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Background & Objective: Alpha-fetoprotein (AFP) is a marker often used to detect carcinoma cells in peripheral blood of patients with hepatocellular carcinoma (HCC). This study was to explore the correlation of perioperative AFP expression in peripheral blood to recurrence of HCC., Methods: Peripheral blood samples from 56 HCC patients, obtained perioperatively, were tested for the presence of AFP mRNA by nested reverse transcription-polymerase chain reaction (RT-PCR) and TaqMan MGB probe real-time quantitative PCR. The peripheral blood samples from 15 patients with benign liver masses and cirrhosis, and 30 healthy volunteers were used as control., Results: The positive rate of AFP mRNA in preoperative peripheral blood was significantly higher in HCC patients than in patients with benign liver masses and cirrhosis (42.9% vs. 13.3%, P=0.035) and healthy volunteers (42.9% vs. 10.0%,P=0.002). The expression of AFP mRNA in preoperative peripheral blood was significantly related to tumor vascular invasion, either observed macroscopically (P=0.029) or microscopically (P<0.001). The 1-, 2-, and 3-year overall and disease-free survival rates were significantly higher in AFP-negative patients than in AFP-positive patients (P=0.003, P=0.039). Cox multivariate analysis showed that preoperative expression of AFP mRNA in peripheral blood was an independent factor for predicting recurrence (P=0.018). The positive rate of AFP mRNA in postoperative peripheral blood samples from HCC patients was 37.5%. The presence of AFP mRNA in postoperative peripheral blood was not related to any clinicopathologic factors, AFP mRNA levels in preoperative peripheral blood, and prognosis of the HCC patients., Conclusion: The presence of AFP mRNA in preoperative peripheral blood is related to tumor invasion of HCC, and may be a predictor maker of tumor recurrence.

Background & Objective: Recent researches have revealed that chemokine-chemokine receptor network plays an important role in tumor metastasis. This study was to investigate the expression of CXCR3, a chemokine receptor, and its correlation to clinicopathologic features of hepatocellular carcinoma (HCC)., Methods: CXCR3 mRNA expression in 7 human HCC cell lines, 18 normal liver tissues and 64 pairs of HCC tissues and adjacent liver tissues was detected by reverse transcription-polymerase chain reaction (RT-PCR) and real-time quantitative PCR; CXCR3 protein expression was detected by immunohistochemistry. The correlation of CXCR3 expression to the metastasis of HCC was analyzed., Results: CXCR3 mRNA was expressed in 2 HCC cell lines (MHCC97-H and MHCC97-L) with metastatic potential, but not in 5 HCC cell lines without metastatic potential. The CXCR3/beta2M expression ratio in MHCC97-H cells (high metastatic potential) was 33.0x10(-4), and that in MHCC97-L cells (low metastatic potential) was 8.7x10(-4). Strong staining of CXCR3 protein in MHCC97-H and MHCC97-L cells was observed. However, the staining of CXCR3 protein was not detected in 4 HCC cell lines without metastatic potential; only weak staining was detected in HepG-2 cells. The expression of CXCR3 protein in HCC is significantly correlated to the invasiveness of tumors (P=0.003). The 1-and 2-year tumor-free survival rates of the HCC patients with strong positive CXCR3 expression were significantly lower than those of the patients with weak positive CXCR3 expression (66.7% vs. 75.0%, 31.3% vs. 59.5%, P=0.044)., Conclusion: The expression of CXCR3 might play a role in the invasion and metastasis of HCC.

Background & Objective: Iressa, a new molecular targeting medicine, has some effects on advanced non-small cell lung cancer, but its effect on hepatocellular carcinoma (HCC) has seldom been reported. This study was to observe the efficacy and adverse effect of Iressa on HCC Hep-3B and HepG2 cell xenografts in nude mice., Methods: The nude mice with Hep-3B and HepG2 cell xenografts were randomized into control group (8 mice), low-dose group (8 mice), and high-dose group (8 mice), and received daily oral gavage of 5% glucose solution, 100 mg/kg Iressa, and 200 mg/kg Iressa, respectively, by 5 days each week for 3 weeks. The mice were killed 2 days after treatment. Inhibitory rate (IR) of tumor growth was calculated. Tumor volume, mice weight, and spleen index (SI) were compared between groups., Results: Body weight and tumor volume of the mice were caparable before treatment. IRs of Hep-3B cell xenograft growth were 32.77% in low-dose group and 46.99% in high-dose group; IRs of HepG2 cell xenograft growth were 68.57% and 75.24%, respectively. Body weight and SI of nude mice with either Hep-3B or HepG2 cell xenografts were significantly lower in high-dose group than in control group, but no obvious difference was observed between low-dose group and control group., Conclusion: Iressa has obvious inhibitory effects on growth of both Hep-3B and HepG2 cell xenografts in nude mice, but high-dose (200 mg/kg) of Iressa may cause body weight lose and immunologic inhibition.

Background & Objective: It is important to accurately estimate liver reserve function before hepatectomy for hepatocellular carcinoma (HCC), and to determine proper hepatic resection volume during operation, thus, to avoid postoperative liver failure. Recently, indocyanine green retention rate at 15 min (ICG(R15)) has been considered as a sensitive marker for liver reserve function. However, how to evaluate the maximal hepatic resection volume according to liver reserve function, especially ICG(R15), remains controversial. This study was to evaluate the influence of ICG(R15) and hepatic resection volume on postoperative liver failure., Methods: Records of 225 HCC patients who underwent hepatectomy were retrospectively reviewed. Preoperative ICG(R15) value, intraoperative hepatic resection volume, and postoperative liver function were analyzed., Results: Of the 225 patients, 113 received resection of no more than 1 segment (group A), 76 received resection of 1-2 segments (group B), 36 received resection of more than 2 segments (group C). When ICG(R15) was below 10%, the incidences of postoperative ascites in groups A, B, and C were 21.2% (14/66), 14.3% (8/56), and 15.4% (4/26), respectively (P>0.05); the incidences of jaundice were 3.0% (2/66), 7.1% (4/56), and 15.4% (4/26), respectively (P>0.05). When ICG(R15) was 10%-20%, the incidences of ascites were 26.8% (11/41), 38.9%(7/18), and 50.0% (5/10), respectively (P>0.05); the incidence of jaundice was lower in group A than in group B, and group C [0 (0/41) vs. 27.8% (5/18), and 20.0% (2/10), P<0.01]; 2 patients, who had 2 or 3 segments resected, died of postoperative encephalopathy. When ICG(R15) was more than 20%, ascites occurred in 2 of 6 patients (33.3%) in group Au both of the 2 cases in group B developed postoperative ascites and jaundice, and 1 died., Conclusions: When ICG(R15) is below 10%, 2 or more segments can be resected safely when ICG(R15) is 10%-20%, 1 segment can be resected safely, 2 or more segments may be resected with great care when ICG(R15) is more than 20%, the patient's general condition and other liver function tests should be taken into consideration if 1 segment is resected, resection of 2 or more segments will cause high surgical risk.

Background & Objective: Accurate estimation of liver reserve function before hepatectomy for liver cancer may avoid postoperative liver failure. Recently,it has been considered that indocyanine green retention rate at 15 minutes (ICG(R15))can assess liver reserve function with exactitude and high sensitivity. This study was to discuss the evaluation of liver cirrhosis severity and liver reverse function by ICG(R15), analyze the relationship between ICG(R15) and post-operative liver failure,and compare ICG(R15) with Child-Pugh grading., Methods: Records of 225 patients with resected hepatocellular carcinoma (HCC)have been collected. Pre-operative data, such as a variety of routine liver biochemistry tests, Child-Pugh grading, and ICG(R15) value, and intra-operative data, post-operative data were analyzed., Results: The mean value of ICG(R15) was (9.9+/-6.2)% in cirrhosis group,and (7.4+/-3.8)% in non-cirrhosis group (P< 0.01). The mean value of ICG(R15) was (8.5+/-5.0)% in mild cirrhosis subgroup, (10.7+/-5.7)% in moderate cirrhosis subgroup, and (15.8+/-9.6)% in severe cirrhosis subgroup; significant differences can be observed while multiple comparisons were performed (P< 0.05). The mean values of ICG(R15) in patients who suffered from post-operative ascites, and jaundice were (11.5+/-6.8)%,and (12.1+/-7.1)%; significantly higher than those without ascites, and jaundice [(8.5+/-4.9)%,and (9.0+/-5.3)%] (P< 0.05). Possible predictor variables indicating risk factors of post-operative complications were entered into a multiple logistic regression model, the results showed that ICG(R15) significantly affected the occurrence of both post-operative ascites and jaundice (P< 0.05). The mean value of ICG(R15) of patients of Child-Pugh B grade was (15.2+/-8.6)%, much higher than that of patients of Child-Pugh A grade [(8.8+/-5.1)%](P< 0.01). ICG(R15) values were above 10% in 67 of the 212 patients of Child-Pugh A grade, and 6 of these 67 patients have a value above 20%., Conclusions: ICG(R15) value rises with the aggravation of liver cirrhosis,it affects the occurrence of post-operative liver failure significantly. Some correlation can be observed between ICG(R15) and Child-Pugh grading.

Background & Objective: Most cases of hepatocellular carcinoma (HCC) are unresectable even without extra-hepatic metastasis. In addition, about 80%-90% patients in China are accompanied with cirrhosis. Liver transplantation is probably more proper for these patients than other treatments. This study was to explore the value of liver transplantation for treatment of advanced HCC without extra-hepatic metastasis, and to summarize the experience of liver transplantation performed in Cancer Center of Sun Yat-sen University., Methods: Ten patients with advanced HCC without extra-hepatic metastasis who underwent liver transplantation in Sun Yat-sen University Cancer Center from Sept. 2003 to Apr. 2004 were followed up to May 2004, and their clinical records were reviewed retrospectively., Results: The mortality within 1 month after operation was 0.0% for 10 cases of liver transplantation. One patient was alive for 7 month with tumor recurrence, and the remaining 9 patients were alive for 1-6 months without recurrence. Alpha fetoprotein (AFP) decreased to normal range within 2 months in 2 cases with macro tumor thrombus in the trunk of portal vein, and the left branch of portal vein, respectively., Conclusion: Advanced HCC without extra-hepatic metastasis, even with macro tumor thrombus in portal vein, is still indicated for liver transplantation.

Background & Objective: Primary liver cancer (PLC) larger than 10 cm in diameter is called huge PLC. Huge PLC accounts for a number of patients at the time of diagnosis in clinical practice. The outcome of resection in these patients has not been clearly demonstrated. This study was to evaluate the outcome and determined the prognostic factors affecting long-term survival following hepatectomy for huge PLC., Methods: One hundred and seventy-three patients with huge PLC who underwent hepatectomy from 1964 to 1993 were followed up to January 2003 and reviewed retrospectively. The factors affecting long-term survival were studied by univariate and multivariate analysis., Results: The overall 3-, 5-, and 10-year survival rates were 31.9%, 21.8%, and 8.3%, respectively. Thirty-seven patients survived more than 5 years and 8 patients survived more than 10 years. Univariate analysis showed that sex, Child-Pugh classification, degree of coexisting cirrhosis and radical resection were significant prognostic factors. The Cox multivariate proportional hazard model indicated that independent prognostic factors for long-term survival were degree of coexisting cirrhosis and radical resection., Conclusions: Hepatic resection for huge PLC offers the chance of long-term survival. It should be used to treat patients with huge PLC at first choice. Degree of coexisting cirrhosis and radical resection were the only two prognostic factors for long-term survival following hepatectomy for huge PLC.

Background & Objective: Transcatheter arterial chemoembolization (TACE) has been proved to injure hepatic functional reserve. The current study was designed to evaluate the effect of Chinese herbal medicines in treatment of hepatic functional reserve injury after TACE., Methods: Sixty-one advanced hepatocellular carcinoma patients were divided into two groups: groups A (Western medicine combined with Chinese herbal medicine group, n = 30) and group B (Western medicine group, n = 31). Western medicines were used to protect hepatic function and alleviate TACE syndrome in both group A and group B. Invigorating the spleen and activating blood circulation Chinese herbal medicines were added only in group A before and after TACE. Retention rate of Indocyanine green at 15 minutes (ICGR15) was measured in both group A and group B before 1st, 2nd TACE and one month after 2nd TACE respectively., Results: Hepatic functional reserve before 1st TACE was 11.18% +/- 7.30% in group A and 11.83 +/- 7.18% in group B, (P > 0.05). Hepatic functional reserve before 2nd TACE was 11.69% +/- 5.13% in group A and 16.64 +/- 10.15% in group B, (P < 0.05). Hepatic functional reserve one month after 2nd TACE was 11.53% +/- 5.30% in group A and 19.80 +/- 11.26% in group B, (P < 0.05)., Conclusions: Invigorating the spleen and activating blood circulation Chinese herbal medicine can prevent hepatic functional reserve injury after TACE.