Objective To analyze the disease burden of liver cancer caused by nonalcoholic steatohepatitis (NASH) among the Chinese population by utilizing the latest global burden of disease (GBD) 2021 data, and conduct a comparative analysis with the global situation, so as to provide references and lessons for the formulation of public health policies and disease management plans in China. Methods GBD 2021 database publicly released in May 2024 was searched and relevant disease burden data of liver cancer caused by NASH in China and globally from 1990 to 2021 was sorted out. Joinpoint regression model was employed to calculate the average annual percentage change (AAPC) of the age-standardized rates of various burden indicators in order to evaluate the changing characteristics of disease epidemiology over time. Meanwhile, Bayesian method was used to predict the number of incidences and deaths of liver cancer caused by NASH in China and globally from 2022 to 2045. Results Compared with 1990, in 2021, the number of incidences, prevalence, deaths, disability-adjusted life years, age-standardized incidence rate and age-standardized prevalence rate of liver cancer caused by NASH in the overall, male and female populations in China and globally all increased. Moreover, in 1990 and 2021, all the burden indicators of the Chinese male population were higher than those of the female population in the corresponding years. The overall trend analysis showed that during the 32 years from 1990 to 2021, the age-standardized incidence rate [AAPC=0.44%, 95%CI (0.35%, 0.53%), P<0.001] and the age-standardized prevalence rate [AAPC=0.92%, 95%CI (0.73%, 1.11%), P<0.001] of liver cancer caused by NASH in the overall population in China both showed a significant upward trend. In addition, in 1990 and 2021, the age-standardized rates of all the burden indicators of the overall population in China were higher than the global levels in the corresponding years. The prediction results of the Bayesian model showed that from 2022 to 2045, the number of incidences and deaths of liver cancer caused by NASH in the overall, male and female populations in China and globally will generally show an upward trend. Conclusions The disease burden of liver cancer caused by NASH in China and globally is generally on the rise. In order to curb the increasing disease burden, it is necessary to formulate relevant public health policies and disease management plans in a timely manner.
ObjectiveTo summarize and analyze the application of ex vivo liver resection and autotransplantation (ELRA) in the treatment of hepatobiliary diseases. MethodThe related literature about ELRA used to treat various hepatobiliary space-occupyingdiseases at home and abroad in recent years was comprehensively searched and summarized. ResultsELRA had overcome the limitations of limited operational space in traditional surgery for the treatment of hepatobiliary space-occupying diseases reduced dependence on donor livers, and avoided post-transplant rejection. It had been applied in the treatment of hepatic alveolar echinococcosis, liver cancer, cholangiocarcinoma, and rare liver space-occupying diseases. ConclusionsWith the maturation of ELRA techniques and the continuous improvement of ex vivo liver perfusion technology, along with rigorous preoperative evaluation and meticulous postoperative management, postoperative complications of ELRA have significantly decreased compared to the initial stages of its application. By strictly adhering to surgical indications, this procedure is expected to be used treatment in an increasing number of hepatobiliary space-occupying diseases.
ObjectiveTo understand the latest progress of enrichment technology of circulating tumor cells (CTCs), and summarize the principle, advantages and disadvantages of various enrichment technologies and their applications in primary liver cancer (PLC). MethodThe literature relevant to the enrichment methods of CTCs in the PLC was reviewed and summarized. ResultsThe clinical significances of CTCs in the early diagnosis and staging, hierarchical diagnosis and treatment, and efficacy monitoring of patients with PLC had been recognized. There were many separation and enrichment technologies for CTC, which were mainly based on the differences of physical and biochemical characteristics, as well as the combination of enrichment methods with various principles. Each enrichment method had corresponding advantages and disadvantages, and few enrichment methods for CTC was applied to PLC. ConclusionsAlthough many problems need to be solved in enrichment method of CTCs at present, it is believed that the existing problems will be solved one by one with continuous improvement of technology. And CTC detection is expected to apply in clinical, so as to provide more efficient diagnosis and treatment methods for patients with PLC.
Indocyanine green fluorescence imaging has been widely used in hepatobiliary surgery, which can guide accurate hepatectomy and improve the prognosis of patients. Lipiodol–indocyanine green emulsion as a pure physical way to prepare lipiodol-drug mixed solvent can be used for primary interventional embolization and subsequent fluorescence-guided hepatectomy. In this paper, the application of iodized oil-indocyanine green emulsion in hepatectomy was summarized by reviewing relevant research progress at home and abroad, and further discussion and prospect were made.
ObjectiveThe present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer.MethodsThe MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer.ResultsAn elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up.ConclusionsThepatient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
Ferroptosis, as a new form of programmed cell death, affects the occurrence, progression and treatment of liver cancer. In this paper, the discovery, characteristics, regulatory mechanisms, inhibitors, inducers, and detection indicators of ferroptosis were systematically summarized and analyzed, and the effects of ferroptosis on the progression, metastasis, treatment, and prognosis of liver cancer were summarized. Finally, it was concluded that targeting ferroptosis is a promising treatment strategy for liver cancer.
ObjectiveTo evaluate the prognostic value of osteopontin (OPN) in patients with liver cancer by using meta-analysis.MethodsWe searched PubMed, Embase, Web of science, Wanfang database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database, and Chinese Biomedical Literature Database to identify relevant articles from their inception to October 31, 2018. A meta-analysis was carried out by using the STATA 12.0 software.ResultsA total of 13 studies were included in this meta-analysis, including 2 171 liver cancer cases. The pooled data of studies showed that OPN expression level was negatively associated with overall survival time (HR=1.58, 95% CI was (1.37, 1.79), P<0.001) and disease free survival time (HR=1.67, 95% CI was (1.39, 1.96), P<0.001). High expression of OPN for patients with liver cancer had shorter overall survival time and disease-free survival time compared with those of low expression of OPN.ConclusionCurrent evidence shows that high expression of OPN is closely related to poor prognosis of patients with liver cancer.
Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.