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| 1 | 三维可视化技术在中晚期肝细胞癌外科治疗中的应用价值显示文摘背景与目的:三维(3D)可视化技术借助计算机对CT和(或)MRI的检查图像进行3D立体重建,可直观、清晰地将肝脏、胰腺、胆道、血管及肿瘤的形态和空间分布等进行展示,这对于明确肝脏脉管系统的解剖变异、准确计算残余肝体积以及手术规划具有重要的意义。本研究探讨术前肝脏3D可视化评估在中国肝癌分期(CNLC)Ⅱ~Ⅲa期患者外科治疗中的临床价值。方法:回顾性分析2015年—2017年在复旦大学附属中山医院肝肿瘤外科接受手术治疗的CNLCⅡ~Ⅲa期肝细胞癌(HCC)患者的临床资料。根据术前接受的评估方式,将患者分为常规影像学评估组和3D可视化评估组。采用Kaplan-Meier法比较两组患者的术后无复发生存期(RFS)和总生存期(OS),并通过单因素和多因素Cox回归分析确定影响患者预后的相关风险因素。结果:共有110例接受手术治疗的CNLCⅡ~Ⅲa期HCC患者被纳入研究,其中常规影像学评估组74例,3D可视化评估组36例。两组患者在性别、年龄、乙肝表面抗原、甲胎蛋白、肝功能Child-Pugh分级、肿瘤直径、肿瘤数量、大血管侵犯情况、CNLC分期、预防性介入治疗和辅助靶向治疗方面差异均无统计学意义(均P>0.05)。常规影像学评估组和3D可视化评估组的90 d病死率分别为2.8%(1/36)和4.1%(3/74),差异无统计学意义(P>0.05)。Kaplan-Meier生存分析结果显示,3D可视化评估组的OS率和RFS率均明显优于常规影像学评估组(P=0.024;P=0.014)。多因素Cox回归分析结果显示,术前3D可视化评估是OS和RFS的独立保护因素(P=0.015;P=0.010)。结论:术前3D可视化评估可显著改善中晚期HCC患者手术治疗的预后,在中晚期HCC外科治疗中具有良好的应用价值,值得进一步探索和推广。 | 张势域 成剑文 闫加艳 郭德镇 姜芝峰 杜凡 陈财忠 樊嘉 周俭 杨欣荣 | 2023 | 中国普通外科杂志2023，32，7： | 2 |
| 2 | 预防高危因素患者肝癌切除术后复发的治疗进展显示文摘肝癌术后的高复发及转移率仍然是阻碍着患者生存的障碍,降低复发是改善肝切除术后预后的关键。针对肝癌术后存在高复发和转移风险,目前尚无预防和治疗的标准方案。本文讨论了可能降低肝癌术后复发风险并提高生存率的辅助治疗方案的进展,包括肝动脉化疗栓塞、分子靶向药物和免疫疗法的辅助全身治疗、抗病毒和其它局部治疗以及潜在的联合治疗。选择具有个性化的联合治疗模式可能是防治HCC术后复发的发展趋势,但这仍需要进一步验证。 | 管玉婷 曾国斌 陈建平 吴雄健 | 2023 | 岭南现代临床外科2023，23，2： | 0 |
| 3 | Role of radiomics in the diagnosis and treatment of gastrointestinal cancer显示文摘Gastrointestinal cancer(GIC)has high morbidity and mortality as one of the main causes of cancer death.Preoperative risk stratification is critical to guide patient management,but traditional imaging studies have difficulty predicting its biological behavior.The emerging field of radiomics allows the conversion of potential pathophysiological information in existing medical images that cannot be visually recognized into high-dimensional quantitative image features.Tumor lesion characterization,therapeutic response evaluation,and survival prediction can be achieved by analyzing the relationships between these features and clinical and genetic data.In recent years,the clinical application of radiomics to GIC has increased dramatically.In this editorial,we describe the latest progress in the application of radiomics to GIC and discuss the value of its potential clinical applications,as well as its limitations and future directions. | Qi Mao Mao-Ting Zhou Zhang-Ping Zhao Ning Liu Lin Yang Xiao-Ming Zhang | 2022 | World Journal of Gastroenterology2022，28，42： | 0 |
| 4 | Combined TIM-3 and PD-1 blockade restrains hepatocellular carcinoma development by facilitating CD4+ and CD8+T cellmediated antitumor immune responses显示文摘BACKGROUND Immune checkpoint inhibitors(ICIs)targeting programmed cell death protein 1(PD-1)and T cell immunoglobulin and mucin domain-containing protein 3(TIM-3)are beneficial to the resumption of anti-tumor immunity response and hold extreme potential as efficient therapies for certain malignancies.However,ICIs with a single target exhibit poor overall response rate in hepatocellular carcinoma(HCC)patients due to the complex pathological mechanisms of HCC.AIM To investigate the effects of combined TIM-3 and PD-1 blockade on tumor development in an HCC mouse model,aiming to identify more effective immunotherapies and provide more treatment options for HCC patients.METHODS The levels of PD-1 and TIM-3 on CD4+and CD8+T cells from tumor tissues,ascites,and matched adjacent tissues from HCC patients were determined with flow cytometry.An HCC xenograft mouse model was established and treated with anti-TIM-3 monoclonal antibody(mAb)and/or anti-PD-1 mAb.Tumor growth in each group was measured.Hematoxylin and eosin staining and immunohistochemical staining were used to evaluate T cell infiltration in tumors.The percentage of CD4+and CD8+T cells in tissue samples from mice was tested with flow cytometry.The percentages of PD-1+CD8+,TIM-3+CD8+,and PD-1+TIM-3+CD8+T cells was accessed by flow cytometry.The levels of the cytokines including tumor necrosis factor alpha(TNF-α),interferon-γ(IFN-γ),interleukin(IL)-6,and IL-10 in tumor tissues were gauged with enzyme-linked immunosorbent assay kits.RESULTS We confirmed that PD-1 and TIM-3 expression was substantially upregulated in CD4+and CD8+T cells isolated from tumor tissues and ascites of HCC patients.TIM-3 mAb and PD-1 mAb treatment both reduced tumor volume and weight,while combined blockade had more substantial anti-tumor effects than individual treatment.Then we showed that combined therapy increased T cell infiltration into tumor tissues,and downregulated PD-1 and TIM-3 expression on CD8+T cells in tumor tissues.Moreover,combined treatment facilitated the production of T cell effector cytokines TNF-α and IFN-γ,and reduced the production of immunosuppressive cytokines IL-10 and IL-6 in tumor tissues.Thus,we implicated that combined blockade could ameliorate T cell exhaustion in HCC mouse model.CONCLUSION Combined TIM-3 and PD-1 blockade restrains HCC development by facilitating CD4+ and CD8+T cell-mediated antitumor immune responses. | Xu-Sheng Zhang Hong-Cai Zhou Peng Wei Long Chen Wei-Hu Ma Lin Ding Shi-Cai Liang Ben-Dong Chen | 2023 | World Journal of Gastrointestinal Oncology2023，15，12： | 0 |
| 5 | Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy显示文摘BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option. | Gao-Yuan Yang Zhi-Wei He Yong-Chang Tang Feng Yuan Ming-Bo Cao Yu-Peng Ren Yu-Xuan Li Xiao-Rui Su Zhi-Cheng Yao Mei-Hai Deng | 2024 | World Journal of Gastrointestinal Surgery2024，16，1： | 0 |
| 6 | 小鼠第13.5天胚肝细胞诱导HepG2细胞分化的作用机制显示文摘目的探讨小鼠第13.5天胚肝细胞是否通过抑制β-Catenin诱导人肝细胞肝癌细胞株HepG2细胞分化及其作用机制。方法用免疫荧光法检测肝细胞标记分子-白蛋白(ALB)的分布,以鉴定小鼠第13.5天胚肝细胞。小鼠第13.5天胚肝细胞与HepG2细胞株共培养24 h、48 h后,采用qRT-PCR方法检测HepG2细胞株中肝癌标记分子-甲胎蛋白(AFP)、肝细胞分化调控因子-肝细胞核因子4α(HNF-4α)和成熟肝细胞标记分子-细胞色素P450家族成员1B1(CYP1B1)和乙醇脱氢酶1C(ADH1C)的mRNA表达。共培养48 h后,观察HepG2细胞株形态变化,采用Western blot法检测AFP、HNF-4α和β-Catenin的蛋白含量,免疫荧光法检测β-Catenin蛋白在细胞的分布。应用β-Catenin抑制剂处理后,观察HepG2细胞株形态变化并且检测AFP蛋白表达。结果原代培养细胞ALB荧光显示阳性。与对照组相比,共培养后HepG2细胞株中,AFP相对mRNA表达量在24 h和48 h均显著降低,HNF-4α、CYP1B1和ADH1C的相对mRNA表达量在24 h和48 h均显著升高。与对照组相比,共培养48 h后,HepG2细胞株生长明显抑制,细胞形态趋于正常肝细胞的六边形,AFP和HNF-4α蛋白表达明显升高。与对照组相比,共培养48 h后,β-Catenin的蛋白含量明显降低,同时HepG2细胞株中β-Catenin的荧光明显减弱。与对照组相比,β-Catenin抑制剂处理可明显改变HepG2细胞株形态,引起共培养组HepG2细胞株形态更剧烈的变化,显著抑制AFP的蛋白表达。结论小鼠第13.5天胚肝细胞可能主要通过抑制β-Catenin,诱导HepG2细胞株分化。 | 肖志刚 郑丽 王梓瀛 刘昆 王瑜 齐锦生 栗彦宁 | 2022 | 中国比较医学杂志2022，32，4： | 0 |
| 7 | 原发性肝癌中医证候及用药特点的回顾性分析显示文摘目的探讨原发性肝癌中医证型分布、证素特征和用药规律。方法以岳阳中西医结合医院266例肝癌诊疗数据为基础,进行频次、因子、聚类、关联规则和熵聚类分析。结果频次分析发现证候多为虚证。用药以补气健脾药为主,解毒药次之。因子分析发现证素病位多为脾、肝、肾,病性多为气滞、毒、血瘀。聚类发现最常见证型是肝郁脾虚证。基于证候差异,高置信度关联规则共50项,熵聚类18项。结论原发性肝癌证型分布是肝郁脾虚、气血亏虚、肝肾阴虚及湿热毒聚。用药受“中西汇通”影响,补虚搭配祛毒、理气、化瘀、清热、滋阴诸法,随证加减。 | 马铭悦 牛晓骥 王守梅 王倩 胡爱艳 方磊 张树辉 | 2023 | 时珍国医国药2023，34，9： | 0 |
| 8 | 瑞戈非尼联合卡瑞利珠单抗治疗难治性肝复发癌获得完全缓解病例的临床经验显示文摘目的 探讨难治性肝复发癌的治疗新方法。方法 对南方医科大学附属东莞医院肝胆胰外科使用二线靶向药物瑞戈非尼联合卡瑞利珠单抗治疗的1例难治性肝复发癌获得完全缓解(complete remission,CR)患者的治疗过程及治疗效果进行回顾性分析与总结。结果 该患者在前期近3年时间内先后经过根治性消融、肝中叶复发癌切除、肝S2及S8段复发癌消融及一线靶向药物仑伐替尼多学科多种方法治疗,仍然出现肝内广泛复发转移,最后改用二线靶向药物瑞戈非尼联合卡瑞利珠单抗进行全身系统治疗,肝内病变全部液化坏死且大部分明显缩小或消失,甲胎蛋白由最高峰值20 867.00μg/L降至正常,治疗效果评价为CR且稳定维持已超过12个月,无明显毒副反应,生活质量好,坚持正常工作。结论 二线靶向药物瑞戈非尼联合免疫新疗法,仍然有可能对经过各种综合治疗失败的难治性肝复发癌产生疗效,甚至获得长期无瘤生存的希望和机会。 | 蒋经柱 李浩权 王在国 叶振伟 陈韵壕 张伟标 廖景升 | 2022 | 中国普外基础与临床杂志2022，29，9： | 0 |
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