Objective To summarize clinicopathological characteristics and prognosis of hepatocellular carcinoma (HCC) expressing " stemness”-related markers. Method The clinical researches on HCC expressing " stemness”-related markers in recent years were reviewed. Results The HCC expressing " stemness”-related markers was the special subtype with the aggressive biological behavior as compared with the conventional HCC, which were associated with the increased serum α-fetoprotein level, vascular invasion, larger tumor, poor differentiation, and poor clinical outcome. The approved " stemness”-related markers included EpCAM, CD133, K19, and CD44, which often co-expressed and had their own characteristics. The presentation of " stemness”-related marker was heterogeneous and it increased the difficulty to carry on the research of therapeutic agents targeted against this aggressive HCC. Conclusion HCC expressing " stemness”-related marker is a special subtype with a strong invasiveness, which provides a new direction of targeting therapy for HCC.
ObjectiveTo summarize the complete response (CR, which referred to the imaging level) achieved by conversion therapy for hepatocellular carcinoma (HCC) in the current researches, and explore the further therapy strategies and outcomes for patients acquired CR. MethodThe domestic and foreign literature on the research of CR achieved by conversion therapy for HCC was reviewed and summarized. ResultsWith the great progress of conversion therapy such as local therapy, systemic therapy, and local therapy in combination with systemic therapy for HCC, the proportion of the CR was increasing after conversion therapy. For the patients who achieved CR after conversion therapy, the surgical resection, liver transplantation, follow-up observation, etc. could be selected and showed a survival benefit. Conclusions From the opinion summarized in this review, with the development of targeted therapy and immunotherapy, as well as the new anti-tumor drugs, a growing number of conversion therapeutic schedules could be provided, CR rate was increasing. At present, for patients who have achieved CR after conversion therapy, surgical or non-surgical treatment can be chosen. However, there is no authoritative conclusion on which therapy method can benefit patients more. The current strategy is to perform personalized treatment plan based on the individual situation of patient, in order to achieve better survival benefit for patient.
【Abstract】Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team (MDT), we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department Ⅲ in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, double-circle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （Pgt;0.05）, which were （5.64±2.00） d in single-circle group, (5.80±3.74） d in double-circle group, （6.22±2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （Plt;0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （Plt;0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （Plt;0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （Plt;0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （Plt;0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （Plt;0.01）. But abdominal distention and diarrhea response had no difference among three groups （Pgt;0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7％(12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （Plt;0.05）. The difference of postoperative intake time, between triple-circle group and single-circle group, between triple-circle group and double-circle group, had statistical significance （Plt;0.05）. But wound recover time among three groups had no obvious difference （Pgt;0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
ObjectiveTo investigate the expression change characteristic of stemness-related markers for recurrent hepatocellular carcinoma (HCC), and to discuss the relationship between stemness-related markers and clinicopathologic characteristics of HCC.MethodsWe collected 25 recurrent HCC patients who also had the first liver resection for HCC in Sichuan Cancer Hospital from Jan. 2010 to Oct. 2018. Immunohistochemistry was used to compare expressions of CD133, CD90, CD117, and epithelial cell adhesion molecule (EpCAM) in HCC tissues. Fluorescence in situ hybridization was used to detect telomere length.ResultsThe primary HCC had higher platelet count, larger tumor, less microvascular invasion (MVI), and less multiple HCC than the recurrent HCC (P<0.05), but the expressions of CD90, CD133, CD117, and EpCAM were not significantly differed after recurrence (P>0.05). The expressions of CD90, CD133, CD117, and EpCAM were not associated with tumor size, tumor number, Barcelona Clinic Liver Cancer Staging (BCLC staging), satellite nodules, and differentiation (P>0.05). The MVI-positive group had a significantly higher expression level of EpCAM (P=0.016) and longer telomere length (P=0.001). The telomere length was longer for tumors diameter less than 5 cm (P=0.038) and poor differentiation (P=0.046). Correlation analysis found that there was no relationship between telomere length and expression levels of EpCAM (r=–0.092, P=0.513), CD90 (r=–0.235, P=0.100), CD133 (r=0.024, P=0.867), and CD117 (r=–0.277, P=0.052), but an apparent positive correlation between expression levels of EpCAM and CD133 was found (r=0.358, P=0.011). Survival analysis found that poor differentiation (P=0.003) and BCLC B–C staging (P=0.040) were the risk factors of disease-free survival for patients after first HCC resection, and BCLC B–C staging (P=0.017) and tumor diameter more than 5 cm (P=0.035) were the risk factors for recurrent HCC.ConclusionsRecurrent HCC had similar stemness-related markers expression and longer telomere length. Expression level of EpCAM and telomere length were associated with MVI.
Objective To diagnose and treat a patient with obstructive jaundice and hepatic bile duct tumor by multi-disciplinary team (MDT) and to provide individualized treatment. Methods By MDT model, a patient with obstructive jaundice and hepatic bile duct tumor, who was ever misdiagnosed as hilar cholangiocarcinoma, was discussed. The diagnosis, perioperative period management, and operation scheme were carried out by the MDT. Results After discussion of MDT, the patient was diagnosed as " hepatocellular carcinoma with bile duct tumor thrombi”, not " hilar cholangiocarcinoma”. Although hepatocellular carcinoma with bile duct tumor thrombi was end-stage disease, radical treatment was still considered. A plan of treatment was carried out by the MDT. Firstly, the percutaneous transhepatic cholangial drainage was operated for the predicted reserved half liver to relieve biliary obstruction. Secondly, hemihepatectomy combined with bile duct resection was carried out by the surgery team. The patient had nice postoperative recovery and there was no tumor recurrence after 6-month follow-up after surgery up to now. Conclusions MDT model do not only reduce misdiagnose, but also can provide the best therapeutic regimen and individualized treatment for patient presented with obstructive jaundice and hepatic bile duct tumor.
ObjectiveTo discuss the relation between postoperative prognostic nutritional index (PNI) and serious complications (Clavien-Dindo complications classification Ⅲ to Ⅴ) after hepatectomy for patients with hepatocellular carcinoma (HCC). MethodsAccording to the inclusion and exclusion criteria, the HCC patients who underwent hepatectomy in the Sichuan Cancer Hospital from January 2009 to January 2016 were retrospectively collected. The predictive ability of postoperative PNI for postoperative complications was evaluated by receiver operating characteristic (ROC) curve, and the optimal cutoff value was determined. At the same time, the related factors affecting the severe complications and overall survival after hepatectomy in the HCC patients were analyzed by non-conditional logistic regression and Cox proportional hazards regression analysis, respectively. ResultsA total of 779 patients were enrolled, and the postoperative complications occurred in 238 (30.6%) cases, including 68 (8.7%) cases of serious complications. The postoperative PNI of all patients was 35.8±4.9, the ROC curve analysis showed that the area under the ROC curve of postoperative PNI for predicting postoperative severe complications was 0.735, the optimal cutoff value was 35.7, and the sensitivity and specificity were 0.868 and 0.518, respectively. The patients were classified as a lower postoperative PNI (≤35.7, 397 patients) and higher postoperative PNI (>35.7, 382 patients) based on the optimal cutoff value. Compared with patients with higher postoperative PNI, the patients with lower postoperative PNI had later stage of tumor (P<0.001) , worse liver function (P<0.05), and larger volume of excised liver (P<0.001), more blood loss (P<0.001), and higher proportion of intraoperative blood transfusion (P<0.001), higher serious complication (P<0.001) and mortality (P=0.039). The multivariate logistic regression analysis found that the preoperative Child-Pugh score grade B, American Society of Anesthesiologists grade Ⅲ–Ⅳ, intraoperation blood transfusion, preoperative decreased platelet level, and lower postoperative PNI increased the probability of postoperative serious complications in the HCC patients (P<0.05). The overall survival of HCC patients with higher postoperative PNI was better than that of patients with lower postoperative PNI (P=0.007), but there was no statistical difference in tumor-free survival between the two (P=0.073), and it was not fount that the postoperative PNI was associated with the overall survival of HCC patients underwent hepatectomy by the Cox proportional hazards regression multivariate analysis (P=0.276). ConclusionsThe optimal cutoff value of postoperative PNI for predicting postoperative serous complications determined in this study is 35.7, which has a higher predictive value. Patients with higher postoperative PNI and lower postoperative PNI in incidence of postoperative serious complications are obviously different, patients with higher postoperative PNI has a better overall survival than those with lower postoperative PNI.
Objective To learn and analyse the current clinicians’ knowledge and attitudes towards patient safety, and to provide relevant evidence for future medical education. Method We conducted a survey on clinicians mainly in West China Hospital of Sichuan University with group random sampling method. We analysed the data on the clinicians’ knowledge and attitudes with SPSS softerware. Result Totally 300 questionnaires were distributed, of which 258 were completed adequately. The results showed the clinicians’ knowledge on patient safety was poor, however, the respcnse from the clinicians in Outpatient Department were better than those in Inpatient Department. The majority of the clinicians (above 95.00%) were willing to learn the knowledge of patient safety. Conclusion As the clinicians are willing to learn the knowledge of patient safety positively, it is necessary to integrate patient safety education into the current medical education curriculum.
ObjectiveTo investigate the effects of telomerase reverse transcriptase (TERT) promoter mutation and TERT mRNA expression on the prognosis of patients with hepatocellular carcinoma (HCC) after radical resection, and the clinicopathological factors affecting the prognosis of patients with HCC after radical resection were explored.MethodsClinical data of 212 HCC patients underwent radical resection from Jan. 2009 to Jan. 2016 in The Affiliated Cancer Hospital of University of Electronic Science and Technology of China were selected and analyzed. The mutations of TERT, TP53, and catenin beta 1 (CTNNB1) were detected by Sanger sequencing, and the expression of TERT mRNA was detected by SYBR. Patients were followed up routinely and their overall survival (OS) and disease-free survival (DFS) were recorded.ResultsThe mutation rates of the TERT promoter, TP53, and CTNNB1 gene were 17.9% (38/212), 40.1% (85/212), and 13.7% (29/212), respectively. The TERT promoter mutation had significant correlation with Child-Pugh classification and preoperative albumin value (P<0.05). Expression level of TERT mRNA had significant correlation with HBV infection, Child-Pugh classification, preoperative AST value and ALT value (P<0.05). Cox proportional hazards regression result showed that anatomical hepatectomy, tumor diameter>5 cm, and high expression of TERT mRNA were significant prognostic factors of OS (P<0.05); preoperative platelets count≤100×109/L, tumor diameter>5 cm, and high expression of TERT mRNA were significant prognostic factors of DFS (P<0.05).ConclusionFor patients after HCC surgery, high expression of TERT mRNA may be a key factor affecting the prognosis of HCC patients.