Objective To retrospectively analyze the short- term efficacy and long- term survival rates of transcatheter arterial chemoembolization( TACE) combined with percutaneous microwave coagulation therapy( PMCT) versus TACE monotherapy in the treatment of large primary hepatic carcinoma. Methods Sixty- seven patients with unresectable large primary hepatic carcinoma( > 5. 0 cm) who were admitted to our hospital from February 2011 to May 2014 were enrolled as subjects. Among these patients,34 patients received TACE monotherapy and 33 patients received TACE combined with PMCT. At one month after treatment,the abdomen was re- examined using contrast-enhanced computed tomography or magnetic resonance imaging,and liver function and alpha- fetoprotein( AFP) level were measured. The follow- up period varied from 3 to 36 months. Comparison of short- term outcomes,AFP level,and long- term survival rates were performed between the two groups. Comparison of continuous data was made by t test,and comparison of categorical data by χ2test and Fisher's test. Results The complete ablation rate and the response rate were significantly higher in the combination therapy group than in the TACE monotherapy group( 54. 5% vs 20. 6%,P = 0. 004; 97% vs 64. 7%,P = 0. 001). The AFP level after treatment with combination therapy was significantly lower than that before treatment with combination therapy and that after treatment with TACE monotherapy( P < 0. 001; P <0. 001). Patients in both groups had varying degrees of liver dysfunction and elevated aminotransferase,but with no severe complications such as bleeding,gastrostoma,colon fistula,bile duct injury,and needle tract metastasis,as well as deaths. The median survival time in the combination therapy group and the TACE monotherapy group was 13 months and 9 months,respectively,and the mean survival time was14. 00 ± 1. 63 months and 10. 83 ± 1. 19 months,respectively. The 1-,2-,and 3- year overall survival rates in the combination therapy group were significantly higher than those in the TACE monotherapy group( 63. 6% vs 28. 4%; 15. 2% vs 5. 9%; 4. 5% vs 0%; P =0. 044). Conclusion TACE combined with PMCT is a safe and effective therapy regimen,which achieves better treatment outcomes in local tumor control,substantially lower AFP level,and longer survival time than TACE monotherapy.

Objective To investigate the efficacy of intensity- modulated radiotherapy( IMRT) in treating large primary hepatocellular carcinoma( LHCC) which is unsuitable for surgery or has poor response to radiofrequency ablation,interventional therapy,and other local treatments,and to identify the prognostic factors for survival. Methods We retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short- term efficacy and prognosis were observed and analyzed. The Kaplan- Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. Results The complete remission,partial remission,stable disease,and disease progression rates were 3. 57%,32. 14%,53. 57%,and 10. 72%,respectively. The overall median progression- free survival( PFS) time was 6. 43 months,and the median overall survival( OS) time was 11. 43 months. The 1- and 2- year survival rates were 46. 79% and 25. 23%,respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition,the independent prognostic factors for OS included tumor response rate,tumor diameter,and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort,radiation- induced liver damage,and myelosuppression. Conclusion IMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.

Objective To determine the efficacy and prognostic factors of intensity- modulated radiotherapy( IMRT) for primary hepatocellular carcinoma( HCC) with portal vein and / or inferior vena cava tumor thrombus. Methods Twenty- three HCC patients with portal vein and / or inferior vena cava tumor thrombus received IMRT with an 8 MV linear accelerator at the Cancer Center of General Hospital of Armed Police Forces,Anhui Medical University,from April 2008 to August 2011. A single dose of 3 to 6 Gy was delivered at five fractions per week,with a total dose of 56 to 96 Gy and a median dose of 60 Gy. Survival time was recorded,and adverse reactions were evaluated. Survival rate calculation and survival analysis were performed using the Kaplan- Meier method. Comparison of categorical between two groups was made by chi- square test. Results One patient did not complete radiotherapy due to upper gastrointestinal bleeding. Of 22 patients who completed IMRT,4 achieved complete remission and 10 achieved partial remission,with an overall response rate of 63. 7%. Our analysis showed that the type of tumor thrombus and tumor size were associated with tumor response rate and were significant prognostic factors( P< 0. 05). The median survival time was 13. 4 months. The 1-,2-,and 3- year survival rates were 59%,27%,and 18%,respectively. The 22 patients who completed radiotherapy did not experience acute radiation injury or late adverse outcomes such as radiation- induced liver disease. Conclusion This study suggests IMRT is a safe and effective treatment option for HCC patients with portal vein and / or inferior vena cava tumor thrombus.

Objective To compare the clinical efficacy of sorafenib combined with capecitabine in Hui versus Han residents with advanced hepatocellular carcinoma( HCC) in Sanya,Hainan,China. Methods A total of 96 Hui and Han residents with advanced HCC took oral capecitabine 1500 mg / m2 twice daily for 14 days followed by a 7- day withdrawal,which was repeated at least twice; besides,sorafenib was given orally at a dose of 400 mg twice daily until tumor progression occurred. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chi- square test. Results In the two groups of Hui and Han patients,the rates of alpha- fetoprotein reduction were 60. 9% and 40. 0%,respectively( χ2= 4. 173,P = 0. 041); the rates of serum ferritin reduction were 50. 0% and 30. 0%,respectively( χ2= 4. 007,P = 0. 027); the rates of tumor regression were 54. 3% and 34. 0% as shown by CT( χ2= 4. 030,P = 0. 045); the response rates were 32. 6% and 14. 0%,respectively( χ2= 4. 697,P = 0. 030). Survival analysis suggested the combination of sorafenib and capecitabine had provided a significantly higher overall survival rate in Hui patients than in Han patients( P< 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion In Sanya,a combination of sorafenib and capecitabine has better efficacy in Hui patients with advanced HCC than in Han patients,and the former have a higher overall survival rate.

Objective To evaluate the clinical value of ultrasound- guided percutaneous cinobufagin injection for the treatment of portal vein tumor thrombus( PVTT) in primary liver cancer( PLC) patients. Methods A total of 25 PLC patients with PVTT who were admitted to our hospital from January 2009 to March 2012 were recruited in this study. These patients underwent ultrasound- guided percutaneous cinobufagin injection three times a week,and each course of treatment was 4- 5 weeks. After treatment,the clinical efficacy and survival rates were determined,and the changes in levels of alpha fetoprotein( AFP) and alanine aminotransferase( ALT) were evaluated. Results Seventeen patients showed varying degrees of improvement after treatment,with an overall response rate of 68%. In addition,the levels of AFP and ALT were significantly reduced after treatment( P < 0. 05). The survival rates at 3,6,12,and 24 months after treatment were88%,76%,60%,and 32%,respectively. Conclusion Ultrasound- guided percutaneous cinobufagin injection has good efficacy in the treatment of PVTT in PLC patients and shows a good clinical value.

Objective To investigate the relationship between tumor location and pain level in computed tomography( CT)- guided percutaneous microwave ablation( MWA) of hepatocellular carcinoma( HCC) under local anesthesia. Methods A total of 42 tumors in 35 HCC patients were given CT- guided percutaneous MWA under local anesthesia after transcatheter hepatic arterial chemoembolization. The 35 patients were divided into two groups based on the distance from the tumor to the Glisson's capsule and / or the branch of the portal vein. Group A( 19 tumors out of 16 patients) had a distance of ≤5 mm from the tumor to the Glisson's capsule and / or the branch of the portal vein,and group B( 23 tumors out of 19 patients) had a distance of > 5 mm from the tumor to both the Glisson's capsule and the branch of the portal vein. The pain levels of the two groups were evaluated by visual analogue scale( VAS). The tumor size,baseline VAS score,intraoperative VAS score( the highest VAS score during MWA),relative VAS score( intraoperative VAS score minus baseline VAS score),the highest tolerated MWA power,ablation time,and meperidine hydrochloride dose were recorded and compared between the two groups. The comparison was made by Mann- Whitney U test. Results The 16 cases in group A had significantly higher intraoperative VAS score and relative VAS score than the 19 cases in group B( 3. 25 ± 0. 68 vs 2. 74 ± 0. 73,P = 0. 042; 3. 00 ± 0. 52 vs 2. 47 ± 0. 61,P = 0. 009). It showed that the patients whose tumor was close to the Glisson' s capsule had a greater pain level than the patients whose tumor was away from the Glisson's capsule. The dose of meperidine hydrochloride in group A was significantly higher than that in group B( 78. 1 ± 20. 2 mg vs 64. 5± 17. 3 mg,P = 0. 039). After treatment with high dose of meperidine hydrochloride,groups A and B showed no significant differences in the highest tolerated MWA power and ablation time( 73. 8 ± 15. 4 W vs 75. 8 ± 17. 7 W,P > 0. 05; 6. 6 ± 1. 8 min vs 6. 4 ± 2. 1 min,P >0. 05). Conclusion The patients who have a longer distance between the tumor and the Glisson's capsule and the branch of the portal vein suffer greater pain in MWA therapy. Additional meperidine hydrochloride can help complete the MWA treatment.

Objective To explore the differences in clinical characteristics between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) primary hepatic carcinoma( PHC) treated by hepatectomy. Methods Forty- three HBs Ag( +) and 18 HBs Ag(-) /HBc Ab( +)patients who underwent liver resection against PHC from October 2009 to November 2014 in Guangzhou 8th People's Hospital were selected for the study. The clinical data of the subjects,including sex,age,histological differentiation,intravascular tumor thrombi,and hepatic cirrhosis,were compared,using t test for continuous data,chi- square test for categorical data,and Mann- Whitney U test for non- parametric data. Results No significant differences existed between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) PHC in terms of the age of onset( 50. 77 ± 12. 93 years vs 54. 28 ± 9. 89 years,t =- 1. 031,P > 0. 05),the incidence of cholangiocarcinoma( 2. 3% vs16. 7%,χ2= 2. 24,P > 0. 05),the incidence of hepatic cirrhosis( 62. 8% vs 44. 4%,χ2= 1. 746,P > 0. 05),alpha- fetoprotein level( 3638 ± 7869 ng/ml vs 3577 ± 9628 ng/ml,t = 0. 026,P > 0. 05),histological differentiation( Z =- 1. 085,P > 0. 05),and the rate of intravascular tumor thrombi( 34. 9% vs 22. 2%,χ2= 0. 949,P > 0. 05). Conclusion There are no significant differences in the age of onset and progression of disease between patients with HBs Ag( +) and HBs Ag(-) / HBc Ab( +) PHC treated by hepatectomy. However,given the possibility of occult hepatitis B virus infection,it is necessary to monitor hepatic carcinoma even post HBs Ag seroconversion

Objective To analyze the usage of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy.Methods A total of 121 patients with liver cancer and liver cirrhosis who received hepatectomy in our hospital from January 2012 to January2014 were divided into control group( n = 60) and observation group( n = 61). Both groups received human serum albumin in addition to the routine treatment for liver protection. The observation group was given intravenous drip of 5% human serum albumin within 48 h after surgery. The plasma albumin concentrations of patients were measured at 48 h after surgery,and if the concentration was < 35 g / L,the patients would be given 20% human serum albumin until the concentration was ≥35 g / L. The control group was given intravenous drip of 20%human serum albumin within 48 h after surgery until the plasma albumin concentration was ≥35 g / L. The amounts of used human serum albumin and plasma were recorded for both groups. The urine volume,abdominal drainage volume,central venous pressure( CVP),mean arterial pressure( MAP),and thromboelastogram( TEG) R and K values were measured at 1,3,7,and 10 days after surgery. The liver function indices before and after surgery and the indocyanine green retention rate at 15 minutes( ICG R15) at 7 days after surgery were measured. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chisquare test. Results( 1) There were no significant differences in age,sex,Child- Pugh classification,surgical approach,intraoperative blood loss,occlusion time of the first porta hepatis,and operation time between the two groups( P > 0. 05). But there were significant differences in the amounts of used human serum albumin and plasma and the length of hospital stay between the two groups( P < 0. 05).( 2) There were significant differences in daily urine volume,CVP,MAP,abdominal drainage volume,and interstitial fluid volume at 1 and 3 days after surgery between the two groups( P < 0. 05),but there were no significant differences in the above indices at 7 days after surgery between the two groups( P > 0. 05). There were no significant differences in alanine aminotransferase,aspartate aminotransferase,total bilirubin,and TEG R and K values at 1 and 3 days after surgery between the two groups( P > 0. 05),but significant differences were observed in the above indices at 7 days after surgery( P < 0. 05).( 3) There was a significant difference in ICGR15 at 7 days after surgery between the observation group and the control group( 16. 59% ± 4. 4% vs 13. 21% ± 4. 2%,t = 5. 23,P = 0. 000). Conclusion The isotonic albumin and hypertonic albumin used in different periods after surgery have a better clinical effect than hypertonic albumin alone.

Objective To investigate the characteristics of trace elements and amino acid metabolism in the blood of patients with hepatocellular carcinoma( HCC) and to guide clinical treatment. Methods This study included 125 untreated patients with primary HCC in Tangshan Maternal and Child Health Hospital and Tangshan Guzhi District Hospital from March to November,2013,as well as 50 healthy controls who underwent physical examination in Tangshan Maternal and Child Health Hospital. Blood trace elements were measured by atomic absorption spectrophotometry,and the levels of amino acids were determined by an amino acid analyzer. Comparison of continuous data was made by t test. Results Compared with the controls,the HCC patients had a significantly higher Cu level( t = 6. 30,P < 0. 05) and significantly lower Zn,Fe,and Mg levels( t = 10. 15,3. 98,and 2. 25,all P < 0. 05). The HCC patients showed significant increases in tyrosine,phenylalanine,and methionine levels( t = 10. 10,13. 46,and 2. 34,all P < 0. 05) and significant decreases in valine,isoleucine,leucine,and arginine levels( t = 3. 65,2. 98,5. 67,and 8. 35,all P < 0. 05). Conclusion HCC patients show changes in various amino acids and trace elements in blood. Measurement of trace elements and amino acids is of certain significance for evaluating HCC patients' condition and guiding clinical treatment.

Objective To compare the efficacy of radiofrequency ablation( RFA) versus percutaneous ethanol injection( PEI) in the treatment of primary liver cancer( PLC). Methods A search of Pub Med,EMBASE,CKNI,VIP,and Wanfang Data identified all randomized controlled trials( RCTs) related to therapeutic comparison between RFA and PEI in patients with PLC. Quality of each study was assessed,meta- analysis was performed with Review Manager 5. 0 software,and the results were analyzed with fixed effect model and random effect model. Results Seven RCTs were included in this study. The results of meta- analysis indicated that,compared with the PEI group,the RFA group had a significantly higher tumor necrosis rate( P = 0. 008,OR = 2. 66,95% CI: 1. 29- 5. 48). The 1-,2-,and 3- year survival rates and 1- and 3- year tumor- free survival rates of the RFA group were significantly higher than those of the PEI group( P <0. 05). The RFA group had significantly lower 1-,2-,and 3- year local recurrence rates in comparison with the PEI group( P < 0. 05).There was no significant difference in 2- year tumor- free survival rate between the two groups( P = 0. 06). Conclusion The efficacy of RFA is superior to that of PEI,which is of clinical significance to guide the selection of methods for PLC treatment.

Objective To systematically evaluate the efficacy and safety of octreotide in the treatment of hepatocellular carcinoma( HCC).Methods Online databases including Pub Med,Cochrane Library,Embase,China National Knowledge Internet,Wanfang Data,and China Science and Technology Journal Database were comprehensively searched for relevant randomized controlled trials( RCTs) of octreotide in the treatment of HCC. The quality of included studies was assessed using the method recommended by the Cochrane handbook for systematic review. A meta- analysis was performed by using Rev Man 5. 3. 4 software. Results Eleven RCTs were included,which involved 909 cases( treatment group,452 cases; control group,457 cases). As for clinical efficacy,octreotide significantly increased the response rate( RR =2. 30,95% CI: 1. 25 ~ 4. 22,P = 0. 007) and decreased the progression rate( RR = 0. 78,95% CI: 0. 59 ~ 1. 04,P = 0. 09),but there was no significant difference in disease control rate and progression rate between the two groups( P > 0. 05). The overall survival rate and6- month,1- year,and 2- year survival rates in the treatment group were not significantly higher than those of the control group( all P >0. 05). As regards to safety,severe adverse events in the treatment group were significantly reduced( RR = 0. 72,95% CI: 0. 54 ~ 0. 98,P= 0. 03),but there were no significant differences in diarrhea,nausea / vomiting,liver function abnormality,and blood glucose fluctuation between the two groups( all P > 0. 05). Conclusion For HCC patients,octreotide can significantly increase the clinical response rate incidence of grade 3 /4 adverse events,but it does not lead to significant improvement in disease progression and survival rate.

Objective To evaluate the effect and predictive value of preoperative neutrophil- lymphocyte ratio( NLR) on the prognosis of patients undergoing radical resection for hepatocellular carcinoma( HCC). Methods The clinical data of 245 patients who received radical resection for HCC in our hospital from 2004 to 2009 were retrospectively analyzed. The effects of clinicopathological parameters including NLR on overall survival( OS) time were assessed by univariate analysis using the log- rank test. The significant variables were further analyzed by multivariate analysis using the Cox regression model. Results Using NLR = 1. 5,2,and 3 as cut- off points,the patients were divided into four groups. The median OS time in groups with NLR < 1. 5,1. 5≤NLR < 2,2≤NLR < 3,and NLR≥3 was 39. 6,38. 3,25. 4,and 19. 9 months,respectively( P = 0. 003). Multivariate analysis showed that preoperative NLR,levels of alpha- fetoprotein and alanine aminotransferase in peripheral blood,number of tumor nodules,maximum size of tumor,and portal vein tumor thrombus were independent prognostic factors for HCC( P < 0. 05). Conclusion Preoperative NLR in peripheral blood is a novel prognostic biomarker for HCC after radical resection.

Objective To investigate the expression levels of angiogenesis- related factors in various clinical stages of hepatitis B- related hepatocellular carcinoma( HCC) and their clinical significance. Methods Seventy patients with hepatitis B- related HCC who were admitted to our hospital from 2011 to 2013 were enrolled as subjects and divided into four groups according to the HCC staging criteria: very early HCC group( n = 18),early HCC group( n = 17),advanced HCC group( n = 18),and end- stage HCC group( n = 17). Eighteen healthy volunteers were used as controls. The Luminex 200 liquid suspension array system was used to determine the expression levels of vascular endothelial growth factor( VEGF),vascular endothelial growth factor receptors( VEGFR- 1 and VEGFR- 2),and hepatocyte growth factor( HGF) in each clinical stage of hepatitis B- related HCC. Comparison of continuous data between two groups was made by t test. Results Compared with the control group,the very early HCC group had significantly higher levels of VEGF and HGF( t = 2. 69,P = 0. 008; t =2. 18,P = 0. 002). The early HCC group had significantly higher levels of VEGF,VEGFR- 1,and HGF than the control group( t = 1. 73,P = 0. 01; t = 2. 03,P = 0. 009; t = 2. 54,P = 0. 008). The levels of VEGF,VEGFR- 1,and HGF were significantly higher in the advanced HCC group than in the control group( t = 1. 64,P = 0. 01; t = 4. 38,P = 0. 007; t = 4. 02,P = 0. 005). In the end- stage HCC group,the levels of VEGF,VEGFR- 1,VEGFR- 2,and HGF were significantly higher than those in the control group( t = 4. 37,P =0. 007; t = 20. 24,P = 0. 009; t = 2. 21,P = 0. 01; t = 3. 06,P = 0. 003). Conclusion The levels of angiogenesis- related factors,VEGF and HGF,have already been substantially increased in the very early HCC,which induces a substantial upregulation of expression of VEGFR- 1 and VEGFR- 2 along with the progression of HCC.

Objective To evaluate the correlation between interleukin( IL) 6 and primary hepatocellular carcinoma( HCC). Methods Case- control studies that included quantitative data on plasma or serum IL- 6 levels of patients with HCC were identified from Pub Med,ISI Web of Knowledge,CBM,and CNKI. A meta- analysis was performed to quantitatively and comprehensively analyze data. Results Twenty- five studies were included and the meta- analysis was conducted separately for 3 groups: HCC vs controls,HCC vs liver cirrhosis,and HCC vs hepatitis. The serum IL- 6 levels of patients with HCC were significantly higher than those of healthy controls( 25 studies,standardized mean difference( SMD) 5. 02,95% CI: 4. 13- 5. 91,Z = 11. 05,P < 0. 000 1),patients with liver cirrhosis( 15 studies,SMD =2. 36,95% CI: 1. 54- 3. 19,Z = 5. 60,P < 0. 000 1),and patients with hepatitis( 7 studies,SMD = 2. 63,95% CI: 1. 24- 4. 03,Z =3. 69,P = 0. 000 2). Conclusion The inflammatory mediator,IL- 6,may play an important role in the development and progression of HCC.

Objective To observe the inhibitory and pro- apoptotic effects of two poly( ADP- ribose) polymerase( PARP- 1) inhibitors,AG- 014699 and AZD2281,on human hepatoma Hep G2 cells and preliminarily explore the mechanism by which AG- 014699 induces Hep G2 cell apoptosis,and to provide a new therapeutic target for hepatoma. Methods The effects of different concentrations of AG-014699 and AZD2281 on Hep G2 cell proliferation were determined by MTT assay. The cell apoptosis rate was measured by flow cytometry.The expression levels of caspase- 3 and caspase- 8 were measured by Western Blot. Inter- group comparison was made by t test. Results Both AG- 014699 and AZD2281 suppressed Hep G2 cell proliferation in a time- and dose- dependent manner. However,the sensitivity of Hep G2 cells to the two PARP- 1 inhibitors was different. The half- maximal inhibitory concentrations of AG- 014699 and AZD2281 at48 h determined by MTT assay were about 20 μmol / L and 400 μmol / L,respectively. Flow cytometry and Western blot were not used to evaluate the apoptosis of Hep G2 cells exposed to AZD2281 to which these cells were not sensitive. Hep G2 cell apoptosis could be induced by10,30,and 50 μmol / L AG- 014699,and the highest apoptosis rate at 48 h was significantly higher than that of the control group( 31. 00% ± 2. 13% vs 0. 9% ± 0. 013%,P < 0. 01). Compared with those in the control group,the protein levels of caspase- 3 and caspase- 8 in Hep G2 cells after 48- h exposure to 30,and 50 μmol / L AG- 014699 increased. Conclusion The two PARP- 1 inhibitors AG- 014699 and AZD2281 can inhibit the proliferation of Hep G2 cells,which showed different sensitivities to the two inhibitors. AG-014699 can induce Hep G2 cell apoptosis by up- regulating the protein expression of caspase- 3 and caspase- 8.

Objective To assess the impairment of liver function and investigate possible causes in local residents in Miaofeng Village,Mali Town,Wushan County,Gansu Province,China,and to provide a basis for the etiological study of idiopathic liver damage. Methods The residents in Miaofeng Village were screened for liver function and an epidemiological study was conducted. Serological testing was performed for those with abnormal screening results. Trace elements in drinking water and soil such as arsenic,chromium,and selenium were also tested. Results Of all residents,23. 8% and 10. 7% showed abnormal levels of alanine aminotransferase and aspartate aminotransferase,respectively. Positivity of HBs Ag was detected in 11 cases,fatty liver was identified in 3 cases,and absence of selenium in soil was also confirmed. Conclusion A proportion of local residents in Miaofeng Village have impaired liver function and the absence of selenium in soil may be a contributing factor to this phenomenon.