Objective To identify genes associated with hepatocellular carcinoma (HCC) as candidate diagnostic markers in a genome-wide scale. Methods The gene expression profiles of 40 pairs of HCC tumor tissue and peripheral non-tumorous liver tissue were analyzed by using gene chip technology.The gene chips were fabricated at the National Cancer Institute (NCI). Each gene chip contained 9 180 genes. The fluorescent targets were prepared by a direct labeling approach using two kinds of fluorescences as following: 100 μg of total RNA from non-cancerous liver tissue was labeled with Cy3-dUTP and 200 μg of total RNA from HCC was labeled with Cy5-dUTP. The targets were mixed together and hybridized with genes on the gene chips. Unsupervised hierarchical clustering analysis was done by CLUSTER and TREEVIEW software using median centered correlation and complete linkage. Results A total of 10 genes were found up-regulated in over 80% of primary tumors comparing with that of their corresponding non-tumorous liver tissues at a two-fold filter with an unsupervised hierarchical clustering algorithm, including protocadherin-alpha 9, ESTs, Homo sapiens cDNA FLJ, KPNA2, RPS20, SNRPE, CDKN2A, UBD, MDK and ANXA2.Conclusion These genes are supposed to be candidates for the diagnosis of HCC. Further investigation of these genes in a large scale of patients with HCC and patients with non-malignant hepatic diseases will be needed to disclose whether they could be used clinically as novel diagnostic tumor markers for HCC.
Objective To report the authors’ own experience and results of recent studies of anatomical liver resection for patients with hepatocellular carcinoma (HCC). Methods From January 2004 to June 2005, anatomical liver resection procedure were completed in 93 patients with HCC. Surgical techniques were designed to reduce intraoperative blood loss, blood transfusion and postoperative complications by parenchymal crushing with kelly forceps, inflow and outflow selective clamping. In 13 patients with large liver tumors, liver hanging maneuver performed in the course of hemihepatectomy. Liver transection with intermittent closure of the blood influx to the liver, using a Pringle manoeuvre. Results Of 93 patients undergoing hepatectomy for HCC, underlying cirrhosis was present in 82 (88%) patients. The median blood loss was 300 ml (100－6 000 ml) and 71%（66/93） of the patients did not require blood transfusion.The postoperative complication rate was 34%（32/93）, complications were primarily subphrenic collection (8 cases). Within 30 postoperative days, no death was recorded. Conclusion The anatomical liver resection of HCC may be improve the surgical outcome.
Objective To study the effect of HBeAg on recurrence and survival after radical resection of small (≤3 cm) hepatocellular carcinoma (HCC). Methods Two hundreds and twenty-three HCC patients undergone radical resection from 1999 to 2000 were divided into two groups according to serum HBeAg status， HBeAg positive group (n=73) and HBeAg negative group (n=150). The patients’ factors, operative factors and tumorous facors were studied retrospectively between the two groups. And risk factors of overall survival (OS) and disease-free survival (DFS) were analyzed. Results There were no significant differences in operative and tumorous factors between the two groups, but the HBeAg positive group were younger with more severe cirrhosis (P=0.004, P=0.008). The OS and DFS were significantly different between the HBeAg positive group and HBeAg negative group. The 1-, 3- and 5-year OS were 91.5%, 76.8%, 60.1% and 95.2%, 85.3%, 73.2%, respectively (P=0.053)； and the 1-, 3- and 5-year DFS were 73.3%, 53.7%, 40.3% and 86.6%, 65.5%, 54.5%, respectively (P=0.002). Multivariate analysis revealed that age ＞50 years, HBeAg positive and macronodular cirrhosis were significantly related to OS, and HBeAg positive, multiple tumor nodulars were significantly related to DFS. Positive serum HBeAg status was an independent risk factor for both OS and DFS. Conclusion Positive serum HBeAg is closely related to early recurrence and survival after radical resection of patients with small HCC.
Objective Exploring the way to obtain long-term, high-quality survival of patients with primary liver cancer (PLC) by surgical resection. MethodReviewing the diagnosis, treatment and follow-up outcomes of 10 PLC patients who were most representative, confirmed by pathology and survived for 30 years or more after surgical treatment at Zhongshan Hospital, Affiliated to Fudan University from July 1958 to September 1995, and summarizing the successful experiences with references. ResultsCase one: male, 50-year-old. Case one survived for forty-three years of long-term survival after surgery, who was the ealiest one to break the 40-year survival barrier. Case 2: female, 36-year-old. Case 2 had remained tumor-free survival for 57 years after liver resection: the longest record of high-quality survival to date. Case 3: male, 31-year-old. Case 3 had remained 51-year tumor-free survival after resection of a giant (17 cm) hepatocellular carcinoma. Case 4: male, 19-year-old. The patient, suspected of liver cancer based only on abnormally elevated alpha-fetoprotein (AFP) in the 1970s, underwent surgical exploration with immediate liver cancer resection, and had since enjoyed 50 years of tumor-free survival. Case 5: male, 59-year-old. The patient survived to be 103 years old after undergoing liver cancer resection and subsequent pulmonary metastasis resection with tumor-free survival of 43 years. Case 6: female, 19-year-old. The patient survived 50 years after undergoing liver cancer resection. Her liver cancer was found on abnormally elevated AFP in liver cancer screening in the 1970s. She gave birth to a healthy baby girl 10 years after the operation. Now the mother and daughter lead a happy life. Case 7: male, 44-year-old. The patient with a massive liver cancer undervent three sequential surgical interventions: hepatic artery ligation and cannulation, hepatectomy for the primary tumor, and re-resection of recurrent tumor. He had survived for 45 years postoperatively and well. Case 8: male, 57-year-old. The patient with liver cancer accompanied by thrombus in the left hepatic vein and survived for 38 years after undergoing an En Bloc liver cancer resection including removal of the cancer thrombus. Case 9: male, 48-year-old. The patient with hilar liver cancer (segment Ⅷ) had been living healthily for 32 years after a thrilling liver resection. Case 10: 18-month-old, baby girl. The female infant survived 32 years after undergoing liver cancer resection. Now she had grown up, gotten married, had her own children, and the family is living a happy life. ConclusionSurgical resection is the most thorough treatment method, enabling liver cancer patients to achieve long-term or even miraculous survival outcomes.
