentage drop in alpha-fetoprotein (αfp) was a positive predictor (p = 0.0051) and the time from last tace treatment to transplantation was a negative predictor (p < 0.0001) for overall survival.

Conclusions

The percentage drop in αfp and a shorter time from the final tace treatment to transplantation significantly predicted improved overall survival after lt for hcc downsized with tace. As a serum marker, αfp should be followed when tace is used as a strategy to stabilize or downsize hcc lesions before lt.     

Might liver transplantation recipients with primary hepatocellular carcinoma benefit from GVT effect of aGVHD?

Objective:We aimed to access if acute graft-versus-host disease (aGVHD) in liver transplantation recipients of hepatocel ular carcinoma (HCC) might develop a graft-versus-tumor ef ect (GVT) other than ...