Prospective,single-center cohort study analyzing the efcacy of complete laparoscopic resection on recurrent hepatocellular carcinoma

Background: Laparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). How?ever, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efcacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence. Methods: We conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31)underwent laparoscopic hepatectomy, and the control group (n tion time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient= 33) underwent conventional open surgery. Opera?could walk, anal exsufation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse?free survival was compared between the two groups. Results: All surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differencesbetween the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraopera?tive blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6vs. 2.2 ± 0.8 days, P < 0.05), anal exsufation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days,P= 0.014). During the 1?year postoperative follow?up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse?free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recur?rence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was signifi?cantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence. Conclusions: For the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraop?erative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.     

Association of HBV DNA replication with antiviral treatment outcomes in the patients with early-stage HBV-related hepatocellular carcinoma undergoing curative resection

Background: It remains unclear what the antiviral therapy affects disease?free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)?related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels. In this study, we analyzed the association of antiviral treatment with DFS and OS based on the stratifi?cation of baseline HBV DNA load in early?stage (stages I and II) HCC patients. Methods: We included 445 patients with early?stage HBV?related HCC who underwent curative resection, and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification. The Kaplan–Meier and Cox regression analyses were performed to determine the association of clinical characteristics with survival. Results: The median follow?up period was 74 months. For all patients, cumulative OS rates in the antiviral group were significantly higher than those in the non?antiviral group (log?rank test, P = 0.023), whereas no significant differencesin DFS rates were observed. High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients. In patients with baseline HBV DNA levels ≥2000 IU/mL, antiviral treatment was significantly associated withprolonged DFS and OS (log?rank test, P or undetectable, antiviral treatment did not show a significant benefit in prolonging DFS and OS. Conclusions: High baseline HBV DNA levels are associated with poor prognosis in the patients with early?stage HCC, and the antiviral treatment could generate survival benefits for the patients. Therefore, antiviral treatment should be given for these patients. However, the effect of antiviral treatment on the patients with low viral load remains unclear, and further investigation is warranted.     

Impact of serum vascular endothelial growth factor on prognosis in patients with unresectable hepatocellular carcinoma after transarterial chemoembolization

Objective:To investigate the expression level of serum vascular endothelial growth factor(VEGF) in patients with unresectable hepatocellular carcinoma(HCC) and its relationship with the clinicopathological characteristics,and to assess the impact of serum VEGF as a predictive factor for HCC prognosis during transarterial chemoembolization(TACE) treatments.Methods:Serum VEGF levels were measured using enzyme-linked immunosorbent assay(ELISA) in 60 random patients who underwent TACE or transarterial infusion(TAI) for unresectable HCC between May and September 2008 and 12 healthy volunteers were also involved in this study to serve as control.All patients’ clinicopathological features were retrospectively analyzed.Serum VEGF levels were correlated with clinicopathological features of the HCC patients.The patients’ survival rates were analyzed with Kaplan-Meier survival curves and compared by the log-rank test.The prognostic significance of serum VEGF levels and factors related to survival rate were evaluated by univariate and multivariate analysis.Results:The median serum VEGF level in the HCC patients was 285 pg/ml(range 14 1,207 pg/ml),significantly higher than that of healthy controls(P=0.021).The serum VEGF levels were significantly correlated with platelet counts(r=0.396,P=0.002) but not other clinicopathological features.Patients with serum VEGF level >285 pg/ml had worse overall survival compared with those with serum VEGF level <285 pg/ml(P=0.002).By multivariate analysis,the serum VEGF level was a significant prognostic factor.Conclusion: High serum VEGF levels may predict poor prognosis of HCC after TACE. This study highlights the importance of tumor biomarker as a prognostic predictor in TACE therapy for HCC, which has an intrinsic problem of unavailability of histopathological prognostic features.     

Radiation-induced osteosarcoma ofthe maxilla andmandible afterradiotherapy fornasopharyngeal carcinoma

Background: The increasing incidence of radiation?induced osteosarcoma of the maxilla and mandible (RIOSM) has become a signiifcant problem that can limit long?term survival. The purpose of this study was to analyze the associa?tion of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC). Methods: We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat?sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded. Results: For all patients treated for NPC at Sun Yat?sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty?nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who under?went resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1?, 2?, and 3?year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treat?ment type. Conclusions: RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely inter?vention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.     

肝细胞癌的血清标志物

Hepatocellular carcinoma (HCC) is one of the most common malignant tumor with increasing incidence worldwid.Most of patients with HCC are diagnosed at a late stage.Threrfore,the prognosis of HCC patients is generally poor with a 5-year survival rate of 20% if withoutoperration. Screening strategies including α-fetoprotein (AFP) and ultrasound every 6 months in patients with liver cirrhosis,the major risk factor for HCC development, have been recommended to detect HCC at earlier stages amenable to effective treatment strateges.AFP, however,is a marker with poor sensitivity and specificity and the ultrasound is highly dependent on the operator's experience.Apart from AFP, lens culinaris agglutinin-reactive AFP and des-gamma carbexyprothrombin and several other biomarkers(e.g., glypican-3,human hepatocyte growth factor,and insulin-like growth factor) have been proposed as markers for HCC detection.In addition,with recently employed techniques,such as gene-expressing microarrays and proteomics,it is to be expected that new HCC-specific markers will become available in the near future.For all such proposed markers,however,the clinical usefulness has to be carefully evaluated and validated.     

ABO blood group is a predictor of survival in patients with laryngeal cancer

Background:Whether the ABO blood group is associated with the survival of patients with laryngeal cancer remains unknown. The purpose of this study was to investigate the association between the ABO blood group and clinico?pathologic characteristics of patients with laryngeal cancer and assess whether the ABO blood group was associated with prognosis. Methods:We analyzed the records of 1260 patients with laryngeal cancer who underwent curative treatment at Sun Yat?sen University Cancer Center between January 1993 and December 2009. The Chi?square test was used to assess the relationship between the ABO blood group and clinicopathologic characteristics. The Kaplan–Meier method was used to estimate 3?, 5?, and 10?year overall survival (OS) rates. The Cox proportional hazards model was used in univariate and multivariate analyses of OS. Results:No signiifcant association was found between the ABO blood group and clinicopathologic characteristics except for primary tumor site. The median OS for patients with blood groups A, B, AB, and O were 87.0, 80.0, 90.0, and 72.5months, respectively. The 3?, 5?, and 10?year OS rates were 82.4%, 76.0%, and 67.5% for patients with blood group A; 77.4%, 69.8%, and 58.4% for patients with blood group B; 82.2%, 73.1%, and 65.6% for patients with blood group AB; and 71.7%, 66.4%, and 55.5% for patients with blood group O, respectively. Univariate and multivariate analyses showed that the ABO blood group had signiifcant effects on prognosis in patients with laryngeal cancer. Conclusions:The ABO blood group is associated with survival in patients with laryngeal cancer. Patients with blood group O had signiifcantly shorter OS than patients with other ABO blood groups.     

肝细胞癌的血清标志物

Hepatocellular carcinoma (HCC) is one of the most common malignant tumor with increasing incidence worldwid.Most of patients with HCC are diagnosed at a late stage.Threrfore,the prognosis of HCC patients is generally poor with a 5-year survival rate of 20% if withoutoperration. Screening strategies including α-fetoprotein (AFP) and ultrasound every 6 months in patients with liver cirrhosis,the major risk factor for HCC development, have been recommended to detect HCC at earlier stages amenable to effective treatment strateges.AFP, however,is a marker with poor sensitivity and specificity and the ultrasound is highly dependent on the operator's experience.Apart from AFP, lens culinaris agglutinin-reactive AFP and des-gamma carbexyprothrombin and several other biomarkers(e.g., glypican-3,human hepatocyte growth factor,and insulin-like growth factor) have been proposed as markers for HCC detection.In addition,with recently employed techniques,such as gene-expressing microarrays and proteomics,it is to be expected that new HCC-specific markers will become available in the near future.For all such proposed markers,however,the clinical usefulness has to be carefully evaluated and validated.     

EYA4 gene functions as a prognostic marker and inhibits the growth of intrahepatic cholangiocarcinoma

Background: The molecular prognostic markers and carcinogenesis of intrahepatic cholangiocarcinoma (ICC) have not been well documented. The purpose of this study was to investigate the prognostic value of the eyes absent homolog 4 (EYA4) gene in ICC and its biological effects on ICC growth in vitro and in vivo. Methods: One hundred twelve patients with ICC who underwent hepatectomy were enrolled in the study. EYA4 mRNA and EYA4 protein levels in ICC and adjacent non?tumoral tissues were evaluated using real?time quantitative polymerase chain reaction and immunohistochemical staining, respectively. EYA4 protein levels in ICC cells were determined using western blot analysis. The associations between EYA4 expression and clinicopathologic features of ICC were analyzed. To identify independent prognostic factors, univariate and multivariate analyses were performed. The biological effects of EYA4 on ICC cells were evaluated by establishing stable EYA4?overexpressing transfectants in vitro, and EYA4’s effects on tumor growth were evaluated by intra?tumoral injection of EYA4?expressing plasmids in a NOD/SCID murine model of xenograft tumors. Results: ICC tissues had signiifcantly lower EYA4 mRNA and protein levels compared with adjacent non?tumoral tis?sues (both P<0.001). Univariate and multivariate analyses showed that EYA4 protein level, tumor number, adjacent organ invasion, lymph node metastasis, and tumor differentiation were independent prognostic factors for disease?free survival and overall survival (all P<0.05). In vitro, EYA4 overexpression inhibited tumor cell growth, foci formation, and cell invasiveness. In vivo, intra?tumoral injection of EYA4?expressing plasmids signiifcantly inhibited ICC growth in the murine xenograft model compared with the control group (P<0.05). Conclusion: EYA4 gene functioned as a molecular prognostic marker in ICC, and its overexpression inhibited tumor growth in vitro and in vivo.     

Cumulative scores based onplasma D-dimer andserum albumin levels predict survival inesophageal squamous cell carcinoma patients treated withtransthoracic esophagectomy

Background:Recently, studies have shown that plasma D?dimer and serum albumin are prognostic markers for esophageal cancer. The purpose of this study was to evaluate a novel prognostic scoring system—DA score (combi?nation of preoperative plasma D?dimer and serum albumin levels)—and analyze the association between survival of patients with esophageal squamous cell carcinoma (ESCC) and their Glasgow prognostic score. Methods:In this retrospective study, preoperative biochemical markers and clinicopathologic factors in 260 ESCC patients treated with transthoracic esophagectomy were reviewed. According to receiver operating characteristic analysis, the cutoff values of D?dimer and albumin were deifned as 0.5μg/mL and 43.8g/L, respectively. Patients with high D?dimer levels (≥0.5μg/mL) and low albumin levels (<43.8g/L) were assigned a score of 2, those with only one of the two abnormalities were assigned a score of 1, and those with neither of the two abnormalities were assigned a score of 0. Results:ESCC patients with a DA score of 0, 1, and 2 numbered 55, 116, and 89, respectively. Survival analysis showed that patients with a DA score of 2 had lower overall survival (OS) rates than those with DA scores of 1 and 0 (37.1% vs. 52.6% and 76.4%,P<0.001); similar ifndings were observed for disease?free survival (DFS) rates (32.6% vs. 44.8% and 67.3%,P<0.001). In addition, the predictive value of the DA score was also signiifcant in patients with stages I–IIA and stages IIB–IV ESCC. Multivariate Cox regression analyses indicated that hazard ratios (HRs) for predicting OS of patients with DA scores 1 and 2 were 2.25 (P=0.010) and 3.14 (P<0.001), respectively, compared with those with a DA score of 0, and HRs for predicting DFS of patients with DA scores of 1 and 2 were 1.86 (P=0.023) and 2.68 (P<0.001), respectively, compared with those with a DA scores of 0. Conclusions:Our study suggests that preoperative DA scores are notably associated with postoperative survival of ESCC patients.     

A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma

Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.     

Clinicopathological and prognostic differences between mucinous gastric carcinoma and signet-ring cell carcinoma

Objective: To analyze the differences in clinicopathologic characteristics and prognosis between mucinous gastric carcinoma (MGC) and signet-ring cell carcinoma (SRCC). Methods: Clinicopathologic and prognostic data of 1,637 patients with histologically confirmed MGC or SRCC who received surgical operations in the Department of Gastroenterological Surgery, Beijing Cancer Hospital between December 2004 and December 2009 were retrospectively collected and analyzed. The clinicopathological features were analyzed statistically using χ 2 test. Survival was analyzed using the Kaplan-Meier method and multivariate analysis of Cox proportional hazards regression model (backward, stepwise). Results: A total of 181 patients with gastric cancer (74 MGC, 107 SRCC) were included. MGC, when compared with SRCC, was featured by senile patients, stage III and IV, upper third stomach, large tumor size, positive lymph node metastasis, and positive lymphatic vascular invasion (P<0.05). The overall 5-year survival rate showed no difference between the two groups (48.8% vs. 44.8%, P>0.05). However, the survival rate for MGC patients was significant lower than that for SRCC patients when compared among the age <60 years, negative distant metastasis, and tumor localized at upper third stomach (P<0.05). Multivariate Cox proportional hazards models revealed that distant metastasis was a significant independent prognostic indicator in MGC group, and lymph node metastasis and distant metastasis was significant independent prognostic indicators in SRCC group. Conclusions: While compared with SRCC, MGC is associated with a more aggressive tumor biologic behavior. There is no statistically significant difference in distant metastasis, an independent prognostic indicator for both MGC and SRCC, which might be the reason for no significant difference of the overall survival rate between the patients with MGC and SRCC.     

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Background:Gross target volume of primary tumor (GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ifnd a suitable cut?off value of GTV?P for prognosis prediction. Methods:Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic (ROC) curves were used to identify the cut?off values of GTV?P for the prediction of different end?points [overall survival (OS), local relapse?free survival (LRFS), distant metastasis?free survival (DMFS), and disease?free survival (DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system. Results:The 358 patients with locally advanced NPC were divided into two groups by the cut?off value of GTV?P as determined using ROC curves: 219 (61.2%) patients with GTV?P≤46.4mL and 139 (38.8%) with GTV?P>46.4mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P≤46.4mL than in those with GTV?P>46.4mL (allP<0.05). Multivariate analysis indicated that GTV?P>46.4mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriifed that the predictive ability of GTV?P was superior to that of T category (P<0.001). The cut?off values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4mL, respectively. Conclusion:In patients with locally advanced NPC, GTV?P>46.4mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.     

Tumors of ampulla of Vater: A case series and review of chemotherapy options

Carcinomas of the Ampulla of Vater are rare tumors, accounting for 0.2% of gastrointestinal cancers. Compared with other biliary tract neoplasms, these tumors have a relatively favorable prognosis after surgical resection. Based on their epithelium of origin, two subtypes of ampullary carcinoma have been recently distinguished: intestinal and pancreatobiliary. This study evaluates histopathological features and outcomes of ampullary carcinoma and to compares the survival of these tumors to that of other biliary tract tumors. The chemotherapic options available for ampullary cancer are also reviewed. We analyzed data from 20 consecutive patients with ampullary carcinomas and 26 patients with other biliary tract carcinomas, observed in our Institution. Statistical analysis was performed by using either Fisher’s exact test or χ2 test for categorical variables. Median time of survival was calculated and compared using the Log-Rank test. Similar distribution of demographic characteristics and stage between ampullary and other biliary tract cancers was observed. Patients with ampullary cancer underwent surgery more frequently than other biliary cancers while chemotherapy and radiotherapy were used equally. In accordance with the literature, a longer median survival was observed in the group of ampullary carcinomas.     

Clinical characteristics and prognostic analysis of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN）

Objective： The aim of the study was to analyze the clinicopathologic characteristics of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN） and to explore the prognostic factors for patients and differences of immunohisto- chemical markers between neuroendocrine tumor （NET） and neuroendocrine carcinoma （NEC）. Methods： Retrospective reviews were conducted for the charts of 119 patients with GEP-NEN at the Affiliated Hospital of Qingdao University （China） from August 2003 to December 2013. Kaplan-Meier method was used to do the overall survivals analysis for the patients at different levels of predictive factors. Meanwhile, Cox proportional hazard model was used to select independent risk factors of surJival. Analysis of variance was used to compare the expression of immunohistochemical markers among different patho- logical grades. Results：Among 119 patients, pancreas （45/119, 37.82%） and rectum （33/119, 27.73%） were mostly involved. The onset age of GEP-NEN in female group was younger than that of the male group. There were 13 deaths （10.92%） during 18.9 （0.1-133.4） months follow-up period. Multivariate analysis indicated that neural invasion, gender and pathological grades of NET and NEC were independent risk factors. In neuroendocrine neoplasm （NEN）, Syn expression in G2 was higher than G1 and G3, while CgA showed no significant difference. All markers showed no significant differences between NET and NEC. Conclusion： GEP-NEN may occur at multiple sites of digestive system and lack specific clinical manifestations. Syn expression detected for the prognosis of G1, G2 and G3 tumors have clinical significance. Neural invasion, sex and patho- logical grades were independent prognostic factors for GEP-NEN patients. No significant difference was found in different pathological grades of NET and NEC.     

Significance of the Expression of Rho-GDP Dissociation Inhibitorβ,γin Lung Squamous Cell Carcinoma and Adenocarcinoma

Objective:To study the expression of Rho-GDP dissociation inhibitor β,γ(Rho-GDIβ,Rho-GDIγ)in lung squamous cell carcinoma and adenocarcinoma and its relationship with the expression of RhoC(Ras homologus oncogenes C)and clinicopathologic parameters.Methods:Western blot assay was employed for Rho-GDIβ,Rho-GDIγ and RhoC in lung squamous cell carcinoma and adenocarcinoma and non-neoplastic lung tissues of 37 cases with fresh specimens.Results:The study showed that Rho-GDIβ,Rho-GDIγ and RhoC were expressed in lung cancer and non-neoplastic lung tissues,the level in lung cancer tissue was much higher than that in non-neoplastic tissues(P<0.001).In lung cancer,the expression of Rho-GDIβ was much higher in patients with lymph node metastasis(P=0.021),and the expression of Rho-GDIγ was much higher in poorly differentiated tumor than in well-differentiated and moderately differentiated tumor,but both of them were not correlated with other clinicopathologic parameters.The expressions of Rho-GDIβ and Rho-GDIγ were not correlated with the expression of RhoC.Conclusion:In lung cancer,Rho-GDIβ and Rho-GDIγ may play a role in the tumorigenesis,Rho-GDIβ may promote metastasis,and Rho-GDIγ may have some relationship with differentiation.     

Hepatocellular carcinoma with blood supply from parasitized omental artery: Angiographic appearance and chemoembolization

Objective: To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. Methods: A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. Results: Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor’s oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. Conclusion: Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.     

Diagnostic value of 5 serum biomarkers for hepatocellular carcinoma with different epidemiological backgrounds: A large-scale,retrospective study

Objective:Hepatocellular carcinoma(HCC)is a lethal global disease that requires an accurate diagnosis.We assessed the potential of 5 serum biomarkers(AFP,AFU,GGT-II,GPC3,and HGF)in the diagnosis of HCC.Methods:In this retrospective study,we measured the serum levels of each biomarker using ELISAs in 921 participants,including 298 patients with HCC,154 patients with chronic hepatitis(CH),122 patients with liver cirrhosis(LC),and 347 healthy controls from 3 hospitals.Patients negative for hepatitis B surface antigen and hepatitis C antibody(called"NBNC-HCC")and patients positive for the above indices(called"HBV-HCC and HCV-HCC")were enrolled.The selected diagnostic model was constructed using a training cohort(n=468),and a validation cohort(n=453)was used to validate our results.Receiver operating characteristic analysis was used to evaluate the diagnostic accuracy.Results:Theα-L-fucosidase(AFU)/α-fetoprotein(AFP)combination was best able to distinguish NBNC-HCC[area under the curve:0.986(95%confidence interval:0.958–0.997),sensitivity:92.6%,specificity:98.9%]from healthy controls in the test cohort.For screening populations at risk of developing HCC(CH and LC),the AFP/AFU combination improved the diagnostic specificity for early-stage HCC[area under the curve:0.776(0.712–0.831),sensitivity:52.5%,specificity:91.6%in the test group].In all-stage HBV-HCC and HCV-HCC,AFU was also the best candidate biomarker combined with AFP[area under the curve:0.835(0.784–0.877),sensitivity 69.1%,specificity:87.4%in the test group].All results were verified in the validation group.Conclusions:The AFP/AFU combination could be used to identify NBNC-HCC from healthy controls and hepatitis-related HCC from at-risk patients.