Primary Liver Carcinoma Research Articles

A case of primary liver carcinoma of intermediate (hepatocyte-cholangiocyte) phenotype: comparison of hemodynamics and histopathology

A case of primary liver carcinoma of intermediate (hepatocyte-cholangiocyte) phenotype: comparison of hemodynamics and histopathology

Clinical Studies of Laser Ablation in Treatment of Primary Liver Carcinoma-Associated Portal Vein Tumor Thrombus

To explore the clinical values of laser ablation as a new treatment for portal vein tumor thrombus (PVTT). A total of 43 male patients with primary liver carcinoma (PLC)-associated PVTT were randomized into a laser ablation group and a radiotherapy group. The laser ablation group of 21 cases received direct percutaneous laser ablation under ultrasonographic guide, followed by direct injection into the portal vein with chemotherapy drugs including mitomycin C (MMC) and fluorouracil (5-Fu). The radiotherapy group of 22 cases was treated with X-ray in three-dimensional conformal radiotherapy (3D CRT) once a day for a total of 10 days course. After the treatment, all patients were followed for postoperative adverse reactions, changes of tumor thrombus, and survival time. In comparison with the radiotherapy, laser ablation resulted in decreased postoperative complications such as limb fatigue, ascites, upper gastrointestinal ulcer, and bleeding. The overall remission rates (complete remission [CR] + partial remission [PR]) were 61.9% (13/21) and 31.8% (7/22) in the laser ablation and radiotherapy group, respectively, with a significant difference (P < .05). All cases in the laser group showed clinical improvement and the average survival time prolonged to greater than 19.5 months (P < .002). Percutaneous laser ablation to PVTT is an effective, safe, and simply procedure and has proven to offer significant clinical outcomes in the treatment of PLC-associated PVTT.

PP-067 Effects of interventional therapy for primary liver carcinoma on the liver function of patients

PP-067 Effects of interventional therapy for primary liver carcinoma on the liver function of patients

Hepatocellular Carcinoma and Liver Cirrhosis: Assessment of the Liver Function after Yttrium-90 Radioembolization with Resin Microspheres or after CT-Guided High-Dose-Rate Brachytherapy

Purpose: To identify changes of liver function after single-fraction irradiation or yttrium-90 radioembolization (⁹⁰Y-RE) of hepatocellular carcinoma associated with liver cirrhosis on the basis of laboratory data. Methods and Materials: 24 patients with primary liver carcinoma and liver cirrhosis classified Child-Pugh A or B were treated either by image-guided high-dose-rate brachytherapy (HDR-BT) (12 patients) or by ⁹⁰Y-RE (12 patients). The following laboratory parameters were assessed 1 day before and 3 days, 6 weeks and 3 months after the intervention: total bilirubin and γ-glutamyl transpeptidase (GGTP) as parameters of detoxification function, albumin and cholinesterase (ChE) as direct synthesis parameters, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (AP) as indicators of liver tissue damage. Preinterventional values were taken as baseline, following values were calculated as percentage changes from the baseline value. Statistical analysis was performed using the Wilcoxon-matched pairs test, comparing postinterventional with preinterventional values. Differences were considered statistically significant with a p value <0.05. Results: In all patients the median bilirubin, ALT, AP and albumin values remained within normal limits at any time of follow-up. AST levels in the RE group and GGTP in both groups have been already elevated over a normal range before the intervention, and in both groups both parameters showed a slight increase after interventions. ChE activity was lowered already in the baseline values and showed a further decrease 3 days after BT as well as 3 days and 6 weeks after RE, with final reconstitution to baseline values. All liver function test parameters showed mild changes shortly after radiation therapy but floating laboratory values recovering within 12 weeks to baseline values. Radiation or RE-induced liver disease was recorded in no patient. Conclusions: Liver function parameters show only mild changes shortly after intervention with recovery within 6–12 weeks to baseline values.

Primary liver carcinoma in elderly patients: an analysis of 176 cases

Primary liver carcinoma in elderly patients: an analysis of 176 cases

Neuropeptide Urocortin 1 and Its Receptors Are Expressed in the Human Liver

The corticotropin-releasing hormone (CRH) system, consisting of CRH, urocortins (Ucns), their receptors CRH₁ and CRH₂, and CRH-binding protein, holds the principal role in mediating the response to stress stimuli. Besides their expression in the brain, CRH neuropeptides and receptors have been found in multiple peripheral sites. We investigated the expression of the CRH system in the human liver, using RT-PCR and immunohistochemistry. Ucn 1 gene transcripts were amplified in all the human liver biopsies examined. Ucn 1 immunoreactivity was localized in hepatocytes. CRH₁ and CRH₂₍_α₎ receptor gene expression was also found, and receptor protein had a similar distribution to Ucn 1. Finally, Ucn 1 and CRH receptor expression was demonstrated in hepatic biopsies from a variety of liver pathologies, including primary or metastatic liver carcinoma and cirrhosis. We conclude that the CRH system is expressed by human liver under normal and pathological conditions, Ucn 1 being the major ligand. Further study is required to unfold the biological role of these effectors in liver physiology and pathogenesis, as they may act in an autocrine manner through activation of the CRH receptors expressed locally.

UV inactivation of Adenovirus Type 4 measured by integrated cell culture qPCR

Recent changes to water quality regulations may increase the prevalence of ultraviolet (UV) disinfection in water treatment applications. Adenoviruses currently pose a tremendous challenge to UV disinfection due to the high dose requirements for inactivation. This study validates a strategy combining cell culture and quantitative polymerase chain reaction (qPCR) for direct quantification of infectious adenoviruses in disinfection studies. Using primary liver carcinoma cell monolayers grown in well trays or flasks, post-infection washing, and a 24-hr incubation period, the time and material requirements for the infectivity assays were reduced significantly in comparison to traditional assays based on cytopathogenic effects. With this integrated cell culture quantitative PCR (ICC-qPCR) strategy, a standard curve was used to quantify infectious adenoviruses and ultimately determine relative inactivation for a disinfection study. Using ICC-qPCR, UV doses of approximately 10, 34, 69, and 116 mJ/cm2 corresponded to 1, 2, 3, and 4-log inactivation of adenovirus 4 in water, respectively. The results indicate that the new ICC-qPCR strategy represents a practical alternative for the quantification of adenoviruses in disinfection studies.

Clinicopathological and prognostic features of primary clear cell carcinoma of liver

Objective To investigate the clinicopathological features of primary hepatocellular carcinoma of the liver(PCCCL)and assess the over-all survival rate of PCCCL after hepatectomy and the association between prognosis and clear cell ratio in PCCCL.Methods The clinicopathological data of 43 patients with PCCCL treated with hepatectomy in our hospital from January 1999 to December 2003 were retrospectively analyzed.Results X2 test showed a positive rate of HCV infection(14.0%)and capsule formation(88.4 0A)in the PCCCL group markedly higher than the positive rate of HCV infection(1.2%)and capsule formation(65.0%)in the CHCC group(P=0.000 and 0.005).Meanwhile,the vascular invasion rate was notably Iower in the PCCCL group(53.4%vs.65.0%),but there were no significant differences between the two groups(P=0.129).Kaplan-Meier method showed that the1-,3-and 5-year survival rates were significantly higher in the PCCCL group than in the CHCC group(81%,53%and 39%vs.76%,46%and 32 0A,P=0.021).The prognosis of patients in the PCCCL group was related to capsule formation.vascular invasion,liver cirrhosis and clear cell ratio.The 1-,3-and 5-year survival rates were markedly higher in the group with higher clear cell ratio (≥75%,subgroup B)than in group with lower clear cell ratio(＜75%,subgroup A)(80 0A,43%and 23%vs.85 0A,77% and 68%,P=0.011).Conclusion The notable clinicopathologicaI features of the patients with PCCCL are higher rates of HCV infection.capsule formation and lower rate of vascular invasion.Their prognosis is better than the patients with CHCC and related with the ratio of clear cell. Key words: Carcinoma,hepatocellular; Clear cell carcinoma; HCV; Prognosis

Primary Liver Carcinoma Exhibiting Dual Hepatocellular-Biliary Epithelial Differentiations Associated With Citrin Deficiency

We report a 50-year-old male patient with primary liver carcinoma exhibiting dual hepatocellular and biliary epithelial differentiations associated with citrin deficiency (asymptomatic adult-onset type II citrullinemia, CTLN2). Although so far 14 CTLN2 patients with hepatocellular carcinoma have been reported, this report describes a unique case of liver carcinoma showing the features of both hepatocellular and cholangiocellular carcinoma. In addition to the clinical data of the 14 patients reported previously, the findings in our patient suggest that the citrin deficiency might be one of the key disorders causing hepatocellular carcinoma especially at younger ages and can also play an important role in hepatocarcinogenesis of the hepatic progenitor cells, which have the bipotential to differentiate into both hepatocytes and cholangiocytes.

Clinical investigation on the combination treatment of primary liver carcinoma with trans-portal vein chemoembolization

Objective To inquire into the feasibility and clinical effect of the combination treatment for pri-mary liver carcinoma with trans-portal vein chemoembolization(TPCE). Methods 30 eases of primary liver carcino-ma with 49 neoplasms, who had acquired poor therapeutic effieacies from the treatment of transcatheter arterial chemoembolizalion(TACE) ,were collected and treated with TPCE. Results Of the 28 eases,26 cases with 46 neo-plasms were successfully administered with TPCE. The Child scores of liver function of pre-treatment, 1,3 month of post-treatment were (9.8 ± 2.4), (9.3 ± 2.1 ) and (8.1 ± 1.9 ), respectively. The ratios of the cases of AFP >400μg/L and the determined values of AFP were significantly lower in 1st and 3rd month after the treatment than those of pre-treatment( P < 0.05) ;in the comprehensive analysis of B-ultrusound and CT results, 86.4 % of the neo-plasms were thoroughly ablated at 1 month after the treatment. The relapsing and unthoroughly ablated neoplasms were continuously treated with TPCE. The thoroughly ablating rate was 94.4 % till 3 months after the treatment.Conclusion The combination treatment of TPCE is simply-operated,safe,effective for the primary liver carcinoma,and it can be an alternative treatment for the patients who got poor therapeutic efficacies from the TACE. Key words: Liver neoplasms; Chemoembolization, therapeutic; Portal vein

Evaluation of Chinese version of the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire

To evaluate the effectiveness of the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire in measuring the quality of life in patients with primary hepatic carcinoma (PHC) in China. FACT-Hep questionnaire was translated into Chinese and revised properly. From September 2005 to April 2006, one hundred and eighty patients with primary liver carcinoma were admitted and measured by using the Chinese version of FACT-Hep questionnaire, and the reliabilities, validities and responsibilities of the questionnaire were assessed. Correlation coefficient was higher between items and dimension of their corresponding domain (0.5933+/-0.1652) than that between the items and other domains (0.2749+/-0.1922). Six principal constituents were extracted by factor analysis and represented all domains of the questionnaire. The combinations of components were consistent with what was expected. The correlation coefficient of criterion-related validity was 0.828. The test-retest reliability correlation coefficients of physical, social/family, emotion, function, symptom and total questionnaire were 0.731, 0.334, 0.953, 0.786, 0.785 and 0.801 respectively, and the values of Cronbach's alpha were 0.7397, 0.4193, 0.7914, 0.8250, 0.8399 and 0.9161, respectively. There were statistical differences in scores of FACT-Hep questionnaire in different PHC stages or in different Child-Pugh classes (P<0.05). The FACT-Hep questionnaire can measure the quality of life in patients with PHC with good reliability, validity and responsiveness; it can be used in assessing the disease-specific health-related quality of life of patients with hepatobiliary cancers.

P22 Bone mass density, subsequent risk of colon cancer and survival in postmenopausal women

Intrahepatic cholangiocarcinoma (IHCC) is the second most frequently developed primary carcinoma of liver, after hepatocellular carcinoma (HCC). They are biologically aggressive and they are frequently discovered in late study. Surgical removal is the only curative therapeutic method for treatment of such tumors.From 1.1.2004 to 31.12.2014, at the Department of Surgery, University Hospital Martin and Jessenius Medical Faculty of Comenius University in Martin, we operated 411 patients with benign, primary, metastatic tumors of liver, where in 33 patients (8%) the histology confirmed the primary intrahepatic cholangiocarcinoma of liver. In the group, we evaluated the 1-year and 5-year survival of the patients according to radical resections, the degree of differentiation of tumor (grading), and according to positivity of lymph node. The results were statistically analyzed by the Student t-test and Kaplan–Meier curves of survival.The average age of the patients was 59.6 ± 11.4 years, the males represented 46.2%, the females represented 53.8%. The average age of males was 58 ± 13.2, and females 61 ± 9.8 years. Large anatomic resections of 3 and more segments of liver were performed in 24 patients, anatomic resections and metastasectomies were performed in 6 patients, two patients had radiofrequency ablation of tumor. R0 resection was achieved in 20 patients, R1 resection in 8 patients, and R2 resection in 5 patients. One-year survival in the R0 group was 65%, in the R1 group 62%, and in the R2 resections group it was only 20%; five-year survival after R0 resections was 52%, and in R1 and R2 it was zero, which proved to be statistically significant. The median of survival in R0 resections was 12 months (interval 1–87 months), in R1 resections it was 12 months (interval 1–36 months), and after R2 resections it was 7 months (interval 1–12 months). One-year and five-year survival, depending on the degree of differentiation, was statistically non-significant; however, the five-year survival of G1 tumors is on the level of being statistically significant – the 5-year survival expressed in percentage G1/G2/G3 was 50%/12%/0% respectively. Positive lymph nodes were found in 16 patients (48%) from the group of 33 patients. The one-year and five-year survival was not statistically significant; however, 5 years of survival was recorded in 30% patients with negative lymph node and 0% patients with positivity of lymph node.Resection of tumor is the optional method; it should be attempted to achieve R0 resection and at the same time to preserve sufficient volume of residual functional parenchyma. Radical R0 resection is considered by us as the only possible method of surgical treatment for survival of patients with IHCC.

Observation for adverse effects of autologous transfusionof cytokine-induced killer cells to treat primary liver carcinoma

原发性肝癌(primary hepatocellular carcinoma,HCC)患者经手术、化疗及放疗后难以改变其生存质量,且预后极差[1].近年来生物治疗运用在临床中已显示其独特优势,细胞因子诱导的杀伤(cytokine induced killer,CIK)细胞在体内外增生能力强,具有强大的抗肿瘤活性,可以满足过继性免疫治疗中抗肿瘤细胞的要求[2,3],已成为肝癌手术、放疗、化疗后的一种新的治疗模式。

Alpha-1 Antitrypsin Genotypes in Breast Cancer Patients

Proteolytic enzymes play a significant role in malignancy including, loss of growth regulation, invasiveness and metastases formation. Alpha-1 antitrypsin (A1AT) is a secretory glycoprotein produced mainly in liver and monocytes. It is the most abundant serine protease inhibitor in human plasma. Deficiency of A1AT is an inherited disorder characterized by reduced serum level of A1AT. Protease inhibitor Z (PiZ) and protease inhibitor S (PiS) are the most common deficient genotypes of A1AT. The association of deficient A1AT subtypes with several tumors such as primary liver carcinoma, lung cancer, bladder cancer and malignant hepatoma was reported. This study was aimed to test the relationship between A1AT genotypes Z and S and breast cancer in Jordanian female patients. Blood samples were collected from 111 patients. DNA was isolated and polymerase chain reaction (PCR) was performed to amplify the regions contain the Z and S mutations in exon V, and III, respectively. Genotyping of Z and S alleles was performed by restriction fragment length polymorphism technique using Taq1 restriction enzyme. Our results demonstrated that 100% of the breast cancer patients were homozygous for the normal allele Protease inhibitor MM (PiMM) and no PiZ and PiS genotypes were found. In conclusion, there is no relationship between A1AT deficient genotypes Z and S and breast cancer in Jordanian female patients.

Efficacy analysis of interventional therapy on patients with primary liver carcinoma accompanied with hypoglycemia

目的 探讨原发性肝癌伴发低血糖症患者介入治疗效果.方法 对10例原发性肝癌伴发低血糖症患者行肝癌化疗栓塞(TACE).结果 10例患者经过化疗栓塞后血糖维持在正常范围,1例于介入治疗半个月后再出现低血糖症状,复查CT提示肿瘤未完全控制,再行介入治疗后血糖恢复正常.所有患者血糖随访2个月未再出现低血糖症状.结论 原发性肝癌伴发低血糖症患者行化疗栓塞治疗近期疗效好。

DNA of Helicobacter spp. and common gut bacteria in primary liver carcinoma

Background and aim Gastric and enteric Helicobacter species have been associated with the pathogenesis of some extragastric diseases. Methods We retrospectively investigated the presence of DNA of Helicobacter species in samples of the cancer and the surrounding tumour-free liver tissues of patients with hepatocellular carcinoma (HCC, n = 12) and cholangiocarcinoma (CC, n = 13). The patients were from an area with low liver cancer incidence and with low hepatitis B and C prevalence. Patients with a benign liver disease ( n = 24) were included as controls. Paraffin-embedded liver samples were examined by a Helicobacter genus-specific PCR assay as well as group-specific PCR assays for Enterobacteriaceae, Bacteroides, Lactobacillus and Enterococcus. PCR products of positive samples were characterised by denaturing gradient gel electrophoresis (DGGE) and DNA sequencing. Results PCR assay detected Helicobacter DNA in seven of 12 (58%) and eight of 13 (62%) normal liver tissue specimens from HCC and CC patients, respectively. Two cancer samples from HCC patients were Helicobacter-positive but none of the CC cancers. In the control group, three of 24 (12.5%) patients with a benign liver condition were positive for Helicobacter species ( p < 0.01 compared to results of tumour-free liver tissue from the cancer patients). DGGE and DNA sequence analysis showed that 90% of the detected PCR products were “ H. pylori-like”. DNA of some other enteric bacteria was detected in the liver of one cancer patient and one control (4% of all patients). Conclusion The presence of DNA of Helicobacter species in liver specimens, but not of other common gut bacteria, was associated with human hepatic carcinogenesis.

Hepatitis G Virus Infection in Patients with Hepatocellular Carcinoma in Recife, Brazil

The evidence of a higher incidence of hepatitis G virus (HGV) infection among patients with hepatocellular carcinoma (HCC) and the relatively high prevalence of patients with primary liver carcinoma without apparent risk factors in our country motivated the present study, the objective of which was to determine the frequency of HGV-ribonucleic acid (RNA) in a series of patients with HCC. The diagnosis of HCC was established based on alpha-fetoprotein levels (>400 ng/ml), a compatible image and/or biopsy of the hepatic nodules. Markers of hepatitis B virus (HBV) (HBsAg and anti-HBc), hepatitis C virus (HCV) (anti-HCV) and HGV (HGV-RNA) were investigated using MEIA and RT-PCR (reverse transcriptase polymerase chain reaction). There were 32 patients evaluated, including 20 males (63%), with a mean age of 58 years. Twenty-eight (88%) patients were cirrhotic (Child-Pugh: A = 8 patients, B = 14, and C = 6) and 50% reported alcohol consumption. Serological hepatitis markers were detected in 26 (81%) patients, including HBV in 19 (59%), HCV in 12 (38%) and HGV in 9 (28%). Only one (3%) patient was positive for HGV alone. The prevalence of HGV in blood donors from the same region is 10%. The findings suggest that, despite the frequent detection of HGV markers in patients with HCC, isolated infection with this agent does not seem to be a relevant factor in the etiology of this carcinoma.

Nursing patients with primary carcinoma of liver when cured by self cytokine-induced killer return transfusion

目的 总结自体细胞因子诱导的杀伤(eytokine-induced killer,CIK)细胞回输治疗原发性肝癌的护理方法.方法 对20例采用自体CIK细胞回输治疗原发性肝癌的患者的护理进行分析总结.结果 CIK细胞自体回输后,本组20例患者的症状均有显著的改善.CIK细胞回输治疗原发性肝癌效果明显,且损伤性小、不良反应少、安全性高.如在治疗中加强护理干预,可促进患者症状和体征的改善,延长患者的生命.结论 采用自体CIK细胞治疗,可以消除患者体内残留的肿瘤细胞,具有增殖速度快、杀瘤活性高、杀瘤谱广、毒副作用小等优点,值得临床推广。

Clinical outcomes of ATP-tumor chemosensitivity assay directed chemotherapy in hepatocellular carcinoma

This study aims to investigate the clinical response of ATP tumor chemosensitivity assay (ATP-TCA) directed chemotherapy regimens delivered via hepatic artery infusion in 104 cases of primary liver carcinoma (PLC). Tumor tissue was obtained via laparotomy and cultivated in vitro. This tissue was put through the assay to determine chemosensitivity. A single drug regimen of either 5-FU, MMC and ADM and a combination drug regimen were used. The treatment assigned was dependent on the result of the ATP-TCA. In the control group, 30 cases of diagnosed PLC were given the conventional three-combination drug. The two groups were evaluated after three courses of chemotherapy. The results are as follows. The overall response rate of sensitivity test ranged from 36% to 44% in the single drug therapy groups and 81% in the combination drug group. The clinical overall response rate was 75% in the treatment group and 56% in control group. The treatment group had better results than the control group as survival period over six months was 80% and over one year 44%. In the control group, survival period over six months was 60% and 30% over one year. In short, ATP-TCA directed chemotherapy shows better results for terminal stages of PLC in that you can decrease the dose of drugs thereby reducing the side-effects with possible improvements in therapeutic effects.

Evaluation of Extrahepatic Perfusion of Anticancer Drugs in the Right Gastric Arterial Region on Fused Images Using Combined CT/SPECT: Is Extrahepatic Perfusion Predictive of Gastric Toxicity?

Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinomas of the liver. Since hepatic arteries also supply the stomach and duodenum, HAI may result in unwanted infusion into the upper gastrointestinal tract and consequent gastric toxicity. Using fused images obtained with a combined SPECT/CT system, we assessed extrahepatic perfusion (EHP) and its correlation with gastrointestinal toxicity in patients receiving HAI. We studied 41 patients with primary or metastatic carcinoma of the liver who received HAI chemotherapy consisting of 5-fluorouracil and cisplatin. All underwent abdominal SPECT using a (99m)Tc-MAA (185 MBq) instrument and an injection rate of 0.1 ml/min, identical to the chemotherapy infusion rate. Delivery was through an implantable port. We analyzed the distribution of the anticancer agent on fused images and the relationship between EHP of the right gastric arterial region and gastric toxicity. All patients underwent esophagogastroduodenoscopy (EGDS). Of the 41 patients, 11 (27%) manifested enhancement of the duodenal and gastric pyloric region on fused images. EGDS at the time of reservoir placement detected gastric ulcers in 10 of these patients. Fusion imaging with combined SPECT/CT reflects the actual distribution of the infused anticancer agents. The detection of EHP on fused images is predictive of the direct gastric toxicity from anticancer agents in patients undergoing HAI.