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Malignant biliary obstruction: treatment with interventional radiology

Chinese Medical Journal 2003年第6期116卷 888-892页

作者：翟仁友钱晓军戴定可于平 department of interventional Radiology Beijing Chaoyang HospitalCapital University of Medical SciencesBeijing 100020China

Objective To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction.Methods From January 1995 to Febuary 2001, 243 consecutive patients (161 men and 82 women; aged 26-91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.Results One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8. 64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7. 5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11. 3 months (log rank 32.8, P < 0.001) with an average patency of 9. 7 months(log rank 4. 7, P<0. 05).Conclusion Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After s

关键词： jaundice obstructive·stent·interventional radiology

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Multi-parameter gene expression profiling of peripheral blood for early detection of hepatocellular carcinoma

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World Journal of Gastroenterology 2018年第3期24卷 371-378页

作者： Hui Xie Yao-Qin Xue Peng Liu Peng-Jun Zhang Sheng-Tao Tian Zhao Yang Zhi Guo Hua-Ming Wang department of interventional Therapy 302 Hospital of People’s Liberation Army department of interventional Therapy Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for Cancer department of interventional Therapy Shanxi Province Cancer HospitalShanxi Medical University Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Interventional Therapy DepartmentPeking University Cancer Hospital and Institute

AIM In our previous study, we have built a nine-gene(GPC3, HGF, ANXA1, FOS, SPAG9, HSPA1 B, CXCR4, PFN1, and CALR) expression detection system based on the Ge XP system. Based on peripheral blood and Ge XP, we aimed to analyze the results of genes expression by different multi-parameter analysis methods and build a diagnostic model to classify hepatocellular carcinoma(HCC) patients and healthy *** Logistic regression analysis, discriminant analysis, classification tree analysis, and artificial neural network were used for the multi-parameter gene expression analysis method. One hundred and three patients with early HCC and 54 age-matched healthy normal controls were used to build a diagnostic model. Fiftytwo patients with early HCC and 34 healthy people were used for validation. The area under the curve, sensitivity, and specificity were used as diagnostic *** Artificial neural network of the total nine genes had the best diagnostic value, and the AUC, sensitivity, and specificity were 0.943, 98%, and 85%, respectively. At last, 52 HCC patients and 34 healthy normal controls were used for validation. The sensitivity and specificity were 96% and 86%, *** Multi-parameter analysis methods may increase the diagnostic value compared to single factor analysis and they may be a trend of the clinical diagnosis in the future.

关键词： Hepatocellular carcinoma Peripheral blood Early detection Multi-parameter Diagnostic value

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Efficacy and safety of targeted therapy plus immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX) for unresectable hepatocarcinoma

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World Journal of Gastroenterology 2024年第17期30卷 2321-2331页

作者： Zhi-Peng Lin Xiao-Long Hu Du Chen Da-Bei Huang Xu-Gong Zou Hai Zhong Sheng-Xiang Xu Yuan Chen Xiao-Qun Li Jian Zhang department of interventional Medicine Zhongshan People’s HospitalZhongshan 528400Guangdong ProvinceChina

BACKGROUND The advent of cutting-edge systemic therapies has driven advances in the treatment of hepatocellular carcinoma(HCC),and therapeutic strategies with multiple modes of delivery have been shown to be more efficacious than ***,the mechanisms underlying this innovative treatment modality have not been *** To evaluate the clinical efficacy of targeted therapy plus immunotherapy combined with hepatic arterial infusion chemotherapy(HAIC)of FOLFOX in patients with unresectable *** We enrolled 53 patients with unresectable HCC who received a combination of targeted therapy,immunotherapy,and HAIC of FOLFOX between December 2020 and June 2021 and assessed the efficacy and safety of the treatment *** The objective response rate was 60.4%(32/53),complete response was 24.5%(13/53),partial response was 35.9%(19/53),and stable disease was 39.6%(21/53).The median duration of response and median progression-free survival were 9.1 and 13.9 months,*** surgical conversion rate was 34.0%(18/53),and 1-year overall survival was 83.0%without critical complicating diseases or adverse events(AEs).CONCLUSION The regimen of HAIC of FOLFOX,targeted therapy,and immunotherapy was curative for patients with unresectable HCC,with no serious AEs and a high rate of surgical conversion.

关键词： Hepatocellular carcinoma Hepatic arterial infusion chemotherapy Targeted therapy Immunotherapy Adverse events

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Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

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World Journal of Gastroenterology 2009年第15期15卷 1843-1848页

作者： Rodolfo Sacco Marco Bertini Pasquale Petruzzi Michele Bertoni Irene Bargellini Giampaolo Bresci Graziana Federici Luigi Gambardella Salvatore Metrangolo Giuseppe Parisi Antonio Romano Antonio Scaramuzzino Emanuele Tumino Alessandro Silvestri Emanuele Altomare Claudio Vignali Alfonso Capria Gastroenterology department Pisa University Hospital Institute of Interna Medicine University of Foggia department of Diagnostic and interventional Radiology Pisa University Hospital

AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION：

关键词： Hepatocellular carcinoma Transarterialchemoembolization Liver function Liver cirrhosis Child-Pugh score

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Drug-eluting beads chemoembolization combined with programmed cell death 1 inhibitor and lenvatinib for large hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2024年第11期16卷 4392-4401页

作者： Hui Yang Guang-Ping Qiu Jie Liu Tie-Quan Yang department of interventional Therapy Ningbo No.2 HospitalNingbo 315000Zhejiang ProvinceChina

BACKGROUND The combination of transarterial chemoembolization(TACE),lenvatinib,and programmed cell death 1(PD-1)inhibitor has been widely used in the treatment of advanced hepatocellular carcinoma(HCC)and has achieved promising ***,there are few studies comparing whether drug-eluting beads TACE(DTACE)can bring more survival benefits to patients with large HCC compared to conventional TACE(C-TACE)in this triplet *** To compare the efficacy and adverse events(AEs)of triple therapy comprising DTACE,PD-1 inhibitors,and lenvatinib(D-TACE-P-L)and C-TACE,PD-1 inhibitors,and lenvatinib(C-TACE-P-L)in patients with large HCC(maximum diameter≥5 cm),and analyze the prognostic *** Following a comprehensive review of our hospital’s medical records,this retrospective study included 104 patients:50 received D-TACE-P-L,and 54 received *** employed Kaplan-Meier estimation to assess the median progression-free survival(PFS)between the two groups,utilized Cox multivariate regression analysis to identify prognostic factors,and applied theχ2 test to evaluate *** The objective response rate(ORR)and median PFS were significantly higher in the D-TACE-P-L group compared to the C-TACE-P-L group(ORR:66.0%vs 44.4%,P=0.027;median PFS:6.8 months vs 5.0 months,P=0.041).Cox regression analysis identified treatment option,portal vein tumor thrombus,and hepatic vein invasion as protective factors for *** were comparable between the two CONCLUSION D-TACE-P-L may have significantly better PFS and ORR for large HCC,while exhibiting similar AEs to C-TACE-PL.

关键词： Large hepatocellular carcinoma Conventional transarterial chemoembolization Drug-eluting beads transarterial chemoembolization Programmed cell death 1 inhibitor Lenvatinib

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Role of Transarterial Chemoembolization in the Treatment of Hepatocellular Carcinoma

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Journal of Clinical and Translational Hepatology 2023年第2期11卷 480-489页

作者： Bin-Yan Zhong Zhi-Cheng Jin Jian-Jian Chen Hai-Dong Zhu Xiao-Li Zhu department of interventional Radiology the First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina Center of interventional Radiology&Vascular Surgery Department of RadiologyZhongda HospitalMedical SchoolSoutheast UniversityNanjingJiangsuChina

Hepatocellular carcinoma(HCC)is one of the most common cancers *** to the Barcelona Clinic Liver Cancer(BCLC)staging system,transarterial chemoembolization(TACE)is the first-line recommendation for intermediate-stage *** real-world clinical practice,TACE also plays an important role in early-and advanced-stage *** review article by the experts from Chinese Liver Cancer Clinical Study Alliance(CHANCE)summarizes the available clinical evidence pertaining to the current application of TACE in patients with early-,intermediate-,and advanced-stage *** addition,combination of TACE with other treatment modalities,especially immunotherapy,is reviewed.

关键词： Hepatocellular carcinoma TACE Immunotherapy

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Cullin 4A is associated with epithelial to mesenchymal transition and poor prognosis in perihilar cholangiocarcinoma

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World Journal of Gastroenterology 2017年第13期23卷 2318-2329页

作者： Tong-Jun Zhang Dong Xue Cheng-De Zhang Ze-Dong Zhang Qing-Ran Liu Jian-Qiang Wang department of interventional Vascular Surgery The People's Hospital of Binzhou department of General Surgery The People's Hospital of Binzhou

AIM To explore the functional role of cullin 4A(CUL4A), a core subunit of E3 ubiquitin ligase, in perihilar cholangiocarcinoma(PHCC).METHODS The expression of CUL4 A in PHCC cell lines was evaluated by Western blot and quantitative reverse transcription-polymerase chain reaction. Immunohistochemistry(IHC) was adopted to investigate the relationship between CUL4 A expression and clinicopathological characteristics of PHCC. Univariate analysis and multivariate regression analysis were performed to analyze the risk factors related to overall survival(OS) and progression-free survival(PFS) of PHCC patients. Wound healing, Transwell and Matrigel assays were utilized to explore the function of CUL4 A in PHCC metastasis. Furthermore, expression of epithelial to mesenchymal transition(EMT) markers was verified in cells with CUL4 A knockdown or overexpression. The relationship between CUL4 A expression and E-cadherin expression was also analyzed by IHC assay. Finally, the role of ZEB1 in regulating CUL4 A mediated PHCC was detected by IHC, Western blot, Transwell and Matrigel *** CUL4 A overexpression was detected in PHCC cell lines and clinical specimens. Clinicopathological analysis revealed a close correlation between CUL4 A overexpression and tumour differentiation, T, N and TNM stages in PHCC. Kaplan-Meier analysis revealed that high CUL4 A expression was correlated with poor OS and PFS of PHCC patients. Univariate analysis identified the following four parameters as risk factors related to OS rate of PHCC: T, N, TNM stages and high CUL4 A expression; as well as three related to PFS: N stage, TNM stage and high CUL4 A expression. Further multivariate logistic regression analysis identified high CUL4 A expression as the only independent prognostic factor for PHCC. Moreover, CUL4 A silencing in PHCC cell lines dramatically inhibited metastasis and the EMT. Conversely, CUL4 A overexpression promoted these processes. Mechanistically, ZEB1 was discovered to regula

关键词： perihilar cholangiocarcinoma epithelial to mesenchymal transition ZEB1 Cullin 4A metastasis prognosis

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Prognostic factors for survival after transarterial chemoembolization combined with microwave ablation for hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第46期20卷 17483-17490页

作者： Jia-Yan Ni Hong-Liang Sun Yao-Ting Chen Jiang-Hong Luo Dong Chen Xiong-Ying Jiang Lin-Feng Xu department of interventional Radiology Sun Yat-sen Memorial HospitalSun Yat-sen University

AIM: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).

关键词： Hepatocellular carcinoma Transarterial chemoembolization Microwave ablation Survival Prognosis

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Spontaneous rupture of intrahepatic pseudocyst into the inferior vena cava

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Gastroenterology Report 2018年第3期6卷 225-227,I0003页

作者： Yashwant Patidar Binit Sureka Vaibhav Pratap Singh Kalpana Bansal Rakhi Maiwall department of Radiology/interventional Radiology Institute of Liver and Biliary SciencesNew DelhiIndia

We present an extremely rare case of caudate lobe intrahepatic pancreatic pseudocyst with spontaneous rupture into the inferior vena cava(IVC).A 58-year-old male,a chronic alcoholic,presented with features of pancreatitis for which imaging was *** and contrast-enhanced computed tomography were carried out,which revealed intrahepatic pancreatic pseudocyst in the caudate lobe of the *** was suggestion of spontaneous rupture of the pseudocyst into the IVC,which was well delineated on imaging.

关键词： pancreatic pseudocyst spontaneous rupture inferior vena cava

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Tissue plasminogen activator via cross-collateralization for tandem internal carotid and middle cerebral artery occlusion

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World Journal of Clinical Cases 2013年第9期1卷 290-294页

作者： Ketan R Bulsara Asiri Ediriwickrema Joshua Pepper Fergus Robertson John Aruny Joseph Schindler Neurosurgical department Yale and New Haven Hospital Yale University School of Medicine interventional Radiology department National Hospital for Neurology and Neurosurgery interventional Radiology department Yale and New Haven Hospital

Tandem internal carotid and middle cerebral artery occlusion after carotid dissection predicts poor outcome after systemic thrombolysis. Current treatments include the use of endovascular carotid stenting, which carries with it a high risk of propagating further embolic events and worsening the dissection. New strategies for avoiding the aforementioned side-effects include recanalization using cross-collaterals for delivery of intra-lesional tissue plasminogen activator(t PA). We present two cases that provide further support for this novel approach. Both patients presented with a National Institute of Health Stroke Scale of 20, received intra-arterial t PA via cross-collateralization, and made full recoveries without the need for stenting.

关键词： Tandem internal carotid artery and middle cerebral artery occlusion Intra-arterial tissue plasminogen activator Carotid artery dissection

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