Objective To systematically review the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy in patients with primary liver cancer (PLC). Methods We electronically searched the following databases including CENTRAL, MEDLINE, EMbase, WanFang Data, CBM, CNKI and VIP to collect randomized controlled trials (RCTs) on the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy vs. hepatectomy alone for PLC from inception to October, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 RCTs involving 951 patients were included. The results of meta-analysis showed that, implanting sustained-release 5-fluorouracil during hepatectomy significantly decreased the total recurrence rates of 1-year and 3-year (1 year: RR=0.48, 95%CI 0.36 to 0.65, Plt;0.000 01; 3 years: RR=0.69, 95%CI 0.50 to 0.96, P=0.03). However, the two groups were alike in decreasing the surem levels of AFP. Besides, the commonly-seen adverse reaction of implanting sustained-release 5-fluorouracil during hepatectomy included abdominal pain and bile leakage. Conclusion Implanting sustained-release 5-fluorouracil during hepatectomy can decrease the 1-year and 3-year recurrence rates of PLC patients, especially for HCC at the early stage. But this conclusion should be interpreted with caution and needs more strictly-designed RCTs with large sample size and enough long follow-up to verify.
Objective To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) plus transcatheter arterial chemoembolization (TACE) compared with TACE alone, in the treatment of unresectable hepatocellular carcinoma (HCC). Methods The Cochrane Library, MEDLINE, EMBASE, CANCERLIT, CBM, CNKI and VIP were searched electronically. Relevant journals and conference proceedings were also handsearched. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions, and meta-analyses were performed for homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.10 software. Subgroup analyses by frequency of TACE (lt;3 or ≥3 times) were also performed. Results Thirty seven trials, all published in China, involving 2 653 participants were included. The quality of 2 studies was graded B (medium) and that of the other 35 was graded C (low). Meta-analyses showed that TCM plus TACE, compared with TACE alone, could significantly improve survival, tumor response (complete and partial), quality of life and clinical symptoms, and was also associated with a lower incidence of adverse reactions. Subgroup analyses indicated that, patients with less than three TACE had more significant improvement in survival and clinical symptoms, while patients with three or more TACE had more significant improvement in tumor response and quality of life. The incidence of adverse reactions was similar between these two different frequencies of TACE. Conclusions The treatment regimen of TCM plus TACE is superior to TACE alone in patients with unresectable HCC. As the existing data have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.
目的 评价选择性介入治疗在原发性肝癌（HCC）门脉高压症中的应用价值。 方法 2008年11月－2011年3月，收治65例临床明确诊断的HCC伴门脉高压症患者，选择性使用肝动脉化学疗法（化疗）栓塞术、脾栓塞术、门静脉化疗栓塞术、门静脉支架、胃冠状静脉栓塞术等介入术式，术后通过观察临床指标、定期复查影像检查等了解病变转归，随访生存期并评价疗效。 结果 65例HCC患者均合并不同程度门静脉高压，其中门静脉癌栓46例中有37例显示肝动脉-门静脉分流，通过肝动脉及门静脉化疗栓塞术进行主瘤体及癌栓治疗。11例行门静脉支架置入术，支架置入后门静脉压较术前明显下降（P＜0.01），支架中位通畅时间为5.8个月。39例行胃冠状静脉和（或）胃短静脉栓塞术，术后有4例再次发生门脉高压性出血，再出血率10.26%。18例行脾动脉栓塞术，术后3个月血小板较术前显著升高（P＜0.01）。随访术后3、6、12及24个月的生存率分别为90.77%、69.23%、35.38%及13.85%。 结论 选择性联合使用各种介入术式是治疗HCC及其相关性门脉高压症的一种有效方法，可有效预防高危风险，延长患者生存期。
目的探讨急诊肝动脉栓塞（TAE）治疗原发性肝癌破裂出血的临床效果和意义。方法收集我院近10年来收治的38例原发性肝癌破裂出血的资料，按治疗方法不同分为保守治疗组、急诊手术组及急诊TAE治疗组，比较3组间的输血量、术后肝功恢复率、住院时间及死亡率。结果急诊TAE治疗组与保守治疗组及急诊手术组比较，输血量少，术后肝功恢复率高，住院时间短和死亡率低，差异有统计学意义（Plt;0.05,Plt;0.01）。结论对于失去根治切除机会或不能耐受手术的原发性肝癌破裂出血的患者，可首选急诊TAE方法，并且还可为一部分患者将来行二次根治切除手术创造机会。
Objective To probe into the significance of tuftsin in patients with liver cancer. MethodsThe serum tuftsin level of 12 patients with liver cancer before and after the resection，20 cirrhostic and 20 normal controls were measured by radioimmunoassay (RIA). ResultsTuftsin level in preoperative group （449±106） ng/ml was much lower than that in postoperative group (588±129) ng/ml，cirrhotics group (580±187) ng/ml and control group (703±128) ng/ml (P＜0.01). The tuftsin level in postoperative group was also quite lower than that in control group (P＜0.01). Conclusion We should try our best to excise the liver cancer so that a higher tuftsin level might be obtained which can activate NK cell and T cell.
ObjectiveTo study the effects of newcastle disease virus (NDV) on tumor infiltrating lymphocyte (TIL). MethodsTILs were dissociated from 6 cases of primary hepatic carcinoma. Each case was divided into 3 portions equally, and was added 20 μl NDV with HA titer of 1∶160 (NDV group), rIL2 with the end concentration of 1 000 u/ml (rIL2 group) and 0.9% sodium chloride (control group) respectively, then cultured in the condition of 37℃，5% CO2. CD3, CD4 and CD8 were assayed by flow cytometry. The contents of IL2, IFNγ and TNFβ in supernate of NDV group and control group were examined by ELISA.ResultsCoupled material revealed that CD3 and CD4 were significantly higher in NDV group than in the other two groups (P＜0.05, P＜0.01). CD8 had no significant changes in three groups. The contents of IL2, IFNγ and TNFβ in NDV group were significantly higher than those in control group (P＜0.01, P＜0.01 and P＜0.05 respectively). ConclusionNDV can activate TIL directly.