Objective:A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma(HCC)after narrow-margin hepatectomy(<1 cm).This ...Objective:A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma(HCC)after narrow-margin hepatectomy(<1 cm).This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.Methods:Patients with central HCC after narrow-margin hepatectomy(<1 cm)were prospectively assigned to adjuvant radiotherapy group and control group.Patients'outcome,adverse events,long-term recurrence and survival rates were investigated.Results:The 1-,5-,and 10-year recurrence-free survival(RFS)rates were 81.0%,43.9%,and 38.7%,respectively in adjuvant radiotherapy group and 71.7%,35.8%,and 24.2%,respectively in control group(log-rank test,P=0.09).The 1-,5-,and 10-year overall survival(OS)rates were 96.6%,54.7%,and 42.8%,respectively in adjuvant radiotherapy group and 90.2%,55.1%,and 30.0%,respectively in control group(log-rank test,P=0.20).The 1-,5-,and 10-year RFS rates for patients with small HCC(≤5 cm)were 91.1%,51.6%,and 48.4%,respectively in adjuvant radiotherapy group and 80.0%,36.6%,and 26.6%,respectively in control group(log-rank test,P=0.03).Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group(log-rank test,P=0.05).Conclusions:Our updated results showed a sustained clinical benefit on reducing recurrence,improving longterm survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy.Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.展开更多
Objective: Hand-assisted laparoscopic liver resection has the advantages of open and laparoscopic surgeries.There is still lack of comparison of surgical outcomes between hand-assistied laparoscopic liver resection(HA...Objective: Hand-assisted laparoscopic liver resection has the advantages of open and laparoscopic surgeries.There is still lack of comparison of surgical outcomes between hand-assistied laparoscopic liver resection(HALLR)and open liver resection(OLR). This study compared the surgical outcomes of the two approaches between wellmatched patient cohorts.Methods: Patients who received liver resection during January 2014 and October 2017 in Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College were included in this retrospective study. Propensity score matching(PSM) was performed to reduce selection bias between the two groups. Operation and short-term surgical outcomes were compared between the well matched groups.Results: During this period, 232 patients with a median age of 55.1 years old received OLR, while 49 patients with a median age of 54.7 years old received HALLR. Compared with HALLR group, OLR group has a higher proportion in male patients(190/232, 81.9% vs. 34/49, 69.4%, P=0.048) and lower albumin(43.2±4.5 vs. 44.8±3.7,P=0.020). After PSM, 49 patients from each group were included in the following analysis. Two groups were well balanced in their baseline characteristics, liver functions, preoperative treatments, abdominal surgery history, and surgical difficulty. None perioperative mortality was observed in both groups. Operation time and postoperative complications were similar in two groups(P=0.935, P=0.056). The HALLR group showed less bleeding amount(177.8±217.1 mL vs. 283.1±225.0 mL, P=0.003) and shorter postoperative stay period(6.9±2.2 d vs. 9.0±3.5 d,P=0.001).Conclusions: We demonstrated that hand-assisted laparoscopic surgery is feasible and safe for liver resection,including some difficult cases. HALLR can provide better bleeding control and faster recovery after surgery.展开更多
During the sustainable development of land surface system,different territories undertake different functions.The understanding and representation of territorial differentiation of the land surface system is the main ...During the sustainable development of land surface system,different territories undertake different functions.The understanding and representation of territorial differentiation of the land surface system is the main purpose of comprehensive function regionalization research.Focusing on the theoretical gap of comprehensive geographical regionalization,that is,the spatial decoupling of the physical environment and human activities,the non-nested relationship of spatial scale transformation,and the persistence and uncertainty of the dynamic evolution of territorial functions,this research proposed the identification principles and division methods of comprehensive functional regions.Based on the major function zoning in China,the systematic classification method with function orientation was employed to delineate the comprehensive functions of each territory,such as ecological security,food production and urban development.Then,the geographical regionalization method,which follows the principles of interconnection of different regionalization objectives at different levels and a combination of top-down decomposition and bottom-up aggregation,was used to determine the geographic boundaries.To meet the objective requirements of flexible and dynamic boundaries,two sets of land regionalization schemes for 2035 and 2050 were finally formed,each of which had three spatial levels.The first-level regionalization identified four major regions,which comprehensively represented the relatively stable state of China’s land development and protection pattern under the leading role of physical environment differentiation.The second-level regionalization identified 12 regions,which comprehensively represented the spatial layout of a new development pattern of multi-and inter-provinces coordinating the innovation chain,industrial chain and supply chain based on a relatively independent and complete natural carrier.The third-level regionalization identified 80 sub-regions,which comprehensively represented the functional differentiation patterns of sub-provinces during sustainable development.Compared with the current geographical differentiation research,the study of territorial function differentiation has academic values for the development of integrated geography in exploring the territorial system of the humanenvironment relationship,and it can provide a scientific basis for determining the territorial model of sustainable development and optimizing the pattern of spatial development and protection in China.展开更多
Biomarkers for hepatocellular carcinoma (HCC) following curative resection are not currently sufficient for prognostic indication of overall survival (OS) and disease-free survival (DFS). The aim of this study was to ...Biomarkers for hepatocellular carcinoma (HCC) following curative resection are not currently sufficient for prognostic indication of overall survival (OS) and disease-free survival (DFS). The aim of this study was to investigate the prognostic performance of osteopontin (OPN), matrix metalloproteinase 7 (MMP7), and pregnancy specific glycoprotein 9 (PSG9) in patients with HCC. A total of 179 prospective patients with HCC provided plasma before hepatectomy. Plasma OPN, MMP7, and PSG9 levels were determined by enzyme-linked immunosorbent assay. Correlations between plasma levels, clinical parameters, and outcomes (OS and DFS) were overall analyzed. High OPN (≥149.97 ng/mL), MMP7 (≥2.28 ng/mL), and PSG9 (≥45.59 ng/mL) were prognostic indicators of reduced OS (P<0.001, P<0.001, and P=0.007, respectively). Plasma PSG9 protein level was an independent factor in predicting OS (P=0.008) and DFS (P=0.038). Plasma OPN+MMP7+PSG9 elevation in combination was a prognostic factor for OS (P<0.001). OPN was demonstrated to be a risk factor-associated OS in stage I patients with HCC and patients with low α-fetoprotein levels (<20 ng/mL). These findings suggested that OPN, MMP7, PSG9 and their combined panels may be useful for aiding in tumor recurrence and mortality risk prediction of patients with HCC, particularly in the early stage of HCC carcinogenesis.展开更多
Background: Postoperative radiotherapy (RT) is known to play an important role in the treatment of hepatocellular carcinomas (HCCs), but the specific role of intraoperative electron radiotherapy (IOERT) in HCCs remain...Background: Postoperative radiotherapy (RT) is known to play an important role in the treatment of hepatocellular carcinomas (HCCs), but the specific role of intraoperative electron radiotherapy (IOERT) in HCCs remains unclear. The aim of this study was to investigate the safety and efficacy of IOERT in centrally located HCCs treated with narrow-margin (<1 cm) hepatectomy. Methods: This was a single-center, phase 2, prospective non-randomized controlled study, including 268 patients with centrally located HCCs who underwent narrow-margin hepatectomy. The patients were subsequently allocated to the IOERT group (n=59) or to the control group (n=65). The primary outcome of the study was to compare recurrence-free survival (RFS) between the IOERT group and the control group, and the secondary outcome was to compare overall survival (OS) rate between the two groups. Results: Of 268 patients enrolled, a total of 124 were included in the study: 59 in IOERT group, 65 in control group. The 1-, 2-, 3-year RFS rates were 79.3%, 62.1% and 45.8% for patients in the IOERT group, and 47.6%, 28.6%, and 22.9% for patients in the control group, respectively (P=0.025). The 1-, 2-, and 3-year OS rates were 100.0%, 94.9%, and 83.7% for patients in the IOERT group, and 92.3%, 87.5%, and 79.4% for patients in the control group, respectively (P=0.314). Subgroup analysis of MVI (+) patients revealed that RFS and OS are significantly prolonged in the IOERT subgroup as compared to the control, whereas there was no significant difference of RFS and OS between the two groups in MVI (−) patients. Conclusions: IOERT for centrally located HCCs with concurrent narrow-margin hepatectomy was feasible and safe. Statistically better RFS rate was observed in the IOERT group compared to the control group. Subgroup analysis revealed that IOERT was more beneficial for postoperative survival of HCC patients with MVI. Trial Registration: ChiCTR-TRC-12002802;www.who.int/ictrp.展开更多
Background:Liver cancer as the main leading cancer has caused heavy burdens globally.The prognosis of liver cancer is closely related with postoperative nutrition support.Corn oligopeptides(COPs)are protein hydrolysat...Background:Liver cancer as the main leading cancer has caused heavy burdens globally.The prognosis of liver cancer is closely related with postoperative nutrition support.Corn oligopeptides(COPs)are protein hydrolysates produced by enzymatic treatments,which have shown potential bioactivities,such as inhibiting angiotensin I-converting enzyme,resisting lipid peroxidation and anti-oxidant.However,the correlation between COPs and liver cancer patients is still unknown and the potential mechanism of COPs on liver cancer is unclear as well.The aim of this study was to assess effects of 7-day intervention of COPs after surgery on liver function and serum metabolic profiles of liver cancer patients.Methods:Patients were assigned into COPs intervention group(n=50)and control group(n=91)for 7 days.Investigations were scheduled at 1st day and 7th day after liver resection surgery respectively,mainly including anthropometric,biochemical indexes and liquid chromatography-mass spectrometry(LC/MS)analysis.Results:Seven-day supplementation of COPs on early post-surgery liver cancer patients down-regulated levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin and up-regulated prothrombin time activity and prealbumin levels.LC/MS analysis revealed metabolic signatures including regulation of 16 metabolites,which was closely related with two metabolic pathways(nicotinate and nicotinamide metabolism,fatty acid metabolism).Conclusions:COPs supplementation has displayed the potentials on alleviating the injury of liver function and it may be due to regulation of fatty acid metabolism,nicotinate and nicotinamide metabolism,lipid peroxidation and anti-inflammatory action.More researches are warranted in future to confirm the exact mechanisms.展开更多
基金supported by the CAMS Innovation Fund for Medical Science(CIFMS)(CAMS-2016-I2M-3-025)。
文摘Objective:A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma(HCC)after narrow-margin hepatectomy(<1 cm).This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.Methods:Patients with central HCC after narrow-margin hepatectomy(<1 cm)were prospectively assigned to adjuvant radiotherapy group and control group.Patients'outcome,adverse events,long-term recurrence and survival rates were investigated.Results:The 1-,5-,and 10-year recurrence-free survival(RFS)rates were 81.0%,43.9%,and 38.7%,respectively in adjuvant radiotherapy group and 71.7%,35.8%,and 24.2%,respectively in control group(log-rank test,P=0.09).The 1-,5-,and 10-year overall survival(OS)rates were 96.6%,54.7%,and 42.8%,respectively in adjuvant radiotherapy group and 90.2%,55.1%,and 30.0%,respectively in control group(log-rank test,P=0.20).The 1-,5-,and 10-year RFS rates for patients with small HCC(≤5 cm)were 91.1%,51.6%,and 48.4%,respectively in adjuvant radiotherapy group and 80.0%,36.6%,and 26.6%,respectively in control group(log-rank test,P=0.03).Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group(log-rank test,P=0.05).Conclusions:Our updated results showed a sustained clinical benefit on reducing recurrence,improving longterm survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy.Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.
基金supported by PUMC Youth Fund/ Fundamental Research Funds for the Central Universities (No. 3332016031)National Key Research and Development Plan (No. 2016YFD0400604-03)
文摘Objective: Hand-assisted laparoscopic liver resection has the advantages of open and laparoscopic surgeries.There is still lack of comparison of surgical outcomes between hand-assistied laparoscopic liver resection(HALLR)and open liver resection(OLR). This study compared the surgical outcomes of the two approaches between wellmatched patient cohorts.Methods: Patients who received liver resection during January 2014 and October 2017 in Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College were included in this retrospective study. Propensity score matching(PSM) was performed to reduce selection bias between the two groups. Operation and short-term surgical outcomes were compared between the well matched groups.Results: During this period, 232 patients with a median age of 55.1 years old received OLR, while 49 patients with a median age of 54.7 years old received HALLR. Compared with HALLR group, OLR group has a higher proportion in male patients(190/232, 81.9% vs. 34/49, 69.4%, P=0.048) and lower albumin(43.2±4.5 vs. 44.8±3.7,P=0.020). After PSM, 49 patients from each group were included in the following analysis. Two groups were well balanced in their baseline characteristics, liver functions, preoperative treatments, abdominal surgery history, and surgical difficulty. None perioperative mortality was observed in both groups. Operation time and postoperative complications were similar in two groups(P=0.935, P=0.056). The HALLR group showed less bleeding amount(177.8±217.1 mL vs. 283.1±225.0 mL, P=0.003) and shorter postoperative stay period(6.9±2.2 d vs. 9.0±3.5 d,P=0.001).Conclusions: We demonstrated that hand-assisted laparoscopic surgery is feasible and safe for liver resection,including some difficult cases. HALLR can provide better bleeding control and faster recovery after surgery.
基金supported by the Key Project of the National Natural Science Foundation of China(Grant No.42230510)the Second National Comprehensive Scientific Investigation and Research Project on the Tibetan Plateau(Grant No.2019QZKK0401)the Special Project of Spatial Planning of the Ministry of Natural Resources(Grant No.202012111978)。
文摘During the sustainable development of land surface system,different territories undertake different functions.The understanding and representation of territorial differentiation of the land surface system is the main purpose of comprehensive function regionalization research.Focusing on the theoretical gap of comprehensive geographical regionalization,that is,the spatial decoupling of the physical environment and human activities,the non-nested relationship of spatial scale transformation,and the persistence and uncertainty of the dynamic evolution of territorial functions,this research proposed the identification principles and division methods of comprehensive functional regions.Based on the major function zoning in China,the systematic classification method with function orientation was employed to delineate the comprehensive functions of each territory,such as ecological security,food production and urban development.Then,the geographical regionalization method,which follows the principles of interconnection of different regionalization objectives at different levels and a combination of top-down decomposition and bottom-up aggregation,was used to determine the geographic boundaries.To meet the objective requirements of flexible and dynamic boundaries,two sets of land regionalization schemes for 2035 and 2050 were finally formed,each of which had three spatial levels.The first-level regionalization identified four major regions,which comprehensively represented the relatively stable state of China’s land development and protection pattern under the leading role of physical environment differentiation.The second-level regionalization identified 12 regions,which comprehensively represented the spatial layout of a new development pattern of multi-and inter-provinces coordinating the innovation chain,industrial chain and supply chain based on a relatively independent and complete natural carrier.The third-level regionalization identified 80 sub-regions,which comprehensively represented the functional differentiation patterns of sub-provinces during sustainable development.Compared with the current geographical differentiation research,the study of territorial function differentiation has academic values for the development of integrated geography in exploring the territorial system of the humanenvironment relationship,and it can provide a scientific basis for determining the territorial model of sustainable development and optimizing the pattern of spatial development and protection in China.
基金grants from the CAMS Innovation Fund for Medical Sciences (CIFMS)(No.2016-I2M-1-001)the National Natural Science Foundation of China (No.81172035)the National High Technology Research and Development Program of China (No.2012AA020206).
文摘Biomarkers for hepatocellular carcinoma (HCC) following curative resection are not currently sufficient for prognostic indication of overall survival (OS) and disease-free survival (DFS). The aim of this study was to investigate the prognostic performance of osteopontin (OPN), matrix metalloproteinase 7 (MMP7), and pregnancy specific glycoprotein 9 (PSG9) in patients with HCC. A total of 179 prospective patients with HCC provided plasma before hepatectomy. Plasma OPN, MMP7, and PSG9 levels were determined by enzyme-linked immunosorbent assay. Correlations between plasma levels, clinical parameters, and outcomes (OS and DFS) were overall analyzed. High OPN (≥149.97 ng/mL), MMP7 (≥2.28 ng/mL), and PSG9 (≥45.59 ng/mL) were prognostic indicators of reduced OS (P<0.001, P<0.001, and P=0.007, respectively). Plasma PSG9 protein level was an independent factor in predicting OS (P=0.008) and DFS (P=0.038). Plasma OPN+MMP7+PSG9 elevation in combination was a prognostic factor for OS (P<0.001). OPN was demonstrated to be a risk factor-associated OS in stage I patients with HCC and patients with low α-fetoprotein levels (<20 ng/mL). These findings suggested that OPN, MMP7, PSG9 and their combined panels may be useful for aiding in tumor recurrence and mortality risk prediction of patients with HCC, particularly in the early stage of HCC carcinogenesis.
基金This work was supported by Beijing Municipal Science&Technology Commission(No.Z131107002213166)the Beijing Hope Run Special Fund of Cancer Foundation of China(No.LC2018A15)the PUMC Fund of the Funds for the Central Universities(No.3332018193).
文摘Background: Postoperative radiotherapy (RT) is known to play an important role in the treatment of hepatocellular carcinomas (HCCs), but the specific role of intraoperative electron radiotherapy (IOERT) in HCCs remains unclear. The aim of this study was to investigate the safety and efficacy of IOERT in centrally located HCCs treated with narrow-margin (<1 cm) hepatectomy. Methods: This was a single-center, phase 2, prospective non-randomized controlled study, including 268 patients with centrally located HCCs who underwent narrow-margin hepatectomy. The patients were subsequently allocated to the IOERT group (n=59) or to the control group (n=65). The primary outcome of the study was to compare recurrence-free survival (RFS) between the IOERT group and the control group, and the secondary outcome was to compare overall survival (OS) rate between the two groups. Results: Of 268 patients enrolled, a total of 124 were included in the study: 59 in IOERT group, 65 in control group. The 1-, 2-, 3-year RFS rates were 79.3%, 62.1% and 45.8% for patients in the IOERT group, and 47.6%, 28.6%, and 22.9% for patients in the control group, respectively (P=0.025). The 1-, 2-, and 3-year OS rates were 100.0%, 94.9%, and 83.7% for patients in the IOERT group, and 92.3%, 87.5%, and 79.4% for patients in the control group, respectively (P=0.314). Subgroup analysis of MVI (+) patients revealed that RFS and OS are significantly prolonged in the IOERT subgroup as compared to the control, whereas there was no significant difference of RFS and OS between the two groups in MVI (−) patients. Conclusions: IOERT for centrally located HCCs with concurrent narrow-margin hepatectomy was feasible and safe. Statistically better RFS rate was observed in the IOERT group compared to the control group. Subgroup analysis revealed that IOERT was more beneficial for postoperative survival of HCC patients with MVI. Trial Registration: ChiCTR-TRC-12002802;www.who.int/ictrp.
基金We sincerely thank all support from National Key Research and Development Program of China(No.2016YFD0400604).
文摘Background:Liver cancer as the main leading cancer has caused heavy burdens globally.The prognosis of liver cancer is closely related with postoperative nutrition support.Corn oligopeptides(COPs)are protein hydrolysates produced by enzymatic treatments,which have shown potential bioactivities,such as inhibiting angiotensin I-converting enzyme,resisting lipid peroxidation and anti-oxidant.However,the correlation between COPs and liver cancer patients is still unknown and the potential mechanism of COPs on liver cancer is unclear as well.The aim of this study was to assess effects of 7-day intervention of COPs after surgery on liver function and serum metabolic profiles of liver cancer patients.Methods:Patients were assigned into COPs intervention group(n=50)and control group(n=91)for 7 days.Investigations were scheduled at 1st day and 7th day after liver resection surgery respectively,mainly including anthropometric,biochemical indexes and liquid chromatography-mass spectrometry(LC/MS)analysis.Results:Seven-day supplementation of COPs on early post-surgery liver cancer patients down-regulated levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin and up-regulated prothrombin time activity and prealbumin levels.LC/MS analysis revealed metabolic signatures including regulation of 16 metabolites,which was closely related with two metabolic pathways(nicotinate and nicotinamide metabolism,fatty acid metabolism).Conclusions:COPs supplementation has displayed the potentials on alleviating the injury of liver function and it may be due to regulation of fatty acid metabolism,nicotinate and nicotinamide metabolism,lipid peroxidation and anti-inflammatory action.More researches are warranted in future to confirm the exact mechanisms.
