Lei Yin

Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: A RCT

BACKGROUND & AIMS The aim of this randomized comparative trial (RCT) is to compare partial hepatectomy (PH) with transcatheter arterial chemoembolization (TACE) to treat patients with resectable multiple hepatocellular carcinoma (RMHCC) outside of Milan Criteria. METHODS This RCT was conducted on 173 patients with RMHCC outside of Milan Criteria (a solitary tumor up to 5 cm or multiple tumors up to 3 in number and up to 3 cm for each tumor) who were treated in our centre from November 2008 to September 2010. The patients were randomly assigned to the PH group or the TACE group. The primary outcome measure was overall survival (OS) from the date of treatment. A multivariate Cox proportional hazards regression analysis was performed to assess the prognostic risk factors associated with OS. RESULTS The 1-, 2-, and 3-year OS rates were 76.1%, 63.5%, and 51.5%, respectively, for the PH group compared with 51.8%, 34.8%, and 18.1%, respectively, for the TACE group (Log-rank test, χ(2)=24.246, p<0.001). Multivariate Cox proportional hazards regression analysis revealed the type of treatment (hazard ratio, 0.434; 95% CI, 0.293 to 0.644, p<0.001), number of tumor (hazard ratio, 1.758; 95% CI, 1.213 to 2.548, p=0.003) and gender (hazard ratio, 0.451; 95% CI, 0.236 to 0.862, p=0.016) were significant independent risk factors associated with OS. CONCLUSIONS PH provided better OS for patients with RMHCC outside of Milan Criteria than conventional TACE. The number of tumor and gender were also independent risk factors associated with OS for RMHCC.

Inhibition of autophagy significantly enhances combination therapy with sorafenib and HDAC inhibitors for human hepatoma cells

AIM To clarify whether histone deacetylase inhibitors histone deacetylase inhibitors (HDACIs) can sensitize hepatocellular carcinoma (HCC) cells to sorafenib treatment. METHODS Bax, Bcl-2, ATG5-ATG12, p21, and p27 protein levels in Hep3B, HepG2, and PLC/PRF/5 cells were examined by Western blot. CCK8 and a fluorometric caspase-3 assay were used to examine cellular viability and apoptosis levels. The effect of Beclin-1 on sensitization of HCC cells to sorafenib was examined by transfecting Beclin-1 siRNA into Hep3B, HepG2, and PLC/PRF/5 cells. RESULTS Autophagy inhibition enhances the inhibitory effects of vorinostat and sorafenib alone or in combination on HCC cell growth. Vorinostat and sorafenib synergistically induced apoptosis and cell cycle alterations. Western blot data indicated that HDACIs and Beclin-1 knockdown increased the p53 acetylation level. The knockdown of Beclin-1 enhanced the synergistic effect of the combination of vorinostat with sorafenib. CONCLUSION HDACIs can sensitize HCC cells to sorafenib treatment by regulating the acetylation level of Beclin-1.

Unicentric Castleman’s Disease Presenting With Growth Retardation and Iron Deficiency Anemia

A 16-year-old boy presented with growth retardation and iron deficiency anemia. The disease was identified incidentally in the pararenal retroperitoneum after computed tomography and magnetic resonance imaging scans. A retroperitoneal lesion was removed in its entirety and was histologically confirmed to be a symptom of Castlemans disease of the unicentric plasma cell type. The unicentric plasma cell type appears so rarely in the retroperitoneum that a similar case has been reported only once. The patient was discharged on day 9 after surgery without significant complications and grew 18 cm within a year.

Reanalysis of the gene expression profile in chronic pancreatitis via bioinformatics methods.

BackgroundDiagnosis at an early stage of chronic pancreatitis (CP) is challenging. It has been reported that microRNAs (miRNAs) are increasingly found and applied as targets for the diagnosis and treatment of various cancers. However, to the best of our knowledge, few published papers have described the role of miRNAs in the diagnosis of CP.MethodWe downloaded gene expression profile data from the Gene Expression Omnibus and identified differentially expressed genes (DEGs) between CP and normal samples of Harlan mice and Jackson Laboratory mice. Common DEGs were filtered out, and the semantic similarities of gene classes were calculated using the GOSemSim software package. The gene class with the highest functional consistency was selected, and then the Lists2Networks web-based system was used to analyse regulatory relationships between miRNAs and gene classes. The functional enrichment of the gene classes was assessed based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway annotation terms.ResultsA total of 405 common upregulated DEGs and 7 common downregulated DEGs were extracted from the two kinds of mice. Gene cluster D was selected from the common upregulated DEGs because it had the highest semantic similarity. miRNA 124a (miR-124a) was found to have a significant regulatory relationship with cluster D, and DEGs such as CHSY1 and ABCC4 were found to be regulated by miR-124a. The GO term of response to DNA damage stimulus and the pathway of Escherichia coli infection were significantly enriched in cluster D.ConclusionDNA damage and E. coli infection might play important roles in CP pathogenesis. In addition, miR-124a might be a potential target for the diagnosis and treatment of CP.

Cavoatrial Thrombectomy in Hepatocellular Carcinoma with Tumor Thrombus in the Vena Cava and Atrium Without the Use of Cardiopulmonary Bypass

BACKGROUND Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in hepatic vein, inferior vena cava (IVC), and right atrium (RA) portends a poor prognosis because of intravascular extension leading to rapid distal metastases. En bloc resection of cavoatrial TT without the use of cardiopulmonary bypass (CPB) is challenging. We describe a new method of vascular occlusion for thrombus entering into the RA without the need for CPB as shown in echocardiography. METHODS AND RESULTS Retrospective analysis was carried out in 1 HCC patient, who had undergone hepatectomy with TT extension into IVC and RA. The infrahepatic IVC was occluded with vascular tape and the right atrial appendage was controlled with a Satinsky clamp proximal to the TT. The IVC wall was incised under direct vision from the infrahepatic IVC cranially. The tumor and thrombus were then removed en bloc under direct vision. Thus, cavoatrial thrombectomy was performed under total hepatic vascular exclusion without the use of CPB. He survived for 6 months and died of tumor recurrence. CONCLUSIONS Using this technique, advanced HCC with cavoatrial TT can be resected safely without CPB and thereby avoid dislodgement of TT and air embolism.

Superior Approach for the Exclusion of Hepatic Veins in Major Liver Resection : A Safe and Easy Technique

We describe a technique for isolating and excluding the hepatic veins during liver resection. First, the bare area near the right and left wall of the suprahepatic inferior vena cava (IVC) is dissected, exposing the right, left, and superior walls of the right hepatic vein (RHV) and the left-middle hepatic vein (LMHV). Two Satinsky clamps are used to clamp the roots of the right and common trunk of the LMHV, parallel to the IVC. It is not necessary to dissect the posterior wall of the hepatic veins. We used this method during major liver resection in 65 patients. The mean dissecting time of each hepatic vein was 7.31 ± 3.6 min. No hepatic vein was lacerated during dissection and exclusion. The postoperative complication rate was 31.2%. Thus, the superior approach is a safe and easy maneuver when the posterior wall of the hepatic vein is difficult to dissect due to tumor invasion.

Difficulty in Diagnosis of Leiomyosarcoma of Infrahepatic Inferior Vena Cava

Background: Leiomyosarcomas of inferior vena cava (IVC) are rare tumors that mostly are proposed as a primary malignancy of the IVC. The optimal treatment is completely resects the malignant lesion with preservation of venous return. According to the treated experience of one patient in our hospital, we present our opinions as below. Methods and Results: A 61-year-old woman underwent successful surgical treatment for a leiomyosarcoma with the method of infrahepatic inferior vena cava (IVC). A large tumor that was demonstrated in the Spiegel lobe liver with IVC tumor thrombus was imagined by tomography and magnetic resonance. The tumor was found from IVC, which was performed by suprahepatic and infrahepatic IVC occlusion with Satinskys clamp in the operation. The patient underwent a combined operation which is en bloc resection of the IVC tumor and lobotomy of the left lateral section of liver. Pathological examination confirmed that is primary leiomyosarcoma of the IVC. The patient had a normal live for nearly one year and no recurrence. Conclusion: It is difficult to distinguish leiomyosarcoma from a hepatic tumor. About two thirds of these patients were confirmed as the diagnosis of leiomyosarcomas only after laparotomy. The misdiagnosis to be considered as tumor arising from segment I of the liver with IVC tumor thrombus was lead to the tumor to predominant intra-luminal growth. Radical surgical en bloc resection is the mainly treatment for IVC leiomyosarcomas. Using suprahepatic IVC and infrahepatic IVC occlusion with Satinsky clamp, surgical management of an infrahepatic IVC leiomyosarcoma is a simple vascular surgical techniques.

Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases.

INTRODUCTION Hepatocellular carcinoma (HCC) occurring in pregnancy is quite rare. The prognosis is usually poor because of a delay in diagnosis. Reported cases of HCC in pregnancy are largely isolated with no large experience. Thus the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Our aim was to review our experience with management of four young pregnant women with HCC. PRESENTATION OF CASE Laboratory tests were performed before surgery. We analyzed the effects of age, hepatitis B surface antigens status, cirrhosis at presentation, gestational age of fetus, and maternal outcome. DISCUSSION Increase in alpha-fetoprotein (AFP) level was somewhat useful for diagnosis. Three patients died in 5 months, 6 months, and 24 months from HCC recurrence, and another patient is alive without disease 12 months postoperatively. CONCLUSION Surgery for HCC during pregnancy should be similar to that for non-pregnant women. Complete excision of tumor without termination of pregnancy provides the greatest chance of survival for women with HCC during pregnancy but depends on gestational age of the fetus. Adjuvant treatments are required to improve the long-term results of this type of surgery. The 28-week gestational week is a critical point of fetal maturation which is very important in deciding whether pregnancy should be terminated or not. The pregnancy was terminated in two of our patients when spontaneous rupture of HCC was diagnosed to save the mothers life.

Decreased Expression of ZWINT is Associated With Poor Prognosis in Patients With HCC After Surgery

Background: ZW10 interactor was recently reported to correlate with human cancers. However, the prognostic value of ZW10 interactor in hepatocellular carcinoma was not reported. Methods: The expression level of ZW10 interactor was evaluated by Western blot and immunohistochemistry using tissue microarray. In the present study, we used 5 pairs of hepatocellular carcinoma and peritumoral frozen tissues for Western blot, and 70 paired paraffin-embedded hepatocellular carcinoma and peritumoral tissues as expression pattern cohort (cohort 1), and 280 paraffin-embedded hepatocellular carcinoma tissues were used as prognostic cohort (cohort 2). The integral optic density representing the expression level of ZW10 interactor in each tissue sample, was calculated using Image-Pro Plus. The integral optic density was added to the X-tile software for calculating the outcome-based cut point. Kaplan-Meier and Cox regression were used to evaluate the prognostic values. Results: The expression level ZW10 interactor was decreased in hepatocellular carcinoma tissues in 85.7% (60/70) of the cases compared to the corresponding peritumoral tissues evaluated by immunohistochemistry. Similar result was obtained by Western blot analysis using frozen tissue. Expression of ZW10 interactor was closely correlated with age (P = .0001) and liver cirrhosis in cohort 1 and tumor node metastasis (P = .018), tumor size (P = .005), and vascular invasion (P = .022) in cohort 2 based on χ2 analyses. Survival analyses indicated that patients with hepatocellular carcinoma having low ZW10 interactor expression had a shorter overall survival time and time to recurrence compared to cases with high ZW10 interactor expression in the prognostic cohort (P < .0001 for both overall survival and time to recurrence ). Univariate and multivariate Cox analyses indicated that ZW10 interactor was an independent prognostic factor for overall survival (P = .033). Conclusions: The present study clearly showed that ZW10 interactor was frequently decreased in hepatocellular carcinoma compared to nontumoral liver tissues, and ZW10 interactor could serve as a potential prognostic marker in patients with hepatocellular carcinoma after surgery.

Misdiagnosing hepatic inflammatory pseudotumor as hepatocellular carcinoma: A case report: Misdiagnosing hepatic inflammatory pseudotumor

A 61‐year‐old Chinese male was found to have a lesion in the left liver during a routine body check‐up. Laboratory tests revealed no abnormalities except for a rise in C‐reactive protein. Computed tomography showed features suggestive of hepatocellular carcinoma. The patient underwent liver IVb segmentectomy and cholecystectomy. Histopathology showed features of hepatic inflammatory pseudotumor. The C‐reactive protein decreased to close to normal on postoperative day 9. A patient with hepatic inflammatory pseudotumor who presented with features mimicking hepatocellular carcinoma was reported. A preoperatively raised C‐reactive protein was the only hint which suggested that our patient might have had hepatic inflammatory pseudotumor instead of hepatocellular carcinoma.