Electronic Journal of Liver Tumor

Expert guidance on three-level prevention of radiation-induced liver diseases

Wu Zhifeng, Zeng Zhaochong

2025, 12(2): 1-7.

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With the improvement of the efficacy of radiotherapy (RT) for abdominal tumors such as liver cancer, the clinical contradiction between the efficacy of RT and the occurrence of radiation-induced liver diseases (RILD) has become increasingly prominent. As one of the dose-limiting complications of abdominal tumor RT, RILD currently lacks a consensus on the clinical three-level prevention. On the basis of elucidating the pathogenesis of RILD, this article summarizes the influencing factors and corresponding prevention and treatment measures of RILD prevention and treatment in three levels, and provides expert guidance, summarizes the influencing factors and corresponding measures for RILD prevention and control at three levels, with the aim of enabling clinicians to be familiar with and master the potential fatal RILD during the RT process for abdominal tumors.

A longitudinal study of the trajectory of change in cancer-related fatigue in patients treated with chemotherapy for advanced hepatocellular carcinoma

Jia Yide, Cao Zhiguo, Wu Deping, Chang Yuanhua, Xiang Zhu

2025, 12(2): 8-13.

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Objective: To investigate the trajectory of cancer-related fatigue (CRF) and its influencing factors in chemotherapy patients with advanced hepatocellular carcinoma (HCC).
Methods: Ninety-five patients with advanced HCC treated between October 2021 and October 2023 in Affiliated Hospital of West Anhui Health Vocational College were selected. Patients' CRF was assessed by Piper fatigue scale-revised (PFS-R) before, after and 1 week after 6 chemotherapy sessions. A mixed growth model was used to identify CRF trajectory subtypes. The Kaplan-Meier method was used to analyze the overall survival of different CRF trajectory subtypes. Multifactorial logistic regression was used to analyze the influencing factors of different CRF trajectory subtypes.
Results: A total of four CRF trajectory subtypes were identified in this study: high fatigue fast-growth type in 15 cases (15.8%), high fatigue moderate-growth type in 10 cases (10.5%), moderate fatigue slow-growth type in 29 cases (30.5%) and low fatigue slow-growth type in 41 cases (43.2%). The overall survival rates of high-fatigue rapid-growth, high-fatigue moderate-growth, moderate-fatigue stable, and low-fatigue slow-growth types increased gradually (all P<0.05). Multifactorial logistic regression analysis showed that age, body mass index and C-reactive protein were the common influencing factors for the three CRF growth types (P<0.05); albumin was a independent influencing factors for the moderate-fatigue slow-growth type (P<0.05); and literacy level and mode of residence were the independent influencing factors for the high-fatigue fast-growth type (all P<0.05).
Conclusion: CRF in advanced HCC chemotherapy patients presented four CRF trajectory subtypes, and the unique influencing factors of different CRF trajectory subtypes were identified, which provided clinical basis and new ideas for the personalized and holistic management of CRF in advanced HCC chemotherapy patients.

Heat shock protein family A member 1A expression is increased in hepatocellular carcinoma and mediates sorafenib resistance

Yang Li, Lu Xue

2025, 12(2): 14-21.

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Objective: To explore the expression of heat shock protein family A member 1A (HSPA1A) in hepatocellular carcinoma (HCC) patients and whether it is involved in sorafenib resistance mechanism.
Methods: The 152 patients with HCC admitted to our hospital from March 2022 to March 2024 were selected. Hub genes mediating sorafenib resistance were screened by three microarray data from the Gene Expression Omnibus database. Resistance genes were further explored by The Cancer Genomic Atlas-HCC cohort, immunohistochemistry (IHC), quantitative real-time polymerase chain reaction (RT-qPCR), western blot (WB) analyses, and cellular function. The correlation between HSPA1A expression and sorafenib 50% inhibitory concentration(IC50) was analysed by drug sensitivity. The relationship between HSPA1A expression and autophagy signalling was analysed by single-sample single sample gene set enrichment analysis (ssGSEA) algorithm.
Results: HSPA1A expression was significantly higher in both sorafenib-treated and resistance tissues (P<0.05). IHC, RT-qPCR and WB confirmed that HSPA1A expression levels were higher in sorafenib-resistant patients than in responding patients (all P<0.05). Gene Expression Profiling Interactive Analysis database and IHC showed significantly higher HSPA1A protein expression in HCC tissues. Clinical cohorts and the Kaplan-Meier plotter database confirmed lower overall survival rate and relapse-free survival rate in patients with high HSPA1A expression (all P<0.05). CCK-8, clone formation, scratch and invasion assays confirmed that knockdown of HSPA1A significantly inhibited Huh-7 and MHCC97-L cell viability, proliferation, migration and invasion ability (all P<0.05).CCK-8 assay showed that the IC50 of sorafenib in Huh-7 and MHCC97-L cells knocked down by HSPA1A decreased by 17.4% and 19.3% (all P<0.05), increasing the therapeutic sensitivity of sorafenib. ssGSEA analysis showed that high HSPA1A mRNA expression inhibited autophagy activity (P<0.05).
Conclusion: HSPA1A expression is increased in HCC and may be involved in the mechanism of sorafenib resistance, and the underlying mechanism may be related to autophagy signalling. Further experiments are needed to explore the potential mechanism of HSPA1A in HCC and provide new strategies to overcome sorafenib resistance.

Advances in study on farnesoid X receptor in hepatocellular carcinoma

Zhao Weihua, Li Changying

2025, 12(2): 22-25.

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Farnesoid X receptor (FXR) is a ligand-activated transcription factor involved in the control of bile acid synthesis and enterohepatic circulation. In recent years, more and more studies have shown that the expression of hepatic FXR is inversely correlated with multiple malignant clinicopathological characteristics of hepatocellular carcinoma. This article reviewed the advances in study on FXR in hepatocellular carcinoma to provide necessary reference for the prevention and treatment of hepatocellular carcinoma.

Research progress on resection margin of liver metastasis in colorectal cancer

Han Jixiang, Zhao Jianjun, Wang Jingtao

2025, 12(2): 26-29.

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The resection margin of liver metastases refers to the distance from the tumor edge to the liver section. The liver is the main target organ for distant metastasis of colorectal cancer. The issue of resection margin should not only follow the basic principles of liver surgery, but also consider the unique biological characteristics of colorectal liver metastases. Surgical resection margin is the focus and difficulty in surgical treatment. The definition of R0 resection has undergone a shift from a margin greater than 1 cm to greater than 1 mm. With further research, tumor R1 resection has gradually been proposed and accepted under specific conditions. High tumor burden, RAS gene mutations, tumor pathology, and vascular relationships are associated with higher R1 resection rates. This article intends to review and analyze the study of surgical margins for liver metastases in colorectal cancer.

Evidence summary for perioperative pain management in patients with open hepatectomy

Niu Yushuo, Li Cuicui, Wang Lin, Li Yajun, Zhao Runan, Hou Xiaohong

2025, 12(2): 30-36.

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Objective: To retrieve, evaluate, and integrate evidence of perioperative pain management in patients with open hepatectomy, and to provide references for clinical nursing practice.
Methods: Clinical decisions, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews, and meta-analyses related to perioperative pain management in patients with open hepatectomy were systematically searched from domestic and foreign databases. The search period is from the inception of the databases until August 2023. Three researchers assessed the quality of the literature and extracted and summarized evidence based on this topic.
Results: A total of 18 articles were included, including 1 clinical decision, 4 guidelines, 3 expert consensus, 2 evidence summaries, and 8 systematic reviews. A total of 31 pieces from 8 aspects of evidence were summarized, including team building, pain assessment, pain planning, pain education, preventive analgesia, multimodal analgesia, and dynamic evaluation.
Conclusion: This study summarizes the evidence for perioperative pain management in patients with open hepatectomy and provides a reference basis for clinical practice. Medical staff should take good nursing measures for pain management according to the clinical situation to reduce patients' postoperative pain.

Research on the application of clinical nursing based on the target theory in the transcatheter arterial chemoembolization treatment of patients with intermediate and advanced liver cancer

Kou Yinhu

2025, 12(2): 37-41.

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Objective: To explore the impact of clinical nursing based on the target theory on the recovery and prognosis of patients with intermediate and advanced liver cancer treated with transcatheter arterial chemoembolization (TACE).
Methods: 92 patients with intermediate and advanced liver cancer who were treated with transdermal puncture TACE in Beijing Friendship Hospital, Capital Medical University from February 2022 to March 2024 were selected as the research subjects. They were divided into a control group and a research group according to the random number table method. The number of patients was 46 in each case. The control group received routine nursing care, while the research group adopted clinical care based on the standard theory in addition to routine care. Hospitalization (length of stay, cost of stay), pain (visual analogue scale [VAS] score), psychological state (Hamilton anxiety scale [HAMA] score, Hamilton depression scale [HAMD] score), quality of life (quality of life questionnaire-core 30 [QLQ-C30] score) and occurrence of complications were compared between the two groups.
Results: There was no significant difference in hospitalization time and hospitalization expenses between the two groups (both P>0.05). Before nursing, there was no significant difference in the VAS score, HAMA score, HAMD score and QLQ-C30 score between the two groups of patients (all P>0.05). After nursing, the VAS score, HAMA score, and HAMD score of the two groups of patients were significantly decreased, and the decrease was more significant in the study group (all P<0.05); After care, the QLQ-C30 scores of both groups of patients increased significantly, and the increase was more significant in the study group (P<0.05); the incidence of complications in the study group was significantly lower than that of the control group (P<0.05).
Conclusion: Clinical nursing based on target-reaching theory can relieve pain, improve negative emotions, and improve quality of life for patients with advanced liver cancer treated with percutaneous TACE.

A network Meta-analysis of the impact of various teaching methods on medical students' doctor-patient communication

Yang Min, Zhou Yongjia, Xu Caihua, Liu Jingyi, Zhou Haiyan, Li Jiang, Cong Minghua

2025, 12(2): 44-53.

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Objective: To compare the effectiveness of different teaching methods in enhancing the communication skills of medical students in China, providing evidence-based recommendations for optimal teaching strategies.
Methods: From the establishment of the library until October 15, 2024, a systematic search was conducted in seven databases, including China National Knowledge Infrastructure, China Biomedical Literature Database, PubMed, and Web of Science, to evaluate teaching methods on doctor-patient communication among Chinese medical students. Two independent reviewers screened the studies, extracted relevant data, assessed the risk of bias, and performed statistical analyses.
Results: A total of 26 studies involving 2 045 participants and 14 different teaching methods were included. Network Meta-analysis and cumulative ranking probability plots indicated that case-based learning combined with standardized patient teaching (weighted mean difference [WMD]=7.68, 95% confidence interval [95%CI]: 4.76-10.59) and small private online course combined with case-based learning (WMD=7.67, 95%CI: 1.04-14.30) were the most effective in improving medical students' doctor-patient communication skills. Subgroup analysis showed that case-based learning alone was more effective in improving communication skills among medical students and interns, while case-based learning combined with standardized patient teaching was more effective for residents and attending physicians.
Conclusion: Case-based learning combined with standardized patient learning or small private online course appear to be superior to other teaching methods for enhancing doctor-patient communication skills. However, the selection of teaching strategies should be tailored to the specific characteristics of the learners to maximize effectiveness in practical applications.

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