Table of Content

20 June 2023, Volume 23 Issue 03

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Original Articles and Clinical Research

Analysis of risk factors affecting the postoperative prognosis of patients with hepatocellular carcinoma：a single-center analysis

HUANG Rui-qin, HE Kun, QIAN Jun-lin, LUO Qi-jie

2023, 23(03):  205-214.  DOI: 10.3969/j.issn.1009-976X.2023.03.001

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Objective To investigate the independent risk factors affecting the postoperative prognosis of patients with hepatocellular carcinoma. Methods A retrospective analysis was conducted on 211 patients with hepatocellular carcinoma who underwent hepatectomy at Zhongshan People′s Hospital from June 1, 2017, to January 1, 2022. Cox regression analysis was used for univariate and multivariate analysis to determine the independent risk factors influencing disease-free survival and overall survival. Kaplan-Meier survival analysis was employed to evaluate the disease-free survival rate and overall survival rate associated with independent risk factors. Results According to multivariate analysis, alpha-fetoprotein （HR=1.000; 95%CI： 1.000-1.000; P=0.024）, abnormal prothrombin （HR=1.000; 95%CI： 1.000-1.000; P=0.045）, tumor diameter （HR=1.007; 95%CI： 1.001-1.015; P=0.008）, portal vein tumor thrombus （HR=2.590; 95%CI： 1.215-4.132; P=0.023）, microvascular invasion （HR=2.290; 95%CI： 1.282-4.161; P=0.001）, satellite nodules （HR=2.185; 95%CI： 1.177-4.056; P=0.013）, and tumor differentiation type （Medium/high differentiation： HR=1.127; 95%CI： 0.530-2.369; P=0.755; low/high differentiation： HR=2.468; 95%CI： 1.104-5.372; P=0.019） were identified as risk factors influencing patients′ disease-free survival. Tumor diameter （HR=1.011; 95%CI： 1.003-1.017; P=0.031）, liver cirrhosis （HR=2.113; 95%CI： 1.057-3.233; P=0.043）, microvascular invasion （HR=2.159; 95%CI： 1.531-5.238; P=0.029）, satellite nodules （HR=2.778; 95%CI： 1.144-6.744; P=0.024）, and tumor differentiation type （Medium/high differentiation： HR=1.896; 95%CI： 0.368-9.769; P=0.444; Low/high differentiation： HR=3.760; 95%CI： 1.745-8.989; P=0.024） were found to be risk factors affecting patients′ overall survival. The cumulative disease-free survival rates at 1 year, 2 years, and 3 years for CNLC stage I were significantly higher compared to CNLC stages Ⅱ-Ⅲa （81.0%-70.9%-66.9% vs. 61.8%-43.3%-30.3%, P<0.001）. Similarly, the cumulative overall survival rates at 1 year, 2 years, and 3 years for CNLC stage I were also significantly higher than those for CNLC stages Ⅱ-Ⅲa （95.3%-89.5%-87.5% vs. 87.6%-57.6%-57.6%, P<0.001, Median disease-free survival of 17 months）. Conclusion sAlpha-fetoprotein, abnormal prothrombin, portal vein tumor thrombus, tumor diameter, liver cirrhosis, microvascular invasion, satellite nodules, and tumor differentiation type are potential independent risk factors influencing patients′ prognosis. Furthermore, CNLC staging can better evaluate patients′ recurrence and survival outcomes.

Clinical strategy of selective hepatic entry blood flow occlusion in laparoscopic hepatectomy

LI Yu, OU Huo-hui, LIU Qing-bo, GU Chi-chang, LIN Jie, MA Jing, ZHANG Wei-jie, WANG Wei-dong

2023, 23(03):  215-219.  DOI: 10.3969/j.issn.1009-976X.2023.03.002

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Objective To investigate the clinical value of selective hepatic flow occlusion technology for laparoscopic liver resection. Methods From August 2019 to September 2020, laparoscopic hepatectomy was performed in 70 patients with liver diseases. Different selective hepatic flow occlusion techniques were used during the operation according to tumor size, location and other characteristics of the lesions. Results All the 70 patients successfully were completed laparoscopic hepatectomy by different selective entryhepatic blood flow occlusion techniques, without conversion to open surgery. The operation time was 75-320 min, with an average of （226.0±64.1） min, and the intraoperative blood loss was （20-800） ml, with an average of （203.9±193.2） ml. The postoperative hospitalization time was 6-18 d. The average postoperative biliary fistula occurred in 3 cases and pleural effusion in 1 case （11.8±2.9）, with a complication rate of 5.7%. There were no complications such as massive hemorrhage or liver failure, and no perioperative death. Conclusion Laparoscopic liver resection with elective hepatic flow occlusion technology is safe and feasible in clinical application. After comprehensive consideration, the optimal hepatic flow occlusion techniques can effectively reduce intraoperative bleeding, liver ischemia reperfusion injury, and intraoperative and postoperative complications.

Prognostic impact of primary tumor resection combined with chemotherapy on stage Ⅳ colorectal cancer

ZHOU Hua-bin, LIU Yu-lan, WANG Zhong-chang, LI Min, ZHENG Chao

2023, 23(03):  220-229.  DOI: 10.3969/j.issn.1009-976X.2023.03.003

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Objective The survival benefit of primary tumor resection on patients with stage Ⅳ colorectal cancer has been controversial. This study aimed to investigate the prognostic impact of primary tumor resection combined with chemotherapy on patients with stage Ⅳ colorectal cancer. Methods A total of 4108 patients diagnosed with stage Ⅳ colorectal cancer in the SEER database from 2010 to 2015 were enrolled and divided into no primary tumor resection + no chemotherapy group, primary resection alone group, chemotherapy alone group, and primary tumor resection + chemotherapy group according to the treatment methods. The Kaplan-Meier method was used to draw survival curves, the Log-rank method was used to compare the survival differences among different treatment methods, and the Cox proportional risk regression model was applied to assess the prognostic factors of stage Ⅳ colorectal cancer. Results Age ≥60 years, Blacks, right hemicolon, poor differentiation, with lymph node metastasis, multiple metastasis, and elevated CEA were the risk factors for prognosis of stage Ⅳ colorectal cancer, while primary tumor resection and chemotherapy were the protective factors for prognosis of stage Ⅳ colorectal cancer patients. Among the four treatment modalities, the prognosis of the primary tumor resection+chemotherapy group was the best. Conclusion In both stage ⅣA and ⅣB colorectal cancers, primary tumor resection combined with chemotherapy significantly improves patient survival compared to systemic chemotherapy alone.

Clinical value of up-regulated expression of ANAPC5 mRNA in hepatocellular carinnoma and analysis of related pathways

WU Wei-zi, ZHANG Guan-lan, TANG Yu-xing, ZHENG Qing, CHEN Yu, CHEN Ji-tian, ZHAN Yan-ting, MO Wei-jia

2023, 23(03):  230-237.  DOI: 10.3969/j.issn.1009-976X.2023.03.004

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Objective To explore the expression trend and clinical value of ANAPC5 as well as the potential molecular mechanism of ANAPC5 involving in the progression of HCC. Methods Combined with HCC gene microarrays and RNA-seq data worldwide, Wilcoxon test was used to analyze the comprehensive expression of ANAPC5 in HCC by combining SMD. Simultaneously, its clinical value and related pathway analysis in HCC was evaluated. Results By analyzing the results of gene microarray or RNA-seq data of 3820 HCC samples and 3091 non-HCC samples, the combined SMD=0.71（95%CI： 0.55~0.88）, with obvious heterogeneity. The AUC=0.81, sensitivity=0.69 （95%CI： 0.60~0.77）, specificity= 0.81（95%CI： 0.73~0.88）, positive likelihood ratio= 3.78 （95%CI： 2.63~5.47）, negative likelihood ratio=0.39 （95%CI： 0.29~0.48）. Enrichment analysis showed that ANAPC5 was related to ribosome, spliceosome, cell cycle pathways. Conclusion Up_regulation of ANAPC5 may play a role in promoting HCC development.

Discussion on general practice management model of breast cancer

JIN Xiao-yan, LIU Shu-qiong, LUO Shu-juan

2023, 23(03):  238-241.  DOI: 10.3969/j.issn.1009-976X.2023.03.005

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Objective To establish whole process management of breast cancer with general characteristics in general hospital, explore general management mode as chronic disease. Methods By referring to domestic and foreign literature related to the diagnosis、treatment and management of breast cancer, and referring to the disease management process in breast department of our hospital, a whole-process management of breast cancer suitable for the general practice was constructed. Results Step 1, to conduct individualized lifestyle education through the search of risk factors. Step 2, prevention and management of related complications and side effects during the therapy, adhere the standard treatment. Step 3, follow up after discharge to prevent recurrence and manage long-term side effects concomitant diseases. Conclusion The standard process management of breast cancer embodies the concept of general practice, and effectively realizes the whole-process chronic disease management of breast cancer.

Arthroscopic partial meniscectomy combined with exercise therapy versus exercise therapy alone in degenerative meniscal tears：an updated meta-analysis

DENG Wei, ZHANG Sheng-hua, ZHANG Xue-feng

2023, 23(03):  242-251.  DOI: 10.3969/j.issn.1009-976X.2023.03.006

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Objective The optimal treatment of degenerative meniscus tears is still controversial. A meta-analysis was conducted to investigate the clinical efficacy of arthroscopic meniscal plasty combined with exercise therapy versus exercise therapy alone in the treatment of degenerative meniscal tears. Methods According to the principles of PICOS, we searched the literature of prospective randomized controlled trials （RCT） published in PubMed, EMBASE, Web of Science, CNKI, and China Wanfang Data database on the comparison of meniscoplasty combined with exercise therapy and exercise therapy alone in the treatment of degenerative meniscus tears. The search period was from the establishment of the database to September 30, 2022. Literature screening and data extraction were conducted according to the Cochrane manual, and literature risk assessment was conducted. Fixed-effect or random-effect models were selected for meta-analysis according to whether there was heterogeneity, and the results were shown in forest plots. Results Ultimately, twelve RCTS were enrolled, including 1306 patients. The overall risk of bias was rated as low, and the funnel plot showed no significant risk of bias. For pain scores, there were no statistically significant differences between the two groups at 2, 6, 12, and 24 months （P>0.05）. For functional scores, the results showed that arthroscopic partial meniscectomy combined with exercise therapy was higher than exercise therapy alone at 2 months （MD=3.31； 95%CI： 1.60~5.03； P<0.01）. There were no significant differences in functional scores between the two groups at 6, 12, 24 months and 5 years. Conclusion In terms of early functional scores, arthroscopic partial meniscectomy combined with exercise therapy is more effective. However, there were no differences in pain or functional scores during medium- and long-term follow-up. Therefore, the potential of exercise therapy in the treatment of degenerative meniscal tears should be emphasized in clinical work.

Clinicopathological characteristics and risk factors of lateral cervical lymph node metastasis in 45 cases of medullary thyroid carcinoma

YU Wei-ming, QIAN Yu-tong, GUO Qian-nan, ZHU Yue, TAN Liang-ping, ZHANG Sheng

2023, 23(03):  252-256.  DOI: 10.3969/j.issn.1009-976X.2023.03.007

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Objective To retrospectively analyze the clinicopathological characteristics and risk factors for lateral cervical lymph node metastasis of medullary thyroid carcinoma （MTC）. Methods A retrospective analysis was conducted on 45 patients with medullary thyroid carcinoma who underwent initial surgery from November 2013 to November 2021 at Sun Yat-sen University′s Sun Yat-sen Memorial Hospital, using a single factor analysis and a multivariate logistic regression model. Results Among the clinicopathological features, the ratio of male to female was 1.25∶1, with 29 （64.4%） lymph node metastases in the central region and 15 （33.3%） lymph nodes in the lateral cervical region. Univariate analysis showed that patients with primary tumor diameter≥1.9 cm, tumor invasion of capsule, and≥4 lymph nodes in the central cervical region considered for metastasis had a significantly higher risk of lateral cervical lymph node metastasis （P<0.05）. In multivariate logistic analysis, the results showed that only the maximum diameter of the tumor affected the probability of lateral cervical lymph node metastasis, with statistical significance （P<0.05）. Conclusion Compared with thyroid papillary carcinoma, the male patients with MTC in this article had a higher incidence rate than the female patients. When the tumor diameter of MTC patients is ≥1.9 cm, the tumor invades the capsule, and the lymph nodes in the central region of the neck are considered to have multiple metastases, the lymph nodes in the lateral region of the neck should be fully evaluated before surgery to avoid omission and secondary surgery.

Effect of environmental factors on enzyme activity of multi-enzyme medical detergent

HE Hui-yan, WU Li-xiang, LI Chun

2023, 23(03):  257-260.  DOI: 10.3969/j.issn.1009-976X.2023.03.008

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Objective To detect the activity of enzymes in the working solution at different temperature at a certain time interval, so as to determine the best use conditions of the common multi-enzyme medical detergent. Methods Four kinds of multi-enzyme medical detergent from different manufacturers were selected. Solution A was the fast and efficient multi-enzyme medical detergent. Solution B is omnipotent multi-enzyme medical detergent. Solution C is specific alkaline multi-enzyme medical detergent. Solution D is full effect multi-enzyme medical detergent. At room temperature, A, B, C and D were diluted 200 times with pure water to form the working solution, and the pH value of the working liquid was determined. Four different multi-enzyme medical detergent working solution A, B, C and D were placed in a water bath at 15 ℃, 20 ℃, 25 ℃ and 30 ℃ at constant temperature, and stored at different intervals of 1 h, 3 h, 6 h and 8 h. The enzyme activities in the working solutions were measured by sampling, and the enzyme activity stability curve was drawn. Results Under the condition of 15℃~20℃, only about 10% enzyme activity was decreased in 8 h. Under the condition of the same loss, only at 6 h the enzyme activity could be maintained at 25 ℃, and at 3 h the enzyme activity could be maintained at 30 ℃. Conclusion It is suggested that the multi-enzyme medical detergent can be used within 3 h at room temperature after being diluted into working solution. Or under the condition of refrigeration, used within 8 h. The full effect multi-enzyme medical detergent showed the higher enzyme activity stability.

Review

Research progress of sphingomyelinase in gastrointestinal cancers

WANG Rong-yue, SU Yan-ze, CHEN Er-bao, LIU Ji-kui

2023, 23(03):  263-268.  DOI: 10.3969/j.issn.1009-976X.2023.03.010

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SMPD protein family is a kind of hydrolase that plays a major role in sphingomyelin metabolism. At present, relative researches have found that the members of SMPD are abnormally expressed in different types of tumors, and play a key role in the occurrence, development and drug resistance of cancer. Thus, SMPD family is expected to be a potential predictor for tumor diagnosis, prognosis and treatment. Therefore, this review summarizes the structure and function of SMPD gene and protein, and elucidates the research finding of SMPD in gastrointestinal cancers, which provides new ways and strategies into precision medicine and prognosis evaluation.

Research progress on risk factors of postoperative recurrence of liver cancer

LIU Li-qing, ZHANG Li, JIN Yan, XU Jing

2023, 23(03):  269-276.  DOI: 10.3969/j.issn.1009-976X.2023.03.011

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Hepatocellular carcinoma （HCC） is one of the most common cancers. At present, radical hepatectomy is still the main treatment for HCC. Although considerable progress has been made in the monitoring, diagnosis and treatment of HCC patients, the high recurrence rate after radical hepatectomy remains high. There are many risk factors affecting the recurrence of HCC after operation. At present, the risk factors related to the recurrence of HCC after operation can be divided into host factors, tumor factors and surgical factors. This article will review the research progress of risk factors for recurrence after radical resection of HCC, and provide reference for clinical workers.

The effect of collagen type Ⅰ in the progression of pancreatic cancer

KANG Yi-xing, SU Yan-ze, ZHANG Chao-chuang, LEI De-feng, LIN Zhi-heng, WANG Rong-rui, CHEN Xiao, LIU Ji-kui

2023, 23(03):  277-282.  DOI: 10.3969/j.issn.1009-976X.2023.03.012

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Pancreatic cancer （PC）is a malignant tumor with high incidence and high mortality. Although the current treatment strategies have made great progress, metastasis, recurrence and drug resistance of pancreatic cancer are still the main reasons for poor prognosis of patients. Collagen type I （Col-I） is a major extracellular matrix protein and is abnormally expressed in a variety of solid tumors. Recent studies have shown that Col-I is highly expressed in PC, which is closely related to the growth, metastasis, invasion, drug resistance and treatment of PC, and is a new potential therapeutic target for PC. This review focuses on the effects of Col-I on the progression of PCand provides new ideas for the diagnosis and targeted therapy of PC.

Research progress on moyamoya disease

WANG Yu-bo, MA Lin, REN He-cheng, LUO Bin, HUANG Ying

2023, 23(03):  283-288.  DOI: 10.3969/j.issn.1009-976X.2023.03.013

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Moyamoya disease, also known as spontaneous basilar artery occlusion, is a disease characterized by slow thickening of the intima at the end of the internal carotid artery and the beginning of the anterior cerebral artery and middle cerebral artery, the gradual narrowing and occlusion of the lumen of the artery, and compensatory expansion of Perforate the artery at the base of the brain. This article will review the epidemiological features and clinical features of moyamoya disease in Eastern Asia in recent years.