Table of Content

30 September 2025, Volume 12 Issue 3

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Original article

Efficacy and safety of lenvatinib in patients with hepatocellular carcinoma

Zhou Jianguo, Wang Bingchen, Li Haocheng, Zhang Yuewei, Peng Tao, Liu Hongli, Xiang Xiaojun, Sun Chuandong, Liu Jun, Li Guangming, Li Dewei, Wang Yu, Cai Jianqiang

2025, 12(3):  1-6. 

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Objective: To evaluate the efficacy and safety of the comprehensive treatment regimen based on lenvatinib in patients with HCC.
Methods: This study was a retrospective real-world study. A total of 1,000 HCC patients who received comprehensive treatment based on lenvatinib and were admitted to 13 research centers across the country from January 2022 to December 2024 were included. The basic clinical information of patients, treatment plans, laboratory indicators and survival outcomes were all collected and managed through standardized databases. The primary endpoint of the study was progression-free survival (PFS), and the secondary endpoints included the 1-year PFS rate, 1-year overall survival rate (OS), and safety analysis. Statistical analysis was conducted using Kaplan-Meier survival analysis and log-rank test to evaluate the differences in efficacy among different treatment strategies.
Results: Among 1 000 patients, 83.70% were male, and the median age was 59.0 years (IQR: 52.0, 67.0). In the analysis of the combined disease history of the patients, the disease distribution showed significant differences: The proportion of history of hypertension was the highest (15.60%), followed by history of diabetes (5.80%), and liver cirrhosis (5.00%). The proportion of patients who had received surgical treatment in the past was 30.50%, the proportion of liver resection was 19.50%, and only 1.80% of the patients had received radiotherapy. The application rate of interventional therapy in the population of this study was 34.60%. The positive rate of hepatitis B virus surface antigen was 55.10% and the positive rate of anti-hepatitis C virus antibody was 3.80%. According to the Barcelona Clinic Liver Cancer(BCLC) staging, the proportion of patients in the advanced stage (BCLC-C, D stage) was 28.00%. In terms of treatment regimens, 79.80% of the patients received 8mg lenvatinib treatment, 60.7% of the patients received lenvatinib monotherapy, and 20.8% of the patients received combined immunotherapy. The therapeutic effect analysis showed that the median PFS of the overall patients was 7.0 months (95%CI: 7.0-8.0), and the 1-year OS rate was 97.00%(95%CI: 96.00%-98.00%). The 1-year PFS rate was 16.00%(95%CI: 14.00%-19.00%). The adverse events occurred rate was 23.60% during the follow-up period, and no serious adverse events were observed.
Conclusion: The lenvatinib combination strategy has a positive impact on survival prognosis for HCC patients, but it still needs to be optimized for long-term disease control.

Study on gene signatureabel score for predicting prognosis based on TACE response genes in hepatocellular carcinoma

Yan Dong, Han Shanshan, Cao Jiawei, Xu Fei, Li Huai

2025, 12(3):  7-18. 

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Objective: Predicting the response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is a clinical necessity. This study developed a prognostic gene signature score based on TACE-responsive genes to predict TACE response and prognosis.
Methods: In the GSE104580 dataset, differential expression analysis and weighted gene co‐expression network analysis (WGCNA) were used to identify TACE-responsive genes. In the GSE14520 dataset, Least Absolute Shrinkage Selection Operator (LASSO) - Cox regression model was used to analyze prognosis-related response genes and construct gene signature scores, and then validated in the The Cancer Genome Atlas database and the Human Protein Atlas. The CIBERSORT algorithm was used to analyze the abundance of immune infiltration between TACE responders and non-responders; meanwhile, the relationship with the gene expression of 36 immune checkpoints was analyzed. The CIBERSORT algorithm was used to analyze the immune infiltration of TACE response and non-response; meanwhile, the relationship with the gene expression of 36 immune checkpoints was analyzed.
Results: A total of 276 differentially expressed genes were identified in the GSE104580 dataset (all adj.P<0.05); in WGCNA, module 7 (number of genes = 846) and module 8 (number of genes = 127) were identified to be associated with TACE responses. LASSO-Cox regression model found that CTSO, CLGN and RTP4 genes were independently correlated with patient prognosis (all P<0.05). The area under the curve (AUC) of the gene signature score for predicting 1-, 3-, and 5-years death rates was 0.812(0.748-0.965)、0.785(0.687-0.845), and 0.755(0.697-0.838), respectively. Multiple tumors, TNM stage and gene signature score were independently correlated with the prognosis of patients (all P<0.05). The AUC of Nomogram for predicting 1-, 3-, and 5-year overall survival rates were 0.729 (0.455-0.915), 0.753 (0.651-0.915), and 0.727 (0.616-0.821), respectively. There were differences in the abundance of various immune cells between TACE-responsive and no-responsive patients (P<0.05). CTSO, CLGN and RTP4 genes were correlated with the expression of various immune cells and immune checkpoints (all P<0.05).
Conclusion: Gene signature scores based on CTSO, CLGN and RTP4 genes can predict TACE response and prognosis in HCC patients. The Nomogram constructed by the combination of gene signature scores and clinicopathological parameters is helpful for the clinical translation of research results.

ERCC6L mediates DNA repair and replication signaling to promote hepatocellular carcinoma proliferation and metastasis

Li Dongliang, Zhou Baofu, Du Chaogang, Wu Jing, Huang Cheng

2025, 12(3):  19-29. 

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Objective: To explore the mechanism of ERCC6L gene in hepatocellular carcinoma(HCC).
Methods: The expression and prognostic differences of ERCC6L and DNA methylation levels in HCC cells were analyzed by public databases and immunohistochemistry; the effects of ERCC6L expression on HCC cells proliferation, transfer and invasion were analyzed by in vivo and in vitro experiments, and the cell cycle effects of ERCC6L on HCC cells were analyzed by flow cytometry. The effects of ERCC6L on DNA repair and replication signals (RRM1,RRM2,POLE2 and LIG1) in HCC cells were analyzed by functional enrichment and protein immunoblotting experiments.
Results: ERCC6L mRNA and protein levels were up-regulated in HCC tissues (all P<0.05).The overall survival rate of HCC patients with high expression of ERCC6L was lower than that of patients with low expression (P<0.05). ERCC6L showed hypomethylation status in HCC patients,including cg01004805, cg12747864, cg09743261, cg05279113. Knockdown of ERCC6L inhibited HCC cell viability, proliferation, migration and invasive ability, and reduced HCC tumor growth (all P<0.05). The KEGG signaling pathway of ERCC6L was mainly enriched in cell cycle,DNA replication and Fanconi anemia pathways. Knockdown of ERCC6L expression induced G₀/G₁ phase arrest in HCC cells and decreased the levels of RRM1,RRM2,POLE2 and LIG1 protein expression (all P<0.05).
Conclusion: ERCC6L is highly expressed in HCC patients and mediates worse prognosis by a potential mechanism through mediating DNA repair and replication signaling.

Meta-analysis of the effect of exercise intervention on the quality of life of liver transplant patients

Zheng Yulin, Zhang Lili, Guo Huimin, Liu Xin, Xi Shuangmei, Wang Chaoqun, Gu Yanmei, Jing Xuemin

2025, 12(3):  30-35. 

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Objective: To systematically evaluate the effect of exercise intervention on the quality of life of liver transplant (LT) patients.
Methods: A computer search was performed on databases such as CNKI, Wanfang Database, VIP, Sinomed, Cochrane Library, PubMed, Embase, and Web of Science. The search period was from the establishment of the database to September 2024. The literature that met the inclusion and exclusion criteria was analyzed using Revman5.4.1.
Results: Eight articles were finally included, and Meta analysis results showed that exercise intervention could improve the physical health quality of life of LT patients (WMD=12.15, 95%CI: 4.51-19.78, P=0.020), physiological functioning (WMD=18.42, 95%CI: 5.21-31.63, P=0.006), role physical (WMD=10.02, 95%CI: 0.34-19.71, P=0.040), and could reduce body pain (WMD=12.82, 95%CI: 0.23-25.41, P=0.050), still could improve general health (WMD=11.89, 95%CI: 3.21-20.57, P=0 .007), mental health quality of life (WMD=8.29, 95%CI : 2.77-13.80, P=0.003), vitality (WMD=10.14, 95%CI: 5.89-14.39, P<0.000 01), social functioning (WMD=5.50, 95%CI: 0.75-10.24, P=0.020); but there was no significant effect on role emotional (WMD=15.62, 95%CI: -0.64-31.88, P=0.060) and mental health (WMD=6.85, 95%CI: -5.63-19.32, P=0.280).
Conclusion: Exercise intervention can improve the physical health and some mental health quality of life scores of LT patients.

Review

Current status and prospects of artificial intelligence and 5G technology in synergistic medical-educational application in hepatic surgery

Sheng Jiyao, Wen Xin, Wang Zhenxiao, Liu Shui, Zhang Xuewen

2025, 12(3):  36-40. 

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Hepatic surgery, characterized by complex anatomy and high surgical risks, confronts predicaments in clinical practice including uneven distribution of medical resources, insufficient surgical precision, and low efficiency in remote collaboration in clinical practice. In the field of education, it encounters problems such as abstract and hard-to-understand knowledge, scarce practical opportunities, and unbalanced resource distribution. The deep integration of artificial intelligence (AI) and fifth-generation communication technology (5G) offers a potential solution to these problems. The application of AI and 5G in the medical and educational collaboration of liver surgery is expected to achieve the future development goals of high precision, wide coverage, and strong inheritance in liver surgery through new ideas, methods, and technologies of medical and educational collaboration. Moreover, by leveraging innovative technological transformation means, it can broaden the dimension of technological innovation and enhance the breadth of technological application, playing a greater role in the future medical and educational collaboration of liver surgery.

Research progress of radioembolization with ⁹⁰Y microspheres for hepatocellular carcinoma in downstaging before liver transplantation

Li Kaifu, Fan Jun, Luo De, Su Song, Li Bo, Yang Xiaoli

2025, 12(3):  41-44. 

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Patients with hepatocellular carcinoma who meet the requirements for liver transplantation can benefit from this treatment. The Milan standard for liver transplantation has been surpassed by the majority of hepatocellular carcinoma patients, making it challenging for them to benefit from this therapy. Hepatocellular carcinoma can be treated locally or systemically to lower its stage and patients' tumor loads, allowing more patients to qualify for liver transplantation therapy even if they now fall outside of the standard for transplant candidates. Radioembolization with ⁹⁰Y microspheres, one of the many downstaging phase treatment options, has the benefits of a small dosage and shorter treatment times, small volume targeted administration, a good tumor killing effect, and relatively low toxicity. This article will review the fundamentals of radioembolization using ⁹⁰Y microspheres, the need for downstaging prior to liver transplantation, the effectiveness and safety of radioembolization using ⁹⁰Y microspheres in downstaging prior to liver transplantation, and it's advancement in China.

Nursing field

Nurses' experiences in maintaining peripherally inserted central venous catheter in patients with with hepatocellular carcinoma complicated by hepatitis B: a qualitative study

Li Caiyun, Wang Xin, Guo Huanfei, Zhang Jiwen, Liu Yang, Zhang Wei

2025, 12(3):  45-50. 

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Objective: To explore nurses'experiences in maintaining peripherally inserted central venous catheter (PICC) for patients with hepatocellular carcinoma (HCC) complicated by hepatitis B, and to identify their perceptions and needs in the care process in order to inform improvements in clinical practice.
Methods: Using purposive sampling, in-depth interviews were conducted with 15 nurses from the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences. Data were analyzed using Colaizzi's seven-step phenomenological method.
Result: Three main themes were extracted from nurses' experiences in maintaining PICC for patients with liver cancer complicated by hepatitis B: dual pressure from occupational exposure and maintenance (including the risk of occupational exposure and maintenance difficulties in the context of complex conditions), difficulties in nurse-patient interaction (including strong emotional exhaustion of nurses and insufficient maintenance behaviors of patients), and limitations of training effectiveness.
Conclusion: Nurses face multiple challenges in the process of maintaining PICC for patients with liver cancer complicated by hepatitis B. It is suggested that managers take targeted intervention measures to alleviate nurses' occupational dilemmas (such as optimizing resource allocation and guarantee, strengthening the psychological support system; establishing standardized management systems to improve nurses' PICC nursing competence; innovating educational models to meet patients' disease-related needs; and building regional electronic platforms to enhance patient compliance), and improve the quality of PICC maintenance nursing in the context of complex diseases.