Electronic Journal of Liver Tumor

Chinese expert consensus on conversion therapy of immune checkpoint inhibitors combined antiangiogenic targeted drugs for advanced hepatocellular carcinoma (2021 Edition)

Professional Committee for Prevention and Control of Hepatobiliary and Pancreatic Diseases of Chinese Preventive Medicine Association; Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Liver Study Group of Surgery Committee of Beijing Medical Association; Editorial Board of Chinese Journal of Hepatobiliary Surgery

2021, 8(2): 6-15.

Asbtract ( 393 )

PDF (1752KB) ( 548 )

References | Related Articles | Metrics

As many as half of hepatocellular carcinomas are at advanced stage when first diagnosed, and advanced stage hepatocellular carcinoma lacks effective treatment which leads to a very poor prognosis. In recent years, Immune checkpoint inhibitors combined with anti-angiogenesis drugs has shown a high effective rate in the treatment of advanced hepatocellular carcinoma, which significantly prolongs the overall survival of the patients and also provides the possibility of the sequent radical surgery? In order to improve the long-term survival rate of the liver cancer patients and achieve the goal of increasing the 5-year overall survival rate by 15% according to "Healthy China 2030" plan, the Hepatobiliary and Pancreatic Disease Prevention and Control Committee of the Chinese Preventive Medicine Association and the Liver Cancer Committee of the Chinese Anti-Cancer Association have deep discussions on the key points of medical treatment of advanced hepatocellular carcinoma and a preliminary consensus was formed to guide clinical practice, standardize medical behavior, and promote disciplines.

Rethinking liver cancer diagnosis and treatment in China

Zeng Hongmei, Cai Jianqiang

2021, 8(2): 23-25.

Asbtract ( 104 )

PDF (1788KB) ( 33 )

References | Related Articles | Metrics

Liver cancer has become an important public health issue in China. China has world’s largest new cases of liver cancer, accounting for 45.3% of world new cases in 2020. According to the cancer statistics released from International Agency for Research on Cancer, we updated liver cancer statistics in China and worldwide. We reported the progress of liver cancer control and prevention on risk factors. We analyzed the key research questions for liver cancer diagnosis and treatment in China. We provided strategic suggestions to optimize the roadmap of liver cancer control in the new era.

lncRNA MALAT1 impacts cholangiocarcinoma initiation and development by regulating RBE cell invasion and apoptosis

Wei Zhicheng, Ma Teng, Che Xu, Zhao Hong

2021, 8(2): 26-32.

Asbtract ( 58 )

PDF (4285KB) ( 11 )

References | Related Articles | Metrics

Objective: This study aims to explore that metastasis associated in lung denocarcinoma transcript 1(MALAT1)participates in intrahepatic cholangiocarcinoma (ICC) initiation and development via regulating cell invasion, migration, apoptosis in vitro and cell proliferation in vivo. Methods: GeneCards and LncExpDB database were used to reveal basic information of MALAT1. qRT-PCR and FISH were used to detect MALAT1 expression in 27 cases of ICC. Tranwell, Cell wound scratch and Tunel cell apoptosis were used to detect impacts of MALAT1 on RBE cell invasion, migration and apoptosis. FISH, PCNA immunohistochemistry and Ki67 Immunofluorescence were used to detect fluorescent probe signal of MALAT1 in subcutaneous tumor tissues and the cell proliferation in vivo. Results: MALAT1 located in 11p13.1 with a length of 8708bp in transcript, showing different expression in multiple tumors and diseases. MALAT1 was up-regulated in 27 cases of ICC. MALAT1 promoted RBE cell invasion, migration and inhibited apoptosis, while knockdown of MALAT1 could facilitate apoptosis. Positive expression of MALAT1 in subcutaneous tumor tissues was obviously increased. Over-expression MALAT1 could promote in vivo cell proliferation, whereas knockdown of MALAT1 could inhibit in vivo cell proliferation. Conclusion: MALAT1 could serve as a potential maker in ICC, and siMALAT1 provides new studying directions for cholangiocarcinoma diagnosis and therapies.

The significance of cystatin SN expression in hepatocellular carcinoma

Wu Jie, Gao Fei, Zhang Xuesong, Wang Kuiyang, Sui Chengxu, Zhang Liang, Yao Yuanfang, Song Lei

2021, 8(2): 33-38.

Asbtract ( 44 )

PDF (3025KB) ( 11 )

References | Related Articles | Metrics

Objective: To analyze the expression level of cystatin Sn in HCC and its relationship with clinicopathological features, and to explore the relationship between the expression level of cystatin SN and the prognosis of HCC patients. Methods: The clinical data of 72 patients with primary liver cancer were collected, and the expression of cystatin SN was detected by immunohistochemistry in 72 HCC and 60 paraffin samples of paracancerous tissues. Results: The expression intensity of cystatin SN was significantly higher than that of HCC (P<0.05). The patients with high expression level of cystatin SN in HCC were better than those with low expression level in disease-free survival and overall survival (P<0.05). Conclusion: The expression of cystatin SN in HCC is significantly lower than that in paracancerous tissues, and the HCC patients with high expression of cystatin SN were significantly better than those with low expression in disease-free survival and overall survival.

Research progress on the influence of margin width on the prognosis of hepatocellular carcinoma

Huang Xiaozhun, Wang Chunling, Huang Zhangkan, Xu Lin, Zhang Renjie, Bi Xinyu, Che Xu, Zhao Jianjun

2021, 8(2): 39-42.

Asbtract ( 63 )

PDF (1956KB) ( 28 )

References | Related Articles | Metrics

Hepatectomy is still the main treatment for liver malignant tumors. Surgical resection can improve the survival and prognosis of hepatocellular carcinoma. However, the influence of the width of the surgical margin on the survival prognosis of hepatocellular carcinoma is still controversial. Based on the existing literature evidence, this article will review the relationship between the width of surgical margins and the survival and prognosis of hepatocellular carcinoma, therefore, trying to explain the clinical research progress of surgical margins from microvascular invasion and circulating tumor cells.

Progress in diagnosis and treatment of combined hepatocellular cholangiocarcinoma

Huang Zhangkan, Huang Xiaozhun, Xu Lin, Zhang Renjie, Che Xu, Sun Yongkun

2021, 8(2): 43-46.

Asbtract ( 144 )

PDF (1924KB) ( 34 )

References | Related Articles | Metrics

Combined hepatocellular-cholangiocarcinoma is a rare primary liver cancer, which contains a mixture of hepatocytes and cholangiocytes. Because of the diversity of histology and phenotype, it is difficult to diagnose and treat. With the development of biochemical methods and cancer stem cell theory, the special pathological classification, tumor biology and clinical manifestations of Combined hepatocellular-cholangiocarcinoma have been more and more recognized. The thesis summarizes the recent progress in combined hepatocellular-cholangiocarcinoma from the perspective of Pathology, diagnosis, and treatment.

Predictive and prognostic factors in HCC patients treated with lenvatinib

Yu Minghua, Li Wei, Ding Xiaoyan, Chen Jinglong

2021, 8(2): 47-52.

Asbtract ( 40 )

PDF (1946KB) ( 9 )

References | Related Articles | Metrics

Lenvatinib and sorafenib are ⅠA recommended as first-line drugs for systemic treatment of advanced hepatocellular carcinoma, which of them are tyrosinase inhibitors. Sorafenib has been the only standard treatment of advanced liver cancer for 10 years in China. However, due to the overall objective response rate of SHARP trial, REFLECT trial was 2.3%, 9.8%, respectively and the high incidence of adverse reactions, it is limited in the treatment of advanced hepatocellular carcinoma. Lenvatinib has been the first-line drug in China since 2018, and its experience is still insufficient. However, based on the Chinese subgroup analysis of REFLECT study (phaseⅢnon inferiority study), the superiority over sorafenib in objective response rate is confirmed. Due to individual difference, tumor heterogeneity, the dose reduction or discontinuation resulting from adverse reactions, the efficacy varies a lot. Therefore, it is particularly important to predict the efficacy of lenvatinib in patients with advanced liver cancer and has become a new research hotspot. This review discusses the possible predictive factors of the effect of lenvatinib in the treatment of advanced liver cancer, in order to optimize the suitable candidates, improve the efficacy of lenvatinib, and guide the clinical experience of lenvatinib.

Pathological diagnosis and treatment progress of hepatic epithelioid hemangioendothelioma

Liang Yiting, Shi Susheng

2021, 8(2): 53-56.

Asbtract ( 219 )

PDF (1801KB) ( 35 )

References | Related Articles | Metrics

Hepatic epithelioid hemangioendothelioma(HEHE) is a rare vascular endothelial cell tumor, composed of epithelioid and histiocyte-like vascular endothelial cells in mucus or fibrotic stroma, and is low to moderately malignant. The etiology of HEHE is unclear. It can be characterized as single, multiple, or diffuse, and the multifocal form is most common. There is no specificity in imaging diagnosis including ultrasound, MRI, and CT. The diagnosis mainly depends on histopathology and immunohistochemical staining. Immunohistochemical antibodies include vascular endothelial markers CD31, CD34, CD10, D2-40, ERG, FLI-1, factorⅧ etc, and epithelial markers CD8/18, EMA, etc. Changes in molecular biology mainly include the WWTR1-CAMTA1 fusion gene, and a small number of YAP1-TFE3 fusion genes can be detected and diagnosed by FISH. Liver resection and liver transplantation are the preferred treatment methods for HEHE.

The whole process management strategy of irreversible electroporation in the treatment of liver cancer

Wu Huiming, Zhao Jianjun

2021, 8(2): 57-61.

Asbtract ( 39 )

PDF (1783KB) ( 13 )

References | Related Articles | Metrics

Since 2015, irreversible electroporation has been introduced and approved for clinical use in China. So far, some large-scale centers and their experts in China have accumulated rich experience in the application of this technology. However, as a new technology, there are still many blind spots and misunderstandings in its technical promotion and clinical application. Therefore, this paper mainly discusses the basic principles and advantages of irreversible electroporation in the treatment of liver cancer, preoperative case screening, intraoperative operative points, postoperative management, efficacy evaluation, safety and complications, technical disadvantages and limitations, and makes a prospect for the future of irreversible electroporation.

NRS-2002 and CONUT scores and prognostic analysis of patients with advanced hepatocellular carcinoma and Nomogram model construction

Huang Guirong, Wu Deping, Chen Fangpeng, Han Shanshan

2021, 8(2): 62-68.

Asbtract ( 68 )

PDF (3825KB) ( 10 )

References | Related Articles | Metrics

Objective: Nutritional risk screening-2002 (NRS-2002) and controlling nutritional status (CONUT) scores were used to evaluate the nutritional status of patients with advanced hepatocellular carcinoma (HCC) before transcatheter arterial chemoembolization (TACE).The influencing factors of postoperative death were analyzed and Nomogram model was constructed. Methods: 113 patients with advanced HCC who received TACE therapy in Affiliated Hospital of West Anhui Health Vocational College from January 2016 to January 2020 were selected.Univariate and multivariate Cox proportional hazards models were used to analyze the factors affecting the death of patients with advanced HCC.The influential factors of death were used as predictors of the Nomogram model.Internal dataset validation, consistency index(C-index), decision curve analysis (DCA), and time-ROC curve were used to evaluate the predictive performance of Nomogram model. Results: NRS-2002 screened 76 (67.3%) patients with malnutrition, and 758 (51.3%) patients with malnutrition were screened by CONUT score. Kappa value was 0.238 (P < 0.05). The survival time of malnutrition patients screened by NRS-2002 and CONUT score was lower than that of patients with normal nutrition (P < 0.05). Multivariate Cox proportional hazards model analysis showed that ascites (yes), BCLC grade (grade C), PVTT (yes), TACE frequency (>2), TBIL (> 27 μ mol/L) and NRS-2002 (malnutrition) were the independent risk factors of death in patients with advanced HCC (P < 0.05). The results of internal validation showed that the C-index of 6-month survival rate, 12-month survival rate and 24-month survival rate were 0.701 (95%CI: 0.668—0.801), 0.697 (95%CI: 0.611—0.794) and 0.651 (95%CI: 0.601—0.754), respectively. When the risk threshold of nomogram model was higher than 0.16 and lower than 0.89 for predicting the death of patients with advanced HCC after TACE, it provides significant additional clinical benefits. The AUC of Nomogram model was higher than that of BCLC, PVTT, ascites, TACE times, TBIL and NRS-2002. Conclusion: The Nomogram model has high clinical practice and accuracy, and can guide the treatment and management of patients with advanced HCC.

Table of Content