Huichun Liu

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects

OBJECTIVE To observe the clinical effect of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC). METHODS A total of 92 cases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups: 43 patients treated with TACE (TACE group) and 45 patients that received TACE combined with RFA treatment (TACE + RFA group). After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. RESULTS Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment (CR + PR) were 67.4% (29/43) and 91.1% (41/45) for the TACE and combined treatment groups, respectively, and the difference was statistically significant (P<0.05). The quality of life was significantly improved for patients undergoing TACE + RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE + RFA compared with the control group. CONCLUSIONS In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.

Validation of inflammation-based prognostic models in patients with hepatitis B-associated hepatocellular carcinoma: a retrospective observational study

Background and objective The objective of this study was to investigate the prognostic significance of several inflammation-based models in hepatitis B-associated hepatocellular carcinoma (HCC). Patients and methods We retrospectively reviewed 470 cases of hepatitis B-associated HCC. Preoperative data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (neutrophil×platelets/lymphocyte), platelets-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio (NLR). Overall survival and recurrence-free survival were estimated by the Kaplan–Meier method and Cox analysis. Results During a median follow-up time of 29 months, 34.0% (160/470) of patients died and 36.0% (169/470) experienced recurrence. Compared with patients with lower scores of inflammation models, patients in the higher group had larger tumor diameter and higher risk of vascular invasion (both P<0.05). Multivariate analysis revealed that age, tumor size, platelets-to-lymphocyte ratio, NLR, and systemic immune-inflammation index were the independent predictors for both overall survival and recurrence-free survival. Furthermore, the combination of tumor size and NLR showed a significantly better discrimination ability for survival (C-index=0.716, 95% confidence interval: 0.664–0.768) than both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program. Conclusion The inflammation-based markers, in particular the combination of NLR with tumor size, are effective tools for assessing prognosis in hepatitis B-associated HCC.

The effects of nonsteroidal anti-inflammatory drugs in the incident and recurrent risk of hepatocellular carcinoma: a meta-analysis

Background Recent studies have showed that nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce the risk of several types of cancer. However, epidemiological evidence of the association between NSAIDs intake and the risk of hepatocellular carcinoma (HCC) remains controversial. Methods To assess the preventive benefit of NSAIDs in HCC, we simultaneously searched the databases of PubMed, EmBase, Web of Science, and Scopus and screened eligible publications. Results A total of twelve articles (published from 2000 to 2017) from five countries were identified by retrieval. We observed a significantly lower risk of HCC incidence among users of NSAIDs than among those who did not use NSAIDs (pooled hazard ratio [HR] value =0.81, 95% confidence interval [CI]: 0.69–0.94). No evidence of publication bias was observed (Begg’s test, P=0.755; Egger’s test, P=0.564). However, when stratified according to the categories of NSAIDs, users of non-aspirin NSAIDs (HR =0.81, 95% CI: 0.70–0.94), but not aspirin (HR =0.77, 95% CI: 0.58–1.02), showed a statistically significant reduced HCC incidence. We also found that NSAIDs use significantly reduced the recurrent risk of HCC, with a HR value of 0.79 (95% CI: 0.75–0.84), whereas there was no statistically significant association between NSAIDs use and HCC mortality, with a HR value 0.65 (95% CI: 0.40–1.06). Conclusion Taken together, our meta-analysis demonstrates that NSAIDs significantly reduce the incident and recurrent risk of HCC.

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents: A retrospective observational study.

Abstract We aimed to assess the therapeutic effect of reimplantation of biliary metal stents by percutaneous transhepatic cholangial drainage (PTCD) in patients with recurrent malignant obstructive jaundice (MOJ). Furthermore, we explored the prognostic value of inflammation-based markers in these patients. We reviewed 33 cases of recurrent MOJ after implantation of biliary metal stents by PTCD, all of which underwent reimplantation of stents under digital subtraction angiography guidance. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were compared between before and after reimplantation (1 week, 1 month, and 3 months postoperatively). Preoperative clinical data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (SII, neutrophil × platelets/ lymphocyte), platelets-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was overall survival (OS), which was estimated by the Kaplan–Meier method and Cox regression analysis. The levels of ALT, AST, total bilirubin, and direct bilirubin significantly reduced after the reimplantation operation. During a median follow-up time of 10 months, 18 (54.5%) patients died. Gender, albumin, SII, PLR, NLR, and MLR were found to be associated with OS by the log-rank test and univariate analysis. Multivariate Cox analysis identified elevated levels of SII and PLR as significant factors for predicting poor OS. Reimplantation is clinically feasible in patients with recurrent MOJ after implantation of biliary metal stents. SII and PLR are independent, useful inflammation-based prognostic models for predicting outcomes in these patients.

Von Willebrand factor for the liver: Friend or foe?

In the recent publication, Starlinger et al. demonstrated that von Willebrand factor (vWF) was involved in platelet-mediated liver regeneration (LR) following partial hepatectomy. In recent years, increasing evidence indicates that vWF plays critical roles in various hepatic pathophysiological processes. These findings make vWF both friend and foe for the liver. Many studies have reported the promotion of vWF in the progression of virus hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). In patients with chronic hepatitis, plasma level of vWF-Ag is significantly higher compared to the healthy population and vWF-Ag level is increasing with stage of fibrosis. Furthermore, a higher level of vWF-Ag can independently predict ascites, variceal bleeding, and mortality in patients with cirrhosis. Moreover, Liu et al. highlighted that vWF was positively correlated with the tumor grade and tumor node metastasis stage in HCC. In addition, vWF promoted the invasion and migration of HCC cells in vitro. Despite its adverse role in HCC progress, there is growing evidence from experimental and clinical studies indicating that VWF can prevent tumor dissemination. The protective role of VWF against metastasis is mainly attributed to its antiangiogenic potential and proapoptotic properties. In addition, vWF may also play a protective role in acute liver injury (ALI). Sun et al. recently established the animal model of ALI in mice by the intraperitoneal injection of carbon tetrachloride. They found that vWF deficiency was associated with more severe liver injury. Furthermore, vWF deficiency was shown to facilitate the activation of the mitogenactivated protein kinase signaling pathway in injured liver tissues. In conclusion, vWF can produce both protective and detrimental effects in the pathophysiological process of the liver. On the one hand, it may promote LR, relieve ALI, and inhabit metastasis. On the other hand, it is involved in the disease progression of liver cirrhosis and HCC. Therefore, further work should be encouraged so that vWF-modulating drugs can find a place in the liver diseases. Qing Pang, M.D., Ph.D. Huichun Liu, M.D., Ph.D. Hao Jin, M.D. Lei Zhou, M.D. Zhongran Man, M.D. Department of Hepatobiliary Surgery the First Affiliated Hospital of Bengbu Medical College Bengbu, China

Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.