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ABSTRACT: PURPOSETo compare radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC).Patients And methodsA randomized controlled trial was conducted on 189 patients with HCC less than 7 cm at a single tertiary referral center between October 2006 and June 2009. Patients were randomly asssigned to receive TACE combined with RFA (TACE-RFA; n = 94) or RFA alone (n = 95). The primary end point was overall survival. The secondary end point was recurrence-free survival, and the tertiary end point was adverse effects.ResultsAt a follow-up of 7 to 62 months, 34 patients in the TACE-RFA group and 48 patients in the RFA group had died. Thirty-three patients and 52 patients had developed recurrence in the TACE-RFA group and RFA group, respectively. The 1-, 3-, and 4-year overall survivals for the TACE-RFA group and the RFA group were 92.6%, 66.6%, and 61.8% and 85.3%, 59%, and 45.0%, respectively. The corresponding recurrence-free survivals were 79.4%, 60.6%, and 54.8% and 66.7%, 44.2%, and 38.9%, respectively. Patients in the TACE-RFA group had better overall survival and recurrence-free survival than patients in the RFA group (hazard ratio, 0.525; 95% CI, 0.335 to 0.822; P = .002; hazard ratio, 0.575; 95% CI, 0.374 to 0.897; P = .009, respectively). There were no treatment-related deaths. On logistic regression analyses, treatment allocation, tumor size, and tumor number were significant prognostic factors for overall survival, whereas treatment allocation and tumor number were significant prognostic factors for recurrence-free survival. CONCLUSIONTACE-RFA was superior to RFA alone in improving survival for patients with HCC less than 7 cm.
Journal of Clinical Oncology 12/2012; · 18.37 Impact Factor
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Ming Shi,
Li-Gong Lu,
Wan-Qiang Fang,
Rong-Ping Guo,
Min-Shan Chen,
Yong Li,
Jun Luo, Li Xu,
Ru-Hai Zou,
Xiao-Jun Lin,
Ya-Qi Zhang
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ABSTRACT: Background
The aim of our study was to compare the efficacy and safety of: 1) transarterial chemolipiodolization with gelatin sponge embolization vs chemolipiodolization without embolization, and 2) chemolipiodolization with triple chemotherapeutic agents vs epirubicin alone.MethodsA single-blind, three parallel arm, randomized trial was conducted at three clinical centers with patients with biopsy-confirmed unresectable hepatocellular carcinoma. Arm 1 received triple-drug chemolipiodolization and sponge embolization, whereas Arm 2 received triple-drug chemolipiodolization only. Patients in arm 3 were treated with single-drug chemolipiodolization and sponge embolization. We compared overall survival and time to progression. Event-time distributions were estimated by the Kaplan-Meier method. All statistical tests were two-sided.ResultsFrom July 2007 to November 2009, 365 patients (Arm 1: n = 122; Arm 2: n = 121; Arm 3: n = 122) were recruited. The median tumor size was 10.9cm (range = 7-22cm), and 34.5% had macrovascular invasion. The median survivals and time to progression in Arm 1, Arm 2, and Arm 3 were 10.5 and 3.6 months, 10.1 and 3.1 months, and 5.9 and 3.1 months, respectively. Survival was statistically significantly better in Arm 1 than in Arm 3 (P < .001), whereas there was no statistically significant difference between Arm 1 and Arm 2 (P = .20). Objective response rates were 45.9%, 29.7%, and 18.9% for Arm 1, Arm 2, and Arm 3, respectively.Conclusions
Chemolipiodolization played an important role in transarterial chemoembolization, and the choice of chemotherapy regimen may largely affect survival outcomes. However, the removal of embolization from chemoembolization might not statistically significantly decrease survival.
CancerSpectrum Knowledge Environment 11/2012; · 14.07 Impact Factor
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ABSTRACT: Radiofrequency ablation (RFA) has become an important treatment for hepatocellular carcinoma (HCC). The good candidates for RFA are patients with HCC at an early stage (solitary tumor ≤ 5 cm in diameter or ≤ 3 nodules ≤ 3 cm in diameter). Several clinical trials have shown that RFA is effective in resection for the treatment of small HCC. Until now, RFA has been widely used as a radical treatment for small HCC. RFA also plays an important role in the multidisciplinary treatment of HCC and is usually combined with other therapies such as resection, vascular intervention, intratumor ethanol injection, radiotherapy, chemotherapy, targeted drug therapy, and biological immune therapy. In this study, we will introduce our experience of RFA in the treatment of HCC in a cancer center in China.
Oncology 01/2011; 81 Suppl 1:100-4. · 2.27 Impact Factor
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ABSTRACT: Recently, Wnt inhibitory factor-1 (WIF-1) was found to be epigenetically inactivated in several solid tumors, but the biological and clinical relevance of WIF-1 methylation and expression status in hepatocellular carcinoma (HCC) are still unclear. In the present study, reverse transcription polymerase chain reaction (PCR) and methylation-specific PCR were used to examine the WIF-1 expression and methylation in HCC cell lines. In addition, methylation and expression status of WIF-1 in 105 HCC cases were correlated with clinicopathological parameters and prognosis after tumor resection. WIF-1 was expressed in one HCC cell line and L02, both of which were not methylated in promoter region. DNA hypermethylation of WIF-1 promoter was identified in the other four HCC cell lines without WIF-1 expression. In neoplastic and non-neoplastic tissue samples, the rates of WIF-1 methylation were 61.9% and 37.1% (P = 0.001), respectively. WIF-1 was significantly downregulated in neoplastic tissues at messenger ribonucleic acid (mRNA) level, as compared to adjacent non-neoplastic tissues (P = 0.006). A significant inverse association was observed between WIF-1 methylation of and WIF-1 expression (P 0.017, R = -0.232). Methylation of WIF-1 was not associated with patient survival. In contrast, patients whose tumors exhibited negative WIF-1 mRNA expression had lower rates of overall survival. These findings suggested that aberrant methylation of WIF-1 is a common event in hepatocarcinogenesis. In addition, expression, but not methylation, of WIF-1 is a predictor of good outcome in patients undergoing resection of HCC.
Tumor Biology 10/2010; 32(1):233-40. · 1.94 Impact Factor
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ABSTRACT: There are few studies about origins of regulatory T (Treg) cells increased in primary hepatocellular carcinoma (HCC) tissue. Studies showed that Treg cells could be induced by transforming growth factor-beta1 (TGF-beta1), but the relation between TGF-beta1 expression and Treg cell infiltration is unclear in HCC tissue. This study was to investigate the expression of TGF-beta1 and correlations with the amount of Treg cells in HCC, and to evaluate their clinical values in predicting the prognosis of HCC.
Envision immunohistochemistry was used to detect the expression of TGF-beta1 and Foxp3 in 102 specimens of HCC tissue and paired adjacent non-tumor liver tissue.
Of the 102 specimens of HCC, 41 showed low TGF-beta1 expression and 61 (59.8%) showed high expression; of the 102 specimens of adjacent non-tumor tissue, 22 showed low TGF-beta1 expression and 80 (78.4%) showed high expression. The high expression rate of TGF-beta1 was significantly lower in HCC than in adjacent non-tumor tissues (P = 0.001). Average Foxp3+ cell density in HCC was 2.98 cells/HP, but there was very few or no expression of Foxp3 in adjacent non-tumor liver tissue. Expression of TGF-beta1 was positively correlated with expression of Foxp3 in HCC tissues (r = 0.228, P = 0.021). The expression of TGF-beta1 was significantly higher in HCC tissues with high preoperative AFP concentration than in those with low preoperative AFP concentration (P = 0.023). TGF-beta1 and Foxp3 expression had no correlations with tumor diameter, tumor capsule, liver cirrhosis, and so on. The 5-year survival rate was not different between HCC tissues with high and low TGF-beta1 expression (P = 0.790); however, it was significantly lower in HCC tissues with high Treg cell infiltration than in those low infiltration (25% vs. 44%, P = 0.007). Cox multivariate analysis showed that the number of Treg cells and tumor capsule were independent prognostic factors (P = 0.021, P = 0.001).
Expression of TGF-beta1 may relate to the infiltration of Treg cells in HCC tissues, but the relation need to be further investigated. The number of Treg cells in HCC tissues could be used as a potential immunological prognostic indicator for HCC patients after resection.
Chinese journal of cancer 04/2010; 29(4):403-7.
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ABSTRACT: To observe the efficacy and safety of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma (HCC).
Thirty-eight patients with advanced HCC of Child-Pugh status A or B were included in this study. Patients received orally administered sorafenib at a dose of 400 mg twice a day on a continuous schedule. Adverse events were documented. The efficacy and safety were evaluated every four to six weeks.
During the treatment, partial response (PR) was observed in 1 patient (2.6%), minor response (MR) in 5 (13.2%), stable disease (SD) in 16 (42.1%), and progressive disease (PD) in 16 (42.1%), respectively. The median oral administration time of sorafenib was 180 days (range, 15-550 d), and the mean overall survival was 370 days (range, 42-562 days). The median response duration was 169 days (range, 42-426 days). The mean overall survival of 22 patients with controlled disease (PR + MR + SD) was 428 days (95% CI 330-526 days). The most frequent adverse events were dermal reaction (27 cases, 71.1%), gastrointestinal reaction (25 cases, 65.8%), and constitutional symptoms (14 cases, 36.8%). Most of the drug related adverse events were mild and easily to manage and reversible.
Sorafenib monotherapy is effective and tolerable in a part of Chinese patients with advanced hepatocellular carcinoma and liver function of Child-Pugh A or B, and may prolong their survival.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 02/2009; 31(1):58-61.
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ABSTRACT: To evaluate the efficacy and safety of percutaneous radiofrequency ablation (PRFA) and combined with other minimally invasive treatments for recurrent hepatocellular carcinoma (RHCC) after hepatectomy.
Eighty-four patients with RHCC after hepatectomy who were treated with PRFA or combined with other minimally invasive therapies between August 1999 and February 2008 were analyzed retrospectively.
There was no treatment related mortality in the study population, and the morbidity was 2.4% (2/84). The complete ablation rate was 94.0% (79/84), and the 1-, 3- and 5-year overall survival rates were 74.9%, 54.9% and 48.2%, respectively. The 1-, 3- and 5-year overall survival rates of patients with recurrent interval after hepatectomy less than 1 year and over 1 year were 72.1%, 36.2%, 24.2% and 76.8%, 70.6% and 65.1%, respectively (P = 0.040). The 1-, 3- and 5-year overall survival rates of patients with tumor size <or= 3 cm and > 3 cm were 83.2%, 67.7%, 67.7% and 59.1%, 24.2%, 12.1%, respectively (P = 0.003). The 1-, 3- and 5-year overall survival rates of patients treated with PRFA alone and combined with percutaneous ethanol injection (PEI) were 66.7%, 33.3%, 22.2% and 76.5%, 57.3%, 57.3%, respectively (P = 0.017). The 1-, 3- and 5-year overall survival rates of patients treated with PRFA alone and combined with transcatheter hepatic arterial chemoembolization (TACE) were 55.6%, 24.7%, 24.7% and 81.6%, 66.0%, 57.5%, respectively (P = 0.001).
PRFA is an effective and safe treatment for RHCC, and tumor size and recurrent interval after hepatectomy are important prognostic factors. Combination with PEI or TACE may improve the efficacy of PRFA for treatment of RHCC.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2008; 46(21):1617-20.
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ABSTRACT: Most hepatocellular carcinomas (HCC) are associated with cirrhosis. The clinicopathologic characteristics and outcomes of HCC present in non-cirrhotic livers are not well known in Chinese patients. This study was performed to explore the features of these patients and their outcomes after hepatectomy.
96 patients with histologically confirmed HCC in non-cirrhotic liver who underwent partial hepatectomy between 1995 and 2001 in our cancer center were reviewed. A retrospective analysis of the clinicopathologic features was performed, and survival of patients was analyzed by the Kaplan-Meier method and Cox regression model.
Operative mortality and morbidity were none and 8.3% (8/96), respectively. Postoperative overall survival (OS) rates at 1, 3, 5 and 10 years were 84.4, 62.5, 47.9 and 38.2%, respectively, with a median OS of 57 months. Disease-free survival (DFS) rates at 1, 3, and 5 years were 56.3, 39.6, and 33.3%, respectively, with a median DFS of 18 months. TNM stage was an independent prognostic factor for both OS and DFS of non-cirrhotic HCC. Operative blood loss was an independent prognostic factor for OS and DFS of patients who received curative resection.
Curative partial hepatectomy was an effective and safe treatment for non-cirrhotic HCC. Aggressive local therapies were recommended for patients with intrahepatic recurrence.
Digestive surgery 12/2008; 25(5):376-82. · 1.37 Impact Factor
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ABSTRACT: Several researches have reported that epidermal growth factor receptor (EGFR) is expressed frequently in hepatocellular carcinoma (HCC) and paratumor tissues, most likely to contribute to the biological characteristics of HCC, including invasion, metastasis, and resistance to chemotherapy and radiotherapy. The single agent of cetuximab and erlotinib can inhibit the proliferation of HCC cells in vivo and in vitro. This study was to investigate the effects of cetuximab combined erlotinib on the proliferation of HCC cells, and explore the molecular mechanism.
Increasing concentrations of cetuximab (5-500 mg/mL) and erlotinib (2.5-250 micromol/L) alone or in combination were administrated to HCC cell lines HepG2 and Bel-7402. The inhibitory effects of the drugs on cell proliferation at different time points were observed; the combination index (CI) of these two agents was calculated. The expression of key enzymes in EGFR signaling transduction pathway in HepG2 and Bel-7402 cells after different treatments was detected by Western blot.
The single agent of cetuximab and erlotinib inhibited the proliferation of HCC cells in a time-and dose-dependent manner; after 72-hour treatment, the proliferation inhibition rates of HepG2 cells were (43.1+/-1.9)% and (83.4+/-1.3)%, and those of Bel-7402 cells were (35.1+/-2.6)% and (73.9+/-1.2)%. With maximal inhibitory effects of cetuximab combined erlotinib, the proliferation inhibition rates of HepG2 and Bel-7402 cells were (91.1+/-1.0)% and (84.6+/-1.1)%, respectively. The CIs of different concentrations of these two agents at different time points were all less than 1, suggested that they have obvious synergistic activity. The expression of activated key enzymes (p-EGFR, p-ERK1/2, p-AKT) in EGFR signaling transduction pathway in HepG2 and Bel-7402 cells were down-regulated more obviously when these two agents were administrated in combination.
The single agent of cetuximab and erlotinib can inhibit the proliferation of HepG2 and Bel-7402 cells through down-regulating activated key enzymes in EGFR signaling transduction pathway, and they have obvious synergistic activity. The combined EGFR-targeting therapy on HCC xenografts in vivo and on HCC patients is worth of further exploration.
Ai zheng = Aizheng = Chinese journal of cancer 04/2008; 27(4):386-92.
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ABSTRACT: To summarize the 8-year experience of radiofrequency ablation (RFA) on liver malignancies and explore the effect and prognostic factors.
From August 1999 to February 2007, 803 patients with liver malignancies, among which there were 672 with primary liver cancer (PLC) and 131 with liver metastasis, were treated with RFA. There were 781 cases who were performed percutaneously under the guidance of ultrasound, 8 cases under CT, 9 cases with laparoscopy and 5 cases with laparotomy. And there were 117 cases who were treated by RFA combined with percutaneous ethanol injection and 108 cases by RFA combined with trans-catheter arterial chemoembolization.
In the treatment of all the 803 patients with liver malignancies, the mortality was 0.25%, the rate of severe complications was 0.37%. The rate of complete ablation was 92.5%, the loco-recurrence rate was 13.8% and the 1, 2, 3, 4, 5-year survivals were 95.1%, 85.6%, 75.7%, 60.7% and 47.5%, respectively. For the 672 patients with PLCs, the 1, 2, 3, 4, 5-year survivals with stage Ia (Chinese staging system) were 97.8%, 91.5%, 84.6%, 77.1% and 61.9%, respectively, with stage Ib were 93.9%, 83.7%, 69.8%, 45.1% and 42.2%, respectively, with stage II were 86.2%, 67.3%, 47.3%, 17.2% and 0, respectively, and the 1, 2-year survivals with stage III were 67.8% and 0, respectively (P < 0.01).
RFA is a safe and effective method for liver malignancy, and the tumor size and stage are important prognostic factors.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2007; 45(21):1469-71.
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ABSTRACT: CD4+CD25+ regulatory T (Treg) cells, a subset of T cells, can suppress immune responses. Recent studies showed that Treg cells may significantly suppress immune responses, and lead to immune tolerance of tumor cells. However, the clinical significance of Treg cells in hepatocellular carcinoma (HCC) is still unclear. This study was to investigate the correlations of the proportion of Treg cells in peripheral blood to clinical characteristics and prognosis of HCC.
The proportion of Treg cells in peripheral blood of 117 HCC patients, who underwent radical resection in Cancer Center of Sun Yat-sen University from Jan. 1999 through Dec. 2000, was detected by flow cytometry before operation. The proportion of Treg cells in peripheral blood of 40 healthy blood donors was detected as control. All the patients had been followed up till Dec. 30th, 2005. The correlations of Treg cell proportion to clinicopathologic characteristics and prognosis of HCC were analyzed.
The proportion of Treg cells in peripheral blood was significantly higher in HCC group than in control group [(12.54+/-4.69)% vs. (8.81+/-1.98)%, P < 0.01]. The 1-, 3-, and 5-year survival rates of the HCC patients were 83.8%, 49.6%, and 35.9%, respectively. In the 92 patients with single tumor, the proportion of Treg cells was significantly lower in the patients with clear tumor margin than in those with unclear tumor margin [(12.18+/-4.76)% vs. (15.52+/-5.45)%, P < 0.05]. The proportion of Treg cells had no correlations to other clinicopathologic characteristics of HCC (P>0.05). The 5-year survival rate was significantly higher in the patients with high proportion of Treg cells than in those with low proportion of Treg cells (43.9% vs. 28.3%, P = 0.047).
The elevation of the proportion of circulating Treg cells is an independent prognostic factor of HCC.
Ai zheng = Aizheng = Chinese journal of cancer 08/2007; 26(7):748-51.
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ABSTRACT: Most results from clinical trials of neoadjuvant chemotherapy for gastric carcinoma are certain. Meanwhile, microsatellite instability (MSI) is thought to be a new mechanism of cell canceration. This study was to investigate the influence of neoadjuvant chemotherapy on MSI in gastric carcinoma.
Two microsatellite loci D2S123 and D3S1298 in tumor samples from 48 patients with gastric carcinoma, received preoperative chemotherapy of 5-fluorouracil (5-FU) and leucovorin (CF), were analyzed by polymerase chain reaction (PCR), electrophoresis on 8% denatured polyacrylamide gel, and silver staining. The microsatellite statuses of preoperative and postoperative specimens were compared. Chi-square test was used to analyze the influence of neoadjuvant chemotherapy on MSI in gastric carcinoma.
The detection rate of MSI was significantly higher in preoperative samples than in postoperative samples (31.3% vs. 12.5%, P=0.026). After neoadjuvant chemotherapy, 9 cases changed from MSI-positive to MSI-negative, while no MSI-negative cases became MSI-positive.
The neoadjuvant chemotherapy regimen of 5-FU/CF can induce some MSI-positive gastric carcinoma change to MSI-negative, but has no effect on MSI-negative cases.
Ai zheng = Aizheng = Chinese journal of cancer 01/2007; 25(12):1493-6.
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ABSTRACT: Iressa, a new molecular targeting medicine, has some effects on advanced non-small cell lung cancer, but its effect on hepatocellular carcinoma (HCC) has seldom been reported. This study was to observe the efficacy and adverse effect of Iressa on HCC Hep-3B and HepG2 cell xenografts in nude mice.
The nude mice with Hep-3B and HepG2 cell xenografts were randomized into control group (8 mice), low-dose group (8 mice), and high-dose group (8 mice), and received daily oral gavage of 5% glucose solution, 100 mg/kg Iressa, and 200 mg/kg Iressa, respectively, by 5 days each week for 3 weeks. The mice were killed 2 days after treatment. Inhibitory rate (IR) of tumor growth was calculated. Tumor volume, mice weight, and spleen index (SI) were compared between groups.
Body weight and tumor volume of the mice were caparable before treatment. IRs of Hep-3B cell xenograft growth were 32.77% in low-dose group and 46.99% in high-dose group; IRs of HepG2 cell xenograft growth were 68.57% and 75.24%, respectively. Body weight and SI of nude mice with either Hep-3B or HepG2 cell xenografts were significantly lower in high-dose group than in control group, but no obvious difference was observed between low-dose group and control group.
Iressa has obvious inhibitory effects on growth of both Hep-3B and HepG2 cell xenografts in nude mice, but high-dose (200 mg/kg) of Iressa may cause body weight lose and immunologic inhibition.
Ai zheng = Aizheng = Chinese journal of cancer 04/2006; 25(4):447-50.
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ABSTRACT: To compare the effect of different resection margin in hepatectomy on recurrence and survival of patients with hepatocellular carcinoma (HCC), and to determine an appropriate resection margin of hepatectomy for HCC patients.
152 untreated HCC patients were randomly divided into two groups based on the distal and proximal resection margin according to direction of the portal vein flow. Seventy-four patients in the wide-margin group had a distal resection margin of 2 cm and a proximal of 1 cm away from the edge of the primary tumor, while 78 patients in the narrow-margin group had a resection margin of < 1 cm away from the edge of the primary tumor provided that the margin was proven to be histologically free of cancer cells. The distal and proximal margins were defined. The data were analyzed and compared using Kaplan-Meier survival analysis and Log rank test.
The mean overall survival time of patients in wide-margin group and narrow-margin group were 42.0 months and 37.5 months, respectively. The mean tumor-free survival time of these two groups of patients were 35.5 months and 28.8 months, respectively. Patients in wide-margin group had significantly longer overall survival (t = 6.23, P = 0.0125) and tumor-free survival (t = 6.01, P = 0.0142) than patients in the narrow-margin group.
In hepatectomy for hepatocellular cell carcinoma patients, wide distal resection margin of 2 cm and a proximal of 1 cm away from the edge of the primary tumors according to direction of the portal vein flow may reasonably improve the overall and tumor-free survival.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2006; 28(1):47-9.
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You-qing Zhan,
Wei Li,
Xiao-wei Sun,
Ying-bo Chen, Li Xu,
Gong Chen,
Yuan-xiang Guan,
Yuan-fang Li,
Da-zhi Xu,
Xian-fu Sun,
Hua-zheng Zhang,
Zhen-wen Lin
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ABSTRACT: To investigate the approaches to improve therapeutic effect of stomach cancer by analysis of the long-term results of surgical treatment of this disease.
Prognostic factors of stomach cancer were analyzed by Cox multivariate regression model based on clinical data of 2561 stomach cancer cases who underwent surgical treatment from 1964 to 2004 at Sun Yat-sen University Cancer Center. Survival rates were calculated by life table method.
Gastrectomy was performed for 1950 cases with resectability of 76.1%, among which there were 1192 cases of curative resection (46.5%) and 758 cases of non-curative resection (29.6%). The other 611 cases of palliative operation included bypass procedures and laparotomy. Operative mortality of all cases was 0.8% and morbidity was 5.1%. For all cases the 1-, 3- and 5-year survival rate was 52.4%, 38.6% and 35.5%, respectively. The stage-specific 5-year survival rate was 86.8% (Stage I), 58.7% (Stage II), 28.4% (Stage III) and 7.6% (Stage IV), respectively. The 5-year survival after curative resection in the period of 40 years was 45.5%, and increased to 52.7% in the last two decades and 61.8% in recent decade. Stage-specific case proportion during the earlier two decades was 1.4% (Stage I), 10.6% (Stage II), 23.1% (Stage III) and 64.9% (Stage IV), respectively, and that during the recent two decades was 9.3%, 18.5%, 35.3% and 36.8%, respectively. The 5-year survival rate of cases during the earlier two decades was 18.0% and increased to 37.5% during the recent two decades. Multivariate analysis indicated that main prognostic factors of stomach cancer included TNM staging, curative resection and multidisciplinary treatment.
Early detection and curative resection were the most important measures to improve therapeutic effect of stomach cancer. A surgery-predominant multidisciplinary treatment individualizing biological characteristics of tumor, staging of disease and tumor site will contribute to improvement of therapeutic effect of stomach cancer.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2005; 43(17):1109-13.
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ABSTRACT: Along with the advance of medical technology and instruments, many patients with small primary hepatocellular carcinoma (HCC) had been found, who are mainly treated with surgical resection with high postoperative recurrence rate of over 60%. This study was to explore prophylaxis and clinical treatment for these patients to reduce postoperative recurrence rate.
Clinicopathologic data of 283 patients with small HCC, treated in Central Hospital of Kaiping and Cancer Center of Sun Yat-sen University from 1991 through May 2003, were analyzed. Over 85% patients suffered cirrhosis with liver reserve dysfunction, and were mainly treated with irregular hepatectomy. Of the 283 patients, 140 received application of anhydrous alcohol injection or alcohol-soaked gelatin sponge on surgical margin (test group), 143 received no application of alcohol on surgical margin (control group). The 2 groups were comparable in age, gender, tumor location, clinical stage, and Child-Pugh stage.
The 1-year surgical margin recurrence rate was significantly higher in test group than in control group (21.4% vs. 4.4%, P0.05). Intrahepatic metastasis or recurrence rate, 5-year overall survival rate, and tumor-free survival rate were not different between the 2 groups. Both groups had no severe complications.
Application of anhydrous alcohol on surgical margin or anhydrous alcohol injection in remnant liver after irregular hepatectomy may benefit to reduce postoperative recurrence in surgical margin for small PLC, but has no impact on intrahepatic metastases and recurrence in remnant liver.
Ai zheng = Aizheng = Chinese journal of cancer 08/2005; 24(7):834-6.
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ABSTRACT: The resection boundary for gastric cancer is controversial. The study was designed to investigate gastric wall infiltration length of gastric cancer.
A total of 105 patients with gastric cancer who underwent gastrectomy at Cancer Center of Sun Yat-sen University from Apr. 2002 to Feb. 2004 were eligible. During gastrectomy, gastric wall lengths of 18 patients before traction (L1), after traction (L2), and after isolation (L3) were measured. Longitudinal specimen along the center of gastric cancer was fixed to measure the lengths of proximal and distal margins to the cancer. Giant section was observed under microscope to calculate the true infiltration length in proximal and distal margins according to the principle of the length changing uniformity.
In the 18 specimens, L2 was significantly longer than L1 and L3 (P < 0.05); no significant difference was showed between L1 and L3 (P > 0.05). The infiltration length of localized gastric cancer, including early stage cancer, Borrmann I type cancer, and Borrmann II type cancer, was less than 2 cmû that of invasive gastric cancer, including Borrmann III type cancer and Borrmann IV type cancer, was less than 5 cm.
The resection length for localized gastric cancer is at least 2 cm to tumor margin, and for invasive gastric cancer is at least 5 cm to tumor margin.
Ai zheng = Aizheng = Chinese journal of cancer 07/2005; 24(6):707-10.
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ABSTRACT: Whether received radical operation is an important prognostic factor of gastric carcinoma. But the long-term efficacies of radical operation on different patients are not the same. This study was to investigate prognostic factors of gastric carcinoma.
Clinical data of 405 patients with gastric carcinoma, received radical operation from Jan. 1985 to Dec. 1995 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Life table method was used to analyze survival rate, Wilcoxon test was used for statistical comparison, and Cox regression model was used for multivariate analysis.
The 5-year overall survival rate was 43.4%. The 5-year survival rates of patients in pathologic TNM (pTNM) stage I, II, III, and IV were 75.6%, 58.7%, 28.0%, and 18.4%, respectively (P < 0.01). The 5- year survival rates of patients with tumor sizes of less than 2.0 cm, 2.0-3.9 cm, 4.0-5.9 cm, 6.0-7.9 cm, and no less than 8.0 cm were 82.0%, 57.4%, 43.7%, 38.7%, and 26.9%, respectively (P < 0.05). In addition, the 5-year survival rate was higher in patients with perioperative chemotherapy than in patients without perioperative chemotherapy (47.2% vs. 37.8%, P < 0.05). Univariate analysis showed that perioperative chemotherapy, Borrmann type, tumor size, pathologic type, and pTNM stage were prognostic factors of gastric carcinoma. Multivariate analysis showed that pTNM stage, tumor size, and perioperative chemotherapy were independent prognostic factors of gastric carcinoma.
pTNM stage, tumor size, and perioperative chemotherapy are the most significant factors influencing prognosis of gastric carcinoma patients after radical operation. Perioperative chemotherapy contributes to enhance survival rate of gastric carcinoma patients.
Ai zheng = Aizheng = Chinese journal of cancer 06/2005; 24(5):596-9.
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ABSTRACT: Primary hepatic lymphoma (PHL), a rare malignancy, has seldom been reported. This article was to investigate clinicopathologic features and treatment of PHL.
Data of 4 patients with PHL, treated in Cancer Center, Sun Yat-sen University from Nov. 1994 to May 2004, were retrospectively analyzed.
Of the 4 patients, 3 were men, and 1 was woman, with a median age of 53 years old; 3 had single focus, and 1 had multi-foci. All patents were positive for HBV antigen, 3 were misdiagnosed preoperatively, and 1 had no clear diagnosis before operation. Pathologic examination revealed that 3 were B-cell non-Hodgkin's lymphoma, and 1 was Hodgkin's lymphoma. Two patients received resection, and 2 received biopsy; all patients received adjuvant chemotherapy postoperatively.
HBV infection might relate with the development of PHL. PHL should be considered for the patients presented liver mass and B-symptomatolgy. Resection followed by adjuvant chemotherapy with CHOP regiment seems to be the best option for PHL.
Ai zheng = Aizheng = Chinese journal of cancer 03/2005; 24(3):365-7.
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ABSTRACT: Presently, 26.05% of cases with gastric carcinoma hospitalized in Cancer Center of Sun Yat-sen University were revealed adjacent organs involvement in varying degrees in exploration. There have been many arguments about the issue of surgery therapy on these advanced gastric carcinomas for a long time. This study was designed to demonstrate the feasibility of combined multiple organs resection in such cases.
Clinical data of 44 advanced gastric cancer patients received combined multiple organs resections from 1985 to 1995 in Cancer Center of Sun Yat-sen University were enrolled retrospectively. Among them, 34 cases received curative resection and 10 cases received palliative resection. The effects of two kinds of operations were analyzed.
Median survival time was 588 days (average is 1 676 days) in radical combined multiple organs resection group and 344 days (average is 1 045 days) in palliative resection group respectively (P >0.05). In addition, no serious complication occurred and no patients died of extended resection.
Combined multiple organs resection is practicable in curative therapy for gastric carcinoma; even palliative resection may have better treatment effect. So, if permission, radical combined multiple organs resection should be top-priority.
Ai zheng = Aizheng = Chinese journal of cancer 04/2004; 23(3):330-3.
