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Validated preoperative computed tomography risk estimation for postoperative hepatocellular carcinoma recurrence

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World Journal of Gastroenterology 2017年第35期23卷 6467-6473页

作者： Wei Zhang Shao-Lv Lai Jie Chen Dong Xie Fei-Xiang Wu Guan-Qiao Jin Dan-Ke Su departments of Radiology Affiliated Tumor Hospital of Guangxi Medical University hepatobiliary surgery Affiliated Tumor Hospital of Guangxi Medical University

AIM To develop and validate a risk estimation of tumor recurrence following curative resection of operable hepatocellular carcinoma(HCC).METHODS Data for 128 patients with operable HCC(according to Barcelona Clinic Liver Cancer imaging criteria) who underwent preoperative computed tomography(CT) evaluation at our hospital from May 1, 2013 through May 30, 2014 were included in this study. Follow-up data were obtained from hospital medical records. Follow-up data through May 30, 2016 were used to retrospectively analyze preoperative multiphasic CT findings, surgical histopathology results, and serum α-fetoprotein and thymidine kinase-1 levels. The χ~2 test, independent t-test, and Mann-Whitney U test were used to analyze data. A P-value of < 0.05 was considered statistically *** During the follow-up period, 38 of 128 patients(29.7%) had a postoperative HCC recurrence. Microvascular invasion(MVI) was associated with HCC recurrence(χ~2 = 13.253, P < 0.001). Despite postoperative antiviral therapy and chemotherapy, 22 of 44 patients with MVI experienced recurrence after surgical resection. The presence of MVI was 57.9% sensitive, 75.6% specific and 70.3% accurate in predicting postoperative recurrence. Of 84 tumors without MVI, univariate analysis confirmed that tumor margins, tumor margin grade, and tumor capsule detection on multiphasic CT were associated with HCC recurrence(P < 0.05). Univariate analyses showed no difference between groups with respect to hepatic capsular invasion, Ki-67 proliferation marker value, Edmondson-Steiner grade, largest tumor diameter, necrosis, arterial phase enhanced ratio, portovenous phase enhanced ratio, peritumoral enhancement, or serum α-fetoprotein *** Non-smooth tumor margins, incomplete tumor capsules and missing tumor capsules correlated with postoperative HCC recurrence. HCC recurrence following curative resection may be predicted using CT.

关键词： Hepatocellular carcinoma Microvascular invasion Computed tomography Recurrence Tumor margin Tumor capsule

Decreased apoptosis in advanced-stage/high-grade hepatocellular carcinoma complicating chronic hepatitis C is mediated through the downregulation of p21 ras

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Chinese Journal of Cancer Research 2013年第3期25卷 281-288页

作者： Nahed Baddour Ebtehal Farrag Ahmed Zeid Essam Bedewy Yousry Taher departments of Pathology Alexandria Egypt departments of hepatobiliary Unit Internal MedicineAlexandria Egypt departments of Tropical Medicine of the Alexandria Faculty of Medicine Alexandria Egypt

Objective and background： Although p21 ras has been reported to be upregulated in hepatocellular carcinoma complicating chronic hepatitis C type I, p21 ras has a different role in advanced stages, as it has been found to be downregulated. The goal of this study was to investigate the status of p21 ras in early-stage/low-grade and late-stage/high-grade hepatocellular carcinoma and its possible link to apoptosis. Material and methods： Thirty-five cases each of chronic HCV hepatitis type 4 （group I） and cirrhosis with hepatocellular carcinoma （HCC） complicating chronic HCV hepatitis （groups Ⅱ and Ⅲ） were immunohistochemically evaluated using a p21 ras polyclonal antibody. The apoptotic index was determined in histologic sections using the terminal deoxynncleotidyl transferase-mediated d-UTP biotin nick end labeling （TUNEL） assay. Results： Significant differences （P=0.001） were detected in p21 ras protein expression between the three groups. A near 2-fold increase in p21 ras staining was observed in the cirrhotic cases compared to the hepatitis cases, and p21 ras expression was decreased in the HCC group, p21 ras expression correlated with stage （r=0.64, P--0.001） and grade （r=-0.65, P=0.001） in the HCC group and grade in the HCV group （r=0.44, P=0.008）. Both p21 ras expression and TUNEL-LI were significantly lower in large HCCs compared to small HCCs （P=0.01 each）. The TUNEL values were negatively correlated with stage in the HCC group （r=-0.85, P=0.001）. The TUNEL values were also negatively correlated with grade in both the HCV and HCC groups （r=0.89, P=0.001 and r=0.53, P=0.001, respectively）. The p21 ras scores were significantly correlated with the TUNEL-LI values in the HCC group （r=0.63, P=0.001） and HCV group （r=0.88, P=0.001）. Conclusions： p21 ras acts as an initiator in HCC complicating type 4 chronic HCV and is downregulated with HCC progression, which most likely promotes tumor cell survival because it facilitates the downregulation of apoptosis with tumor

关键词： p21 ras terminal deoxynucleotidyl transferase-mediated d-UTP biotin nick end labeling (TUNEL) apoptosis HCV type 4 hepatocellular carcinoma

Asymptomatic hepatobiliary cystadenoma of the hepatic caudate lobe: a case report

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The Journal of Biomedical Research 2013年第4期27卷 336-338页

作者： Zhengdong Fei Yeting Zhou Aiqing Peng Bohua Wu Manhong Sun Shifang Wu departments of Ultrasound Shuyang People's Hospital departments of hepatobiliary surgery Shuyang People's Hospital departments of Radiology Shuyang People's Hospital

Human hepatobiliary cystadenoma is a rare benign cystic tumor of the liver, and is extremely rare in the caudate lobe. We herein present a case of a 70-year-old male with a hepatobiliary cystadenoma originating from t... 详细信息

关键词： liver biliary tract cystadenoma MRI ultrasonography

Hepatocyte apoptosis induced by hepatic ischemia-reperfusion injury in cirrhotic rats

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hepatobiliary & Pancreatic Diseases International 2003年第1期2卷 102-105页

作者： Shao-Qiang Li Li-Jian Liang Jie-Fu Huang Zhi Li the departments of hepatobiliary surgeryand Pathology First Affiliated Hospital, Zhongshan University, Guangzhou 510080, China departments of hepatobiliary surgery First Affi-liated Hospital Zhongshan University Guangzhou 510080 China. lesqch@***

OBJECTIVE: To investigate whether hepatocyte apoptosis in hepatic ischemia-reperfusion (I/R) injury is mediated by Fas pathway. METHODS: Fas-mRNA expression detected by in situ hybridization assay, caspase-3 activity measured by fluorescence spectrophotometer, and hepatocyte apoptosis detected by TUNEL assay were compared in different L/R conditions between cirrhotic and normal rats. The relationship was analyzed between hepatocyte apoptosis, Fas-mRNA expression, and caspase-3 activity. RESULTS: In cirrhotic rats, Fas-mRNA expression and caspase-3 activity were significantly increased when the ischemic time prolonged, and subsequently, hepatocyte apoptosis was increased (P<0.O1). Under the same I/R condition, the Fas-mRNA expression, caspase-3 activity and hepatocyte apoptosis in cirrhotic liver were significantly higher than those in normal liver (P<0.O1). CONCLUSIONS: Hepatocyte apoptosis in hepatic I/R injury might be mediated by Fas pathway. The possible underlying mechanism that cirrhotic liver is more sensitive to ischemic injury than normal liver is alteration of Fas expression level.

关键词： ischemia-reperfusion apoptosis cirrhosis Fas caspase-3

Implications of biomarkers in human hepatocellular carcinoma pathogenesis and therapy

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World Journal of Gastroenterology 2014年第30期20卷 10249-10261页

作者： Li-Li Han Yi Lv Hui Guo Zhi-Ping Ruan Ke-Jun Nan Department of Medical Oncology The First Affiliated Hospital of Medical CollegeXi’an Jiaotong University departments of hepatobiliary surgery The First Affiliated Hospital of Medical CollegeXi’an Jiaotong University

Hepatocellular carcinoma(HCC)is one of the most frequent tumors worldwide and accounts for approximately one-third of all *** the past decade,advances have been made to improve the prognosis of HCC,including improvement in the clinical diagnosis of early-stage HCC using molecular biomarkers and molecular-targeted therapy to treat advanced ***,the diagnosis,pathogenesis and targeted therapy of HCC are not completely independent,and should be comprehensively *** example,a number of tumor markers provide useful clinical information not only for prognosis,but also in pathogenesis and treatment ***,this review will focus on the role of several specific biomarkers implicated in the pathogenesis of HCC and several promising molecular-targeted drugs that target the biomarkers of HCC.

关键词： Biomarkers Pathogenesis Hepatocellular carcinoma Targeted therapy MicroRNAs

Subspecialty radiology and surgery

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hepatobiliary & Pancreatic Diseases International 2013年第2期12卷 122-124页

作者： Steven C Cunningham Saleem Farooqui departments of surgery and Radiology Saint Agnes Hospital

The Master said: "Yu! Shall I teach you the meaning of knowledge?When you know a thing to recognize that you know it; and when you do not, to know that you do not know

关键词： Subspecialty radiology and surgery FNH

Endoscopic management of postcholecystectomy biliary leakage

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hepatobiliary & Pancreatic Diseases International 2010年第4期9卷 409-413页

作者： Virendra Singh Gurpreet Singh Ganga R Verma Rajesh Gupta departments of Hepatology Postgraduate Institute of Medical Education and Research departments of surgery Postgraduate Institute of Medical Education and Research

BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known. METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated. RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients Four developed mild pancreatitis which improved with conservative ***: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.

关键词： biliary fistulae endoscopic retrograde cholangiopancreatography sphincterotomy biliary stent nasobiliary drain biliary strictures

Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction

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hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 88-92页

作者： Virendra Singh Gurpreet Singh Vikas Gupta Rajesh Gupta Rakesh Kapoor departments of Hepatology Postgraduate Institute of Medical Education and Research departments of surgery Postgraduate Institute of Medical Education and Research departments of Radiotherapy Postgraduate Institute of Medical Education and Research

BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to ***-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are *** have been no reports on the use of air ***:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical ***:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were *** cholangiography detected type Ⅱ obstruction in all patients,similar to *** patients underwent unilateral *** endoscopic drainage was achieved in all *** mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major *** cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal ***:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.

关键词： air cholangiogram hilar obstruction malignant plastic stent metal stent unilateral

Lymphoepithelial cysts of the pancreas:a management dilemma

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hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 539-544页

作者： Julie Martin Keith J Roberts Maria Sheridan Gavin A Falk Daniel Joyce R Matthew Walsh Andrew M Smith Gareth Morris-Stiff departments of Pancreatic surgery St James's University Hospital departments of Radiology St James's University Hospital Department of General surgery Section of Surgical Oncology/HPB Cleveland Clinic Foundation

Pancreatic lymphoepithelial cysts（LECs） are rare,benign lesions that are typically unexpected post-operative pathological findings. We aimed to review clinical, radiological and pathological features of LECs that may allow their preoperative diagnosis. Histopathology databases of two large pancreatic units were searched to identify LECs and notes reviewed to determine patient demographic details, mode of presentation, investigations, treatment and outcome. Five male and one female patients were identified. Their median age was 60 years. Lesions were identified on computed tomography performed for abdominal pain in two patients, and were incidentally observed in four patients. Five LECs were located in the tail and one in the body of the pancreas, with a median cyst size of 5 cm. Obtaining cyst fluid was difficult and a largely acellular aspirate was yielded. The pre-operative diagnosis was mucinous cystic neoplasm in all patients. This series of patients were treated distal pancreatectomy and splenectomy. A retrospective review of radiological examinations suggested that LECs have a relatively low signal on T2 imaging and a high signal intensity on T1 weighted images. LECs appear more common in elderly males, and are typically incidental, large, unilocular cysts. Close attention to signal intensity on MRI may allow preoperative diagnosis of these lesions.

关键词： lymphoepithelial cyst pancreas