Electronic Journal of Liver Tumor

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Electronic Journal of Liver Tumor 2025, 12 (4): 1-4.

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

Yang Li, Lu Xue

Electronic Journal of Liver Tumor 2025, 12 (2): 14-21.

Abstract （61）

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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.

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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

Electronic Journal of Liver Tumor 2025, 12 (2): 44-53.

Abstract （60）

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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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Correlation analysis of the indocyanine green retention rate at 15 minutes and the prognosis of patients with primary liver cancer after liver resection surgery

Zhang Mingming, Yang Ning, Wang Haijiao, Wang Xinran

Electronic Journal of Liver Tumor 2025, 12 (4): 14-19.

Abstract （58）

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Objective: To analyze the correlation between the indocyanine green retention rate at 15 minutes(ICG-R15) and the prognosis of liver cancer patients after liver resection surgery.
Method: The clinical data of 242 patients with hepatocellular carcinoma from Xuanwu Hospital of Capital Medical University from May 2024 to March 2025 were collected. Among them, 130 cases had an ICG-R15 value less than 10%, and 112 cases had an ICG-R15 value of 10% or higher. The correlation between different ICG-R15 and surgical prognosis indicators (operation duration, intraoperative blood loss, number of intraoperative drainage tubes, hospital stay, hospital expenses, 24-hour postoperative pain score, postoperative hospital stay, discharge activities of daily living [ADL] score, postoperative liver function, postoperative liver function Child-Pugh classification, postoperative model for end-stage liver disease [MELD] score) was compared.
Result: The single-factor analysis showed that there were statistically significant differences in the operation duration, intraoperative blood loss, postoperative hospital stay, discharge ADL score, postoperative liver function, postoperative liver function Child-Pugh classification, and postoperative MELD score between the two groups (all P<0.05). The multivariate logistic regression analysis revealed that the operation duration, postoperative hospital stay, postoperative liver function, postoperative liver function Child-Pugh classification, and postoperative MELD score were all correlated with the preoperative ICG-R15 level (P<0.05).
Conclusion: ICG-R15 has a predictive effect on the postoperative liver function of patients with primary liver cancer. Preoperative determination of ICG-R15 levels is of great significance for evaluating liver reserve function, predicting the occurrence of postoperative liver dysfunction, and optimizing surgical treatment plans.

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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

Electronic Journal of Liver Tumor 2025, 12 (3): 1-6.

Abstract （57）

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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.

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Efficacy and safety analysis in the treatment of unresectable intrahepatic cholangiocarcinoma by transcatheter arterial chemoembolization with small diameter drug-eluting beads

Xuan Zhiming, Yao Xuesong, Song Peng, Li Shupei, Lai Fengyong, Feng Yexia

Electronic Journal of Liver Tumor 2025, 12 (4): 8-13.

Abstract （54）

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Objective: To evaluate the efficacy and safety of drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) with small diameter drug-eluting beads (DEBs) in the treatment of unresectable intrahepatic cholangiocarcinoma (ICC).
Method: This article retrospectively collected clinical data of 20 patients with unresectable ICC who received small diameter DEB-TACE treatment Chinese Academy of Medical Sciences and Peking Union Medical College Cancer Hospital & Shenzhen Hospital from March 2018 to December 2023. The efficacy and safety of the treatment were analyzed by evaluating indicators such as tumor response, progression free survival (PFS), overall survival (OS), incidence of adverse events, and compared the results with other literatures on conventional diameter DEB-TACE and systemic chemotherapy.
Result: The 3-month objective response rate (ORR) and disease control rate (DCR) of 20 patients with unresectable ICC after DEB-TACE were 60.0% and 95.0%, respectively. The 6-month ORR and DCR were 30.0% and 75.0%, respectively. And the 9-month ORR and DCR were 10.0% and 45.0%, respectively. The median OS and median PFS were 16.4 months and 8.3 months, respectively. The common adverse events after DEB-TACE include bilirubin elevation,abdominal pain,nausea and vomiting, and aminotransferase elevation, all of which are grade 1 or 2, and there is no grade 3 or higher adverse events occurred.
Conclusion: DEB-TACE with small diameter DEBs is a safe and effective local treatment for unresectable ICC patients. Compared with conventional diameter DEB-TACE and systemic chemotherapy, it has similar disease control rates ,longer survival , and lower incidence of adverse events.

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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

Electronic Journal of Liver Tumor 2025, 12 (2): 37-41.

Abstract （50）

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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.

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Research progress on resection margin of liver metastasis in colorectal cancer

Han Jixiang, Zhao Jianjun, Wang Jingtao

Electronic Journal of Liver Tumor 2025, 12 (2): 26-29.

Abstract （44）

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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.

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Evidence summary for perioperative pain management in patients with open hepatectomy

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

Electronic Journal of Liver Tumor 2025, 12 (2): 30-36.

Abstract （43）

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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.

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

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

Electronic Journal of Liver Tumor 2025, 12 (3): 19-29.

Abstract （41）

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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.

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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

Electronic Journal of Liver Tumor 2025, 12 (3): 45-50.

Abstract （40）

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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.

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Electronic Journal of Liver Tumor 2025, 12 (2): 42-43.

Abstract （35）

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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

Electronic Journal of Liver Tumor 2025, 12 (2): 8-13.

Abstract （33）

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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.

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

Wu Zhifeng, Zeng Zhaochong

Electronic Journal of Liver Tumor 2025, 12 (2): 1-7.

Abstract （32）

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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.

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Advances in study on farnesoid X receptor in hepatocellular carcinoma

Zhao Weihua, Li Changying

Electronic Journal of Liver Tumor 2025, 12 (2): 22-25.

Abstract （32）

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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.

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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

Electronic Journal of Liver Tumor 2025, 12 (3): 36-40.

Abstract （31）

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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.

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Electronic Journal of Liver Tumor 2025, 12 (2): 54-56.

Abstract （31）

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