Table of Content

30 December 2025, Volume 12 Issue 4

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Original article

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

2025, 12(4):  8-13. 

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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.

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

2025, 12(4):  14-19. 

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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.

Effect and mechanism analysis of low-dose ETO in adjuvant to PRO anesthesia induction for postoperative prognosis of hepatocellular carcinoma

Zhai Rui, Yu Lichun, Li Hongxiang, Zhai Yongya

2025, 12(4):  20-29. 

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Objective: To analyze the prognostic impact of low-dose etomidate (ETO) assisted propofol (PRO) induction of total intravenous anesthesia on patients with hepatocellular carcinoma (HCC) and to explore the underlying biological mechanisms.
Methods: Eighty-four HCC patients admitted to our hospital from January 2021 to January 2023 were selected. The patients were divided into a control group (n=42) and an experimental group (n=42) according to the randomized numerical table method; the control group was induced by PRO total intravenous anesthesia, and the experimental group was induced by a small dose of ETO-assisted PRO total intravenous anesthesia. The Kaplan-Meier method was employed for survival analysis.The relationship between ETO and the prognosis of HCC patients was determined by univariate and multivariate Cox regression model. Potential biological mechanisms of ETO in HCC radical resection patients were explored by bioinformatics, microarray data, enzyme-linked immunosorbent assay and molecular docking and kinetic modeling.The relationship between ETO and the prognosis of HCC patients was determined by univariate and multivariate Cox regression model.
Results: The recurrence-free survival and overall survival of patients in the experimental group were higher than those of patients in the control group (all P<0.05). Cox regression model analysis showed that ETO was an independent protective factor for recurrence and death in HCC patients (all P<0.05), and tumor stage and CD34 were independent risk factors for recurrence and death in HCC patients (all P<0.05). The results of microarray data showed a total of 143 differentially expressed genes, which were mainly enriched in signaling pathways such as negative regulation of hematopoietic progenitor cell differentiation, mechanistic target of rapamycin(mTOR), p53, vascular endothelial growth factor A and vascular endothelial growth factor receptor 2(VEGFA ,VEGFR2), and interleukin-24(IL-24). The PPI network confirmed that CD34 was a core target gene of ETO anti-HCC. Molecular docking and kinetic modeling confirmed that ETO could bind stably to CD34 protein with a binding free energy of -29.278 kJ/mol.Cox regression model analysis showed that ETO was an independent protective factor for recurrence and death in HCC patients (all P<0.05), and tumor stage and CD34 were independent risk factors for recurrence and death in HCC patients (all P<0.05).
Conclusion: Small-dose ETO-assisted PRO total intravenous anesthesia induction regimen in patients undergoing radical resection for HCC improves prognosis better and may be related to modulation of CD34 expression.

Study on the relationship between serum circIPO11 level and its clinicopathological characteristics and prognosis in patients with primary liver cancer

Yin Yagang, Zhao Jianwen, Tian Hongwei, Wang Dingxin

2025, 12(4):  30-36. 

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Objective: To analyze the relationship between serum circIPO11 level and its clinicopathological features and prognosis in patients with primary liver cancer (PLC).
Methods: From February 2020 to January 2022, 120 PLC patients (case group) and 120 healthy people (control group) were prospective selected by Tianshui First People's Hospital, and the relative expression of circIPO11 in serum of all subjects was determined by real-time fluorescence quantitative PCR.Compare the relative expression of circIPO11 in serum between the control group and the case group, and draw ROC curve to analyze the value of circIPO11 expression in predicting PLC occurrence. The relative expression of circIPO11 in serum of patients with different pathological features in the case group was compared, and the correlation between the expression of circIPO11 and clinicopathological features and prognosis was analyzed. Kaplan-Meier survival analysis and Cox regression model for multivariate prognostic analysis.
Results: The relative expression of serum circIPO11 in case group was higher than that in control group (P< 0.05). The ROC curve showed that the relative expression of serum circIPO11 predicted the AUC(95%CI) of PLC to be 0.883 (0.842-0.925). Compared with PLC patients with different tumor stages, degrees of differentiation, portal vein tumor thrombus, lymph node metastasis and preoperative alpha-fetoprotein level, the difference was statistically significant (all P< 0.05). Point-column correlation showed that the relative expression of serum circIPO11 was positively correlated with portal vein tumor thrombus, lymph node metastasis and preoperative alpha-fetoprotein level in PLC patients (r=0.403,0.298,0.397, P< 0.05). Spearman correlation showed that the relative expression of serum circIPO11 was positively correlated with the tumor stage of PLC patients (r=0.328, P< 0.05) and negatively correlated with the differentiation degree (r=-0.304, P< 0.05).The overall survival rate of 120 patients with PLC was 46.7%(56/120) and the median survival time was 27.5 months (95%CI: 25.8-29.3 months). Kaplan-Meier survival analysis revealed that the median survival times were 29.7 months (95%CI: 27.3-32.2 months) in the low circIPO11 expression group and 25.3 months (95%CI: 22.9-27.7 months) in the high circIPO11 expression group. The 3-year survival rate was significantly higher in the low-expression group compared to the high-expression group (P< 0.05). Multivariate regression analysis showed that tumor stage, differentiation degree, portal vein tumor thrombus, lymph node metastasis, preoperative alpha-fetoprotein level and preoperative circIPO11 expression were independent risk factors for postoperative mortality of PLC patients (all P< 0.05).
Conclusions: circIPO11 is highly expressed in serum of PLC patients, and its expression is related to pathological features such as tumor stage, degree of differentiation, lymph node metastasis and preoperative alpha-fetoprotein level, and the high expression of circIPO11 is a risk factor affecting the survival status of PLC patients after 3 years.

Study on the correlation between collimator angles and dosimetry in stereotactic radiotherapy planning for liver cancer

Dai Wanting, Dong Yu, Wang Qiushi, Fan Pengfei, Li Yuheng, Wu Dengbin

2025, 12(4):  37-42. 

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Objective: To study the dosimetric effect of different collimator angle on stereotactic radiotherapy (SRT) for liver cancer, providing a reference for collimator angle selection in clinical SRT plan design for liver cancer.
Methods: A retrospective analysis was conducted on 20 liver cancer patients treated with SRT from 2018 to 2024. Nine plans were generated with collimator angles ranging from 0°/0° to 80°/280° at 10° intervals, under identical planning parameters. The Friedman test was used to compare differences in conformity index (CI), gradient index (GI), normal liver V₁₀/V₂₀/V₃₀, mean liver dose, 0.03 cm³ spinal cord dose (D_{0.03 cm3} ), monitor units, and γ pass rate (3%/2mm standard).
Results: The results showed that changes in collimator angle significantly affected CI, GI, normal liver V₁₀ and V₃₀, spinal cord D_{0.03 cm3}, and monitor units, with statistically significant differences (all P< 0.05). However, no significant differences were observed in normal liver V20, mean liver dose, or γ pass rate (all P> 0.05).
Conclusion: Collimator angle selection can optimize target dose distribution and reduce normal tissue irradiation, offering valuable clinical guidance for SRT plan design in liver cancer.

Nursing field

Nationwide analysis of current nursing practices for hepatic arterial infusion chemotherapy

Liu Shuyue, Huang Zhongying, Li Jing, Zhan Zhengyin, Lei Juanjuan, Zhang Tian, Wen Zilu, Zhang Yaojun, Li Fuxia

2025, 12(4):  43-49. 

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Objective: To investigate the current status and key challenges of nursing practices for hepatic arterial infusion chemotherapy (HAIC) in China.
Methods: A cross-sectional survey was conducted using the National HAIC Nursing Practice Questionnaire developed by the Integrated Nursing of Hepatobiliary Tumor Committee of the Chinese Anti-Cancer Association. From October to December 2024, 83 hospitals across 24 provinces (autonomous regions/municipalities) in China were selected via convenience sampling. The questionnaire content includes the implementation institutions and nursing management status of HAIC, HAIC treatment plans, lower limb approaches, upper limb approaches, arterial port systems, and the current status of follow-up care.
Results: HAIC procedures were primarily performed in Interventional Therapy Department (96%, 80/83), with 76% (63/83) of patients managed in Hepatobiliary Department. The FOLFOX (Oxaliplatin+Calcium folinate+Fluorouracil) regimen was the dominant treatment protocol (84%, 70/83), and 52% (43/83) of hospitals combined HAIC with transcatheter arterial chemoembolization (TACE). Femoral artery access remained dominant (94%, 78/83), with 88% (73/83) requiring strictly limit bed confinement. Only 12% (10/83) permitted ambulation within 6 hours post-procedure. Upper-limb access (22%, 18/83) was valued for reducing bed rest requirements (94%) and complication risks (44%). Arterial port systems were implemented in 8% (7/83) of hospitals, but 5/7 exhibited nonstandard heparin concentrations during port maintenance.Only 40% (33/83) of hospitals provided post-discharge follow-up, predominantly via telephone (63%, 21/33) or WeChat (29%, 9/33), with intelligent management systems remaining underutilized.
Conclusion: HAIC nursing in China faces challenges including nonstandard technical protocols, excessive postoperative activity restrictions, and underdeveloped continuity of care systems. Establishing evidence-based guidelines, optimizing access strategies, and advancing intelligent follow-up frameworks are urgently needed to enhance treatment efficacy and patient outcomes.