ObjectiveTo systematically review the effects of Liujunzi decoction on improving the quality of life (QOL) of patients with advanced primary liver cancer.
MethodsDatabases including MEDLINE, EMbase, SCI, The Cochrane Library (Issue 2, 2014), CBM, CNKI, VIP and WanFang Data were searched electronically from inception to July 2014 to collect randomized controlled trials (RCTs) about Liujunzi Decoction for advanced primary liver cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of 7 RCTs involving 458 patients were included. The results of meta-analysis showed that the Liujunzi decoction group had significantly higher stability of QOL (RR=0.76, 95%CI 0.64 to 0.91, P=0.002), Karnofsky Performance Score (KPS) (MD=4.47, 95%CI 2.74 to 6.21, P<0.00001) and effective rate of TCM syndrome (RR=0.73, 95%CI 0.62 to 0.86, P=0.0001) than those of the control group.
ConclusionCurrent evidence shows that Liujunzi decoction could improve the QOL and KPS, and relieve TCM syndromes of patients with advanced primary liver cancer, especially for those with spleen deficiency-syndrome. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
ObjectiveTo investigate the effect and prognosis of emergency hepatectomy and second stage hepatectomy after transcatheter arterial chemoembolization (TACE) in spontaneous rupture and bleeding of resectable primary liver cancer.MethodsA total of 42 patients with spontaneous rupture and bleeding of resectable primary liver cancer in this hospital from January 2010 to January 2016 were retrospectively reviewed. Among them 24 cases had accepted the emergency hepatectomy in 24 h–48 h after admission (emergency hepatectomy group, n=24), 18 cases had accepted the second stage hepatectomy in 1 week–2 weeks after the TACE (second stage hepatectomy group, n=18), the intraoperative blood loss and intraoperative blood transfusion volume, perioperative mortality, postoperative incidence of hepatic insufficiency, recurrence rate and abdominal metastasis rate within 1 year after the operation, 1- and 3-year survival rates were compared between the emergency hepatectomy group and the second stage hepatectomy group.ResultsThere was no significant difference in the preoperative general data between these two groups (P>0.050). The intraoperative blood loss and transfusion volume of the emergency hepatectomy group were significantly more than those of the second stage hepatectomy group (P=0.028, P=0.017). There were no significant differences in the perioperative mortality (P=0.489), incidence of hepatic insufficiency (P=1.000), 1- and 3-year survival rates (P=0.650, P=0.463) and 1-year recurrence rate (P=0.601) between these two groups. No intraperitoneal implantation metastasis was found in these two groups.ConclusionBoth emergency hepatectomy and second stage hepatectomy after TACE are safe and effective in treatment of spontaneous rupture and bleeding of resectable primary liver cancer, appropriate treatment should be selected according to the specific conditions of patients.
Objective To understand the role and mechanism of tumor associated macrophages (TAM) on the occurrence and development of primary liver cancer, and its application in the treatment. MethodThe related literatures about the researches of relation between TAM and primary liver cancer at home and abroad in recent years were collected, sorted out, and made a review. Results Under different stimulating factors, TAM could be polarized to anti-tumor type 1 TAMs or tumor-promoting type 2 TAMs, and type 2 TAMs was the main part in the tumor microenvironment. Through some mechanisms such as vascularity-promoting, invasion-promoting, and immunosuppression to promote the occurrence and development of tumors, and potential treatment plans for primary liver cancer could be found by targeting TAM from different perspectives. Conclusion TAM has a wide range of effects on primary liver cancer, and their mechanisms are complex, understanding the relation between them and make an effective control of TAM could provide new therapeutic ideas and plans for clinical treatment of primary liver cancer.
Indocyanine green fluorescence imaging has been widely used in hepatobiliary surgery, which can guide accurate hepatectomy and improve the prognosis of patients. Lipiodol–indocyanine green emulsion as a pure physical way to prepare lipiodol-drug mixed solvent can be used for primary interventional embolization and subsequent fluorescence-guided hepatectomy. In this paper, the application of iodized oil-indocyanine green emulsion in hepatectomy was summarized by reviewing relevant research progress at home and abroad, and further discussion and prospect were made.
ObjectiveTo explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio (GPR) and overall survival (OS) of patients with hepatitis B virus-associated hepatocellular carcinoma (Abbreviated as “patients with HCC”), and to establish a nomogram for predicting OS. MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital, from January 15, 2012 to December 15, 2018, were retrospectively analyzed. The optimal critical value of GPR was determined by receiver operating characteristic curve, then the patients were divided into a low GPR group (GPR was optimal critical value or less ) and high GPR group (GPR was more optimal critical value). The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients. The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC. According to the risk factors of OS for patients with HCC, a nomogram was established. The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated. ResultsA total of 213 patients were gathered. The optimal critical value of GPR was 0.906. There were 114 patients in the low GPR group and 99 patients in the high GPR group. The Kaplan-Meier survival curve analysis showed that the 1-, 3- and 5-year accumulative OS rates were 99.1%, 81.8%, 60.6% in the low GPR group, respectively, which were 74.2%, 49.1%, 35.7% in the low GPR group, respectively. The OS curve of the low GPR group was better than that of the high GPR group (χ2=25.893, P<0.001). The multivariate analysis results showed that the microvascular invasion, incomplete capsule, intraoperative bleeding ＞1 000 mL, postoperative complications, GPR >0.906, low tumor differentiation, and late TNM stage did not contribute to accumulative OS in the patients with HCC (P<0.05). The consistency index (95%CI) of the nomogram in predicting accumulative OS rates at 3- and 5-year for patients with HCC were 0.761 (0.739, 0.783) and 0.735 (0.702, 0.838), respectively. The calibration curves of 3- and 5-year accumulative OS rates of the nomogram were in good agreement with the actual results. ConclusionsPreoperative GPR is associated with OS, and patients with higher GPR have worse prognosis. The nomogram based on GPR has a good accuracy and differentiation.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
Objective To investigate the safety and feasibility of transcatheter arterial chemoembolization (TACE) assisted by transradial approach and cone beam computed tomography (CBCT) three-dimensional vascular reconstruction in the treatment of primary liver cancer. Methods The clinical data of 124 patients with primary liver cancer who underwent precision TACE via radial artery in our hospital from May 2018 to December 2019 were retrospectively collected. Results Among the 124 patients, 118 patients were successfully punctured through the left radial artery and completed the TACE operation. The operation time was (109.57±31.32) min, and the median of postoperative hospitalization was 3 d. One patient changed to the right radial artery to complete TACE due to chronic renal failure and left brachial artery and vein puncture and catheterization before operation. The operation time was 119 minutes, and the patient was discharged after 5 days of hospitalization. After successful puncture of the left radial artery in one patient, the forearm artery was twisted into a loop and the guide wire catheter failed to pass, and the right femoral artery was used to complete TACE. The operation time was 123 minutes, and the patient was discharged after 4 days of improvement. The radial artery puncture was unsuccessful in four patients, and the right femoral artery approach was used to complete the operation; the operation time was (111.66±32.77) min, and the median of postoperative hospitalization was 3 d. One of the patients successfully completed up to 5 consecutive TACE via the radial artery. All patients underwent precision TACE with superselective cannulation assisted by CBCT three-dimensional vascular reconstruction. No vascular injury andocclusion, urinary retention, subcutaneous hemorrhage, and other complications occurred in all patients. Conclusions Trans-radial arterial precision TACE is safe and effective, which can be repeated many times and has few complications and high patient comfort. It can be used as one of the routine approaches of TACE.
Objective
To explore therapeutic effect of radiofrequency ablation (RFA) guided by contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization (TACE).
Methods
The patients with advanced primary liver cancer treated with the TACE firstly from January to December 2014 in this hospital were prospectively collected, then were randomly divided into a conventional ultrasound guided RFA group (control group) and contrast-enhanced ultrasound guided RFA group (study group). The complete ablation rate, liver function, serum alpha-fetoprotein (AFP) level, and 1-, 2-, and 3-year survival rates were observed in the two groups.
Results
A total of 42 patients with advanced primary liver cancer treated with the TACE were enrolled in this study, there were 21 patients in each group. ① There were no significant differences in the baseline data such as the gender, age, BCLC stage, AFP level, and Child grade of liver function between the two groups (P>0.05). ② All the treatments were completed according to the plan, no serious complications or treatment-related death happened. The complete ablation rate of the study group was significantly higher than that of the control group (χ2=5.717, P=0.017), and the AFP level was significantly lower than that of the control group (t=2.618, P=0.012). There was no significant difference in the Child grade of liver function between the 2 groups (P>0.05). ③ The rate of repeat RFA in the study group was significantly lower than that in the control group (χ2=4.434, P=0.035), and there was no significant difference in the TACE treatment rate between the two groups (χ2=1.659, P=0.197). ④ The survival rate of the study group was significantly better than that of the control group by comparing the survival curves (χ2=3.999, P=0.046).
Conclusion
Contrast-enhanced ultrasound guided RFA is superior to conventional ultrasound guided RFA in treatment of advanced primary liver cancer following TACE.
ObjectiveTo evaluate systematically the effectiveness and safety of transcatheter arterial chemoembolization (TACE) in combination with lenvatinib (LEN) in the treatment of intermediate and advanced primary liver cancer (PLC). MethodsThe relevant literature was comprehensively searched in the CNKI, VIP, Ovid, Schopus, PubMed, and other databases from the establishment of the databases to March 14, 2023. The literature was obtained according to the search strategy and the inclusion and exclusion criteria, and the data were extracted and the literature quality was evaluated. The Revman 5.4 software and Stata 15.1 software were used to conduct the meta-analysis to evaluate the effect of TACE+LEN regimen on the objective response rate (ORR), disease control rate (DCR), overall survival (OS), as well as secondary outcome indicators such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha fetoprotein (AFP), and hypertension, diarrhea, hand-foot disease, fatigue, proteinuria, and fever for the patients with PLC. ResultsA total of 15 relevant literature was included, including 1 219 patients with PLC, 591 of whom treated with TACE+LEN and 628 treated with TACE alone. The meta-analysis results showed that the TACE+LEN regimen could increase ORR and DCR and prolong OS (P<0.01), as well as effectively decrease AFP level (P<0.01). However, TACE+LEN regimen increased the risks of hypertension, diarrhea, hand-foot disease, fatigue, and proteinuria as compared with TACE alone treatment (P<0.05). However, there were no statistical impacts on AST and ALT, or the risk of fever (P>0.05). ConclusionFrom the results of this meta-analysis, TACE+LEN regimen has a certain efficacy in treatment of intermediate and advanced PLC, but prevention of its related complications is paid attention to.
ObjectiveTo investigate the effects of pipecolic acid oxidase (PIPOX) on the proliferation, apoptosis, migration and invasion of primary liver cancer cells. MethodsImmunohistochemical staining and analysis of The Cancer Genome Atlas (TCGA) database were used to examine the PIPOX expression levels in liver cancer tissues and paired adjacent normal tissues, and studied their relationship with patient prognosis. Liver cancer cell lines stably overexpressing or knocking out PIPOX were constructed to explore PIPOX’s impact on liver cancer cell proliferation, apoptosis, migration and invasion by conducting in vitro functional experiments such as CCK-8, EdU, apoptosis detection, and Transwell assays. In vivo, nude mice subcutaneous tumor models and lung metastasis models were used to verify PIPOX’s effect on liver cancer growth and metastasis. Real-time quantitative polymerase chain reaction (RT-qPCR) and western blot were both employed to detect the expression of epithelial-mesenchymal transition (EMT) markers in liver cancer cells. ResultsImmunohistochemical staining and TCGA database analysis revealed that PIPOX expression was significantly lower in liver cancer tissues compared to paired adjacent normal tissues (P<0.05). Prognostic analysis indicated shorter overall survival and disease-free survival in PIPOX low expression group (P<0.05). In vitro gain- and loss-of-function experiments showed that PIPOX significantly inhibited liver cancer cell migration and invasion (P<0.05), while having no significant effects on their proliferation and apoptosis (P>0.05). Animal experiments also confirmed that PIPOX significantly inhibited liver cancer lung metastasis (P<0.05), but had no significant effects on tumor growth (P>0.05). Finally, RT-qPCR and western blot results revealed that PIPOX promoted the expression of the epithelial marker E-cadherin (P<0.05) and inhibited the expression of mesenchymal markers (N-cadherin, vimentin, Snail) (P<0.05). ConclusionsPIPOX significantly inhibits liver cancer cell migration and invasion, potentially via suppressing the EMT process. However, PIPOX does not significantly affect liver cancer cell proliferation and apoptosis.
