Successful liver transplant for unresectable hepatoblastoma

Background

Treatment of children with stage III and IV hepatoblastoma has shown little improvement with 5-year survival rates of 64% and 25%, respectively (J Clin Oncol 2000;18:2665-75). A timely and organized treatment program including preoperative chemotherapy combined with living donor liver transplantation and postoperative chemotherapy has been used seeking improved long-term survival in stage III and IV cases.

Methods

A retrospective review of 8 patients with stage III and IV hepatoblastoma unresectable by conventional resection were treated with complete hepatectomy and transplantation. Approval was obtained from our institutional review board.

Results

Since August of 2001, we have treated 6 patients with stage III hepatoblastoma and 2 patients with initial stage IV hepatoblastoma. These patients (age, 23 months-9 years) had all received extensive chemotherapy or prior resections. After chemotherapy, none had gross tumor documented outside of the liver at time of transplantation. All underwent hepatectomy including vena cava resection, in selected cases, with living donor orthotopic liver transplantation. All patients had at least 2 cycles of postoperative chemotherapy. Of 8 patients, 6 are alive and well with normalized alpha-fetoprotein levels. There were 2 late deaths from recurrent disease. Length of follow-up ranged from 7 to 53 months.

Conclusion

Complete hepatectomy with living donor liver transplantation provides optimal surgical treatment in unresectable stage III and initial stage IV disease confined to the liver at resection. This series indicates that children tolerate complete hepatectomy, transplantation, and postoperative chemotherapy well. Referral to a transplant center during the first 3 cycles of chemotherapy appears to offers the best opportunity for long-term survival.     

Experimental myasthenia gravis induced in mice by passive transfer of human myasthenic immunoglobulin : Evidence for an ameliorating effect by alpha-fetoprotein

The induction of experimental autoimmune myasthenia gravis (EAMG) was studied by the passive transfer of gamma-globulin from myasthenia gravis (MG) patients to C57BL/6 mice. Muscular weakness and electromyographic decrements (EMG) could be consistently induced in all mice injected with gamma-globulin from certain selected MG patients. There was, however, no correlation between the antiacetylcholine receptor antibody titre in the donor gamma-globulin and the ability to induce EAMG. The possible beneficial effects of immunoregulatory alpha-fetoprotein (AFP) treatment were investigated employing the passive EAMG model. Mice were protected against the onset of severe symptoms provided the AFP was administered before and after passive transfer. The exaggerated fatigue characteristics associated with murine EAMG as detected by EMG could be alleviated by AFP treatment. These findings raise the possibility that AFP may be of some therapeutic value in the control of MG.     

外周血中AFPmRNA检测对原发性肝癌高危人群监测的意义

目的 :探讨外周血中AFPmRNA检测对原发性肝癌 (以下简称肝癌 )高危人群监测的价值。材料和方法 :采取AFP升高 2次以上的慢性肝病患者 6 3例、12例肝癌、2 1例肝癌术后患者静脉血 5ml,用RT -PCR进行AFPmRNA检测。结果 :AFP定量与AFPmRNA阳性率无显著关系 (P >0 .0 5 ) ,AFP进行升高组、持续升高组和波动组间AFPmRNA阳性率无显著关系(6 4.71%、40 %、40 .5 8% ,P >0 .0 5 ) ,AFP进行升高组、持续升高组发癌率为 5 8.82 % (10 / 17) ,30 % (3/ 10 )显著高于AFP波动组 4.35 % (3/ 6 9,P <0 .0 1)。AFPmRNA阳性检出肝癌 41.6 7% (5 / 12 ) ,高危结节 6 0 % (6 / 10 )、肝癌术后复发 10 0 % (4/ 4)。AFP大于 2 0 0 μg/L能检出 5 8.82 % (10 / 17)肝癌和 2 5 % (1/ 4)的术后复发灶 ,AFP大于 2 0 0 μg/L、AFPmRNA阳性结合影像检测能检出 91.6 7% (11/ 12 )的肝癌和 10 0 % (4/ 4)的术后复发灶。结论AFP进行和持续升高是肝癌发生的高危人群 ,AFPmR NA阳性也是肝癌发生的高危人群 ,AFPmRNA能检测部分AFP阴性的肝癌患者 ,因此 ,AFP、AFPmRNA和影像联合检测能提高小肝癌的检出率     

孕早中期血清妊娠相关血浆蛋白A、甲胎蛋白及雌三醇在预测子痫前期中的临床价值

目的 探讨妊娠早中期血清妊娠相关血浆蛋白A(PAPP-A)、甲胎蛋白(AFP)、雌三醇(uE3)在预测子痫前期中的价值.方法 纳入单胎妊娠孕妇1 912例,其中正常孕妇l 843例(正常组),子痫前期孕妇69例(子痫前期组),子痫前期组分为重度子痫前期组24例及轻度子痫前期组45例.采用酶联免疫吸附法检测1 912例孕妇孕早期血清PAPP-A、人绒毛膜促性腺激素(β-HCG)及孕中期AFP、β-HCG和uE3水平.绘制受试者工作特征(ROC)曲线评价单个指标及联合预测子痫前期的价值.结果 孕早期子痫前期组血清PAPP-A水平明显低于正常组(P＜0.05),重度子痫前期组血清PAPP-A水平明显低于轻度子痫前期组(P＜0.05),但孕早期子痫前期组与正常组、轻度子痫前期组与重度子痫前期组血清β-HCG水平分别比较,差异均无统计学意义(P＞0.05);孕中期子痫前期组血清uE3、AFP水平均低于正常组(P＜0.05),但两组血清β-HCG水平比较,差异无统计学意义(P＞0.05),孕中期轻度子痫前期组血清β-HCG、uE3、AFP水平与重度子痫前期组比较,差异均无统计学意义(P＞0.05);PAPP-A、uE3、AFP单项指标及其联合对子痫前期都有一定的预测价值(P＜0.05),血清PAPP-A、uE3、AFP水平联合预测子痫前期的ROC曲线下面积最大,为0.782.结论 子痫前期孕妇孕早期血清PAPP-A、孕中期AFP及uE3水平低于正常孕妇,血清PAPP-A、uE3、AFP水平单独或者3者联合均可预测子痫前期,而联合预测的价值较高,优于任何一个单独指标.     

甲胎蛋白、甲胎蛋白异质体3在乙型肝炎病毒相关肝癌患者肝动脉化疗栓塞术术后疗效评估中的应用

目的 研究甲胎蛋白(AFP)及甲胎蛋白异质体3(AFP-L3)在乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)患者肝动脉化疗栓塞术(TACE)前后表达量的变化及与影像学的关系.方法 纳入104 例HBV 相关HCC 患者,均行TACE,化学发光法检测术前及术后血清中AFP、AFP-13 的表达量,CT 扫描了解患者术后...     

Predictive value of serum alpha-fetoprotein for tumor regression after preoperative chemotherapy for rectal cancer

BACKGROUNDPreoperative therapy is widely used in locally advanced rectal cancer. It can improve local control of rectal cancer. However, there are few indicators that can predict the effect of preoperative chemotherapy accurately.AIMTo investigate whether the increase in serum α-fetoprotein (AFP) can predict better efficacy of preoperative chemotherapy.METHODSThis was a retrospective study. We analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer. All patients received six cycles of preoperative chemotherapy (mFOLFOX6 every 2 wk). Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy, and fell to normal again within 2 mo. The other 99 patients had a normal level of serum AFP during chemotherapy. Patients were divided into two groups (AFP risen and AFP normal). According to postoperative pathology, we compared tumor regression and complete response rate between the two groups. The primary outcome measure was the tumor regression grade (TRG) after chemotherapy. The difference in pathological complete response between the two groups was also investigated.RESULTSThere were no tumor progression and distant metastasis in both groups during preoperative chemotherapy. Patients in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group (61.5% vs 39.4%). The increase in AFP was a significant predictor for better tumor regression [χ² = 4.144, odds ratio (OR) = 2.666, P = 0.04]. In the AFP risen group, the complete response rate was 30.8%, which was higher than in the AFP normal group (30.8% vs 12.1%, χ² = 4.542, OR = 3.251, P = 0.03).CONCLUSIONPatients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy, and are more likely to achieve pathological complete response.     

肝癌患者围手术期外周血甲胎蛋白mRNA表达与术后复发的关系

背景与目的:甲胎蛋白(alpha-fetoprotein,AFP)mRNA是检测肝癌患者外周血中癌细胞常用的标志物。本研究探讨肝癌患者围手术期的外周血中AFPmRNA表达与术后复发的关系。方法:应用巢式PCR和Taq Man MGB探针法PCR定量技术,检测56例肝细胞癌患者术前和术后外周血、15例良性肝占位性病变合并肝硬化患者外周血以及30例健康志愿者外周血AFP mRNA的表达情况。结果:肝癌患者术前外周血AFP mRNA的阳性率为42.9%(24/56),高于良性肝占位合并肝硬化患者的13.3%(2/15)和健康对照的10.0%(3/30),其差异均有统计学意义(P=0.035,P=0.002)。术前AFP mRNA的表达与肿瘤有无肉眼及镜下血管侵犯的相关性有统计学意义(P=0.029,P<0.001)。AFP mRNA阴性患者1、2、3年生存率及无瘤生存率均比AFP mRNA阳性患者术后高(P=0.003,P=0.039)。Cox多因素分析结果显示术前外周血AFP mRNA阳性是预测术后复发的独立因素(P=0.018)。术后患者外周血AFP mRNA的阳性率为37.5%(21/56),术后AFP mRNA的表达与患者各项临床病理特征、预后以及术前AFP mRNA水平的相关性均无统计学意义。结论:肝癌患者术前外周血中AFP mRNA阳性者比AFP mRNA阳性者肿瘤侵袭性更强,术后可能更易复发。     

Association of primary tumor location with long-term oncological prognosis following hepatectomy for hepatocellular carcinoma:A multicenter propensity score matching analysis

PurposeThere is a striking laterality in the site of hepatocellular carcinoma (HCC), with a strong predominance for the right side; however, the impact of primary tumor location on long-term prognosis after hepatectomy of HCC remains unclear. This study aimed to investigate the effect of primary tumor location on long-term oncological prognosis after hepatectomy for HCC.Patients and methodsData of consecutive patients undergoing curative hepatectomy for HCC between 2008 and 2017 were analyzed. Overall survival (OS) and recurrence-free survival (RFS) of left-sided HCC (LS group) and right-sided HCC (RS group) were compared by using propensity score matching (PSM) analysis. COX regression analysis was performed to assess the adjusted effect of tumor location on long-term oncological prognosis.ResultsOf the 2799 included patients, 707 (25.3%) and 2092 (74.7%) were in the LS and RS groups, respectively. Using PSM analysis, 650 matched pairs of patients were created. In the PSM cohort, median OS (66.0 vs. 72.0 months, P = 0.001) and RFS (28.0 vs. 51.0 months, P < 0.001) were worse among patients in the LS group compared to individuals in the RS group. After further adjustment for other confounders using multivariable COX regression analyses, HCC located on the left side remained independently associated with worse OS and RFS.ConclusionTumors located on the left side are associated with poorer OS and RFS after hepatectomy for HCC. Careful surgical options selection and frequent follow-up to improve long-term survival may be justified for HCC patients with left-sided primary tumors.     

Multimodal Management of Testicular Mesothelioma - A Retrospective Analysis From a Tertiary Cancer Care Centre

The main modality of management of paratesticular mesothelioma remains orchiectomy while the use of adjuvant chemotherapy has not yet been explored. We aim to analyse the outcome of the multimodal management protocol in testicular mesothelioma We conducted a retrospective analysis of patients registered and treated for testicular mesothelioma between 2009 and 2019 in an oncology tertiary care hospital. Patients presenting with nodal, metastatic disease were treated with adjuvant, palliative chemotherapy respectively and their response to treatment was periodically monitored. Eight patients (3 early, 1 nodal, 4 metastatic) with median age of 58 years was included in the study. Patients who had limited (early, nodal) disease (n = 4) had overall survival ranging from 20 to 140 months while metastatic disease (n = 4) had poor outcomes with overall survival ranging from 2 to 13 months. Surgery remains to be an important modality of therapy that improves the local control and overall outcomes and the quality of life even in patients with metastatic disease at the time of diagnosis. Adjuvant chemotherapy might play a role in effective management of locoregional disease. The performance status, the extent of disease at the time of presentation are the important prognostic factors in deciding the outcome of the disease management.