Table of Content

30 June 2018, Volume 23 Issue 6

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Original Articles

Clinical study of the effect of liver stiffness on treatment efficacy of radiofrequency ablation in hepatocellular carcinoma patients

LI Meng, GAO Yue-juan, LI Zhi-yan, CHEN Min, TIAN Jiang-ke, TANG Yu, ZHOU Yan-xian

2018, 23(6):  478-480. 

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Objective To analyze the effect of liver stiffness on treatment efficacy of radiofrequency ablation in hepatocellular carcinoma (HCC) patients.Methods From October 2014 to February 2017, there were 106 patients with 114 nodules receiving ultrasound-guided radiofrequency ablation in our hospital. Liver stiffness measurement (LSM) value was measured by FibroScan before treatment and patients were divided into high-LSM group and low-LSM group with a cutoff value of 17.6 kPa. Differences of complete necrosis rate, local tumor progression rate and intrahepatic recurrence rate between the two groups were analyzed. Results The complete necrosis rates of high-LSM group and low-LSM group were 94.4% and 95.3%, respectively, which showed no statistical difference (P=0.88). The local tumor progression rates and intrahepatic recurrence rates were significantly lower in high-LSM group than those in low-LSM group (16.9% vs. 28.4%, P=0.03 and 7.0% vs. 10.3%, P=0.02, respectively). Conclusion LSM value could be a useful predictor for local tumor progression and intrahepatic recurrence after radiofrequency ablation in HCC patients.

Clinical data analysis of 433 patients with fever of unknown origin

LI Juan, LI Yong-fang, ZHU Chuan-wu, Xie Qing, CAI Wei

2018, 23(6):  481-483. 

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Objective To investigate the cause and clinical characteristics of patients with fever of unknown origin (FUO), and to summarize the clinical experience of its diagnosis and treatment. Methods Clinical data of 433 cases with FUO from the department of infectious diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine was retrospectively analyzed. These cases were divided into group A (2012-2014) and group B (2015-2017) according to their admission date. Results Among the 433 patients, group A included 154 cases of infectious diseases (79.38%), 7 cases of connective tissue disease (3.61%), 8 cases of tumor diseases (4.12%), 7 cases of other diseases (3.61%), and 18 cases of unknown origin (9.28%). Group B included 192 cases of infectious diseases (80.33%), 17 cases of connective tissue disease (7.11%), 12 cases of tumor diseases (5.02%), 6 cases of other diseases (2.51%), and 12 cases of unknown origin (5.02%). Conclusion The main cause in FUO was infectious diseases, followed by connective tissue diseases and tumor diseases. Moreover, connective tissue diseases and tumor diseases had an increasing trend in the past 3 years.

Cyberknife used as downstaging therapy before liver transplantation for patients with hepatocellular carcinoma (report of 2 cases)

Du Yu-juan, Wang Jia, Duan Xue-zhang, Sun Jing, He Wei-ping, Zhang Tao

2018, 23(6):  484-487. 

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Objective To investigate the role of cyberknife in downstaging therapy before liver transplantation for patients with hepatocellular carcinoma.Methods The clinical data of 2 patients with primary liver cancer who had been treated with cyberknife during the last 2 years in our department were collected. Modified Response Evaluation Criteria in Solid Tumors Criteria was used to evaluate tumor shrinkage after downstaging treatment. Time from radiotherapy to liver transplantation and postoperative pathology diagnosis were recorded. Disease-free survival time was assessed in both patients 1 year after liver transplantation. Child-Pugh grading before and after radiotherapy was applied for evaluating the safety of radiographic knife as downstaging treatment. Results Patient 1 was in Barcelona Clinic Liver Cancer stage C (BCLC-C), who received a radiotherapy dose of 50 Gy/10f and achieved partial response (PR) after treatment. Liver transplantation was performed 3 months after radiotherapy in the patient, and no metastasis or recurrence occurred in the > 1-year follow-up. Patient 2 was in BCLC-B stage, and received a radiotherapy dose of 48 Gy/8f and achieved PR after treatment. Liver transplantation was performed 1 year after radiotherapy in the patient and no sign of metastasis or recurrence was observed in the > 1-year follow-up after transplantation. Postoperative pathology showed significant shrinkage of tumors. Liver functions of both patients before and after radiotherapy were A6 and B7, which were slightly impaired. Conclusion Cyberknife can be used as an effective downstaging treatment before liver transplantation because of its mild side effects and satisfying downstaging effects.

Correlation analysis between MR signal characteristics and recurrence time after resection of small hepatocellular carcinoma

WANG Wei-wei,REN Hong-wei,ZHANG Jian-zeng,AN Wei-min,DONG Jing-hui

2018, 23(6):  488-491. 

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Objective To analyze the correlation between magnetic resonance (MR) signal characteristics and recurrence time after resection of small hepatocellular carcinoma (HCC). Methods Patients, who received small HCC with recurrent liver cancer or no recurrence within 36 months after operation from February 2011 to November 2016 in our hospital, were enrolled. All of the patients received dynamic contrast-enhanced MR scan within 1 month before operation. Preoperative MR, T1WI, T2WI and DWI sequence, as well as signal values of arterial, portal and delayed phase of dynamic enhanced scanning were recorded. The signal value ratio of the lesions to the adjacent liver in arterial, portal and delayed phase was calculated. Results For 26 patients enrolled in the study, including 9 cases with recurrence time of more than 36 months, 10 cases with recurrence time of more than 12 months and less than 36 months, and 7 cases with recurrence time of less than 12 months. Signal characteristics of T2WI sequence were statistically significant between the group with recurrence time more than 36 months and the group with recurrence time more than 12 months and less than 36 months (P<0.05). However, there was no statistical difference between DWI sequence and dynamic contrast-enhanced scan among groups with different recurrence time. Conclusion MR signal characteristics of small HCC could be used to predict the recurrence time after surgical resection.

Influence of SII and NLR on the survival time in patients with malignant obstructive jaundice treated with PTCD implantation of biliary mental stents

YUAN Xiao-ling, Bai Yu-pan, YIN Dong-lin, HONG Shen-zhen, Bao Yu-jie, ZHOU Yuan-yuan, YAN Lei, KANG Yao-yue, FAN Shan, CAO Jun-ying, XU Jie

2018, 23(6):  492-495. 

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Objective To analyze the influence of inflammatory factors in patients with malignant obstructive jaundice (MOJ) implanted with biliary mental stents by percutaneous transhepatic cholangial drainage (PTCD). Methods Fourteen patients with MOJ treated with implantation of biliary mental stents by PTCD were enrolled. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and albumin were compared before and after implantation (at week 1, month 1 and 4). Preoperative clinical data were collected to calculate the inflammation indexes, including systemic immune-inflammation index (SII, neutrophil × platelets / lymphocyte), platelets-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio. Overall survival (OS) was estimated by the Kaplan-Meier method and Cox regression analysis. Results Levels of ALT, AST and TBil were significantly decreased after implantation operation, while albumin level was increased at month 4 after operation. During a median follow-up time of 10 months, 7 (50%) patients died. Additionally, SII and NLR were found to be associated with OS. Conclusion PTCD implantation of biliary mental stents is clinically feasible for patients with MOJ, and increased levels of SII and NLR are associated with poor OS after operation.