Surgical treatment for carcinoma of the suprahepatic inferior vena cava.
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Aged↗
Biomedical subjects
Cheng-Chung Wu
Publications and source records attributed to Cheng-Chung Wu.
Detection of the hepatitis B virus X protein (HBx) antigen and anti-HBx antibodies in cases of human hepatocellular carcinoma.
Hepatitis B virus X protein (HBx) expressed in Escherichia coli DH5alpha by recombinant DNA technology was purified to homogeneity by use of glutathione-Sepharose beads. Immunological characterization of the recombinant HBx protein was performed. Specific binding between the anti-HBx monoclonal antibody and HBx protein showed the specificity of the recombinant HBx protein. The intact HBx protein of the factor Xa-digested glutathione S-transferase-HBx fusion protein was further purified and was used as an antigen for screening the titers of anti-HBx antibodies in sera. Titers of anti-HBx in sera from 20 patients with hepatocellular carcinoma (HCC), 20 patients with chronic hepatitis (CH), and 20 healthy individuals were evaluated by Western blotting and a quantitative enzyme-linked immunosorbent assay. The results indicated that 70% of sera from HCC patients and 5% of sera from CH patients contained antibodies with significant binding to the HBx protein. Western blotting of HBx protein in liver extracts from 20 HCC patients was also performed by using the anti-HBx monoclonal antibody. Results showed that 85% of HCC patients' liver tissues contained a specific HBx protein with the same molecular size as the purified intact HBx. Full correlation was found between anti-HBx antibody positivity in serum and HBx protein positivity in HCC tissues. The data demonstrated that the etiology of HCC is involved with hepatitis B virus (HBV) infection and that HBx in particular plays a role in the development of HBV-related HCC.
Adult↗
Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques.
BACKGROUND: Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations. HYPOTHESIS: Hemihepatic inflow occlusion may be beneficial in cirrhotic patients who undergo complex central hepatectomy with a wide liver transection plane. DESIGN: A prospective, randomized study. SETTING: University hospital and tertiary referral center. PATIENTS: During liver parenchymal transection, 58 cirrhotic patients who underwent complex central liver resections with a wide transection plane were prospectively randomized into 2 groups. In the group undergoing total hepatic inflow clamping (group T; n = 28), occlusion of hepatic blood inflow was performed for 15 minutes with declamping for 5 minutes. In the group undergoing selective clamping of ipsilateral blood inflow (group H; n = 30), clamping was performed for 30 minutes with declamping for 5 minutes. INTERVENTION: Comparison of patient backgrounds, operative procedures, and early postoperative results. MAIN OUTCOME MEASURES: Operative blood loss, need for blood transfusion, and postoperative morbidity. RESULTS: The patients' backgrounds, operative procedures, and area of liver transection plane were not significantly different between the 2 groups. In all patients, the liver transection areas were greater than 60 cm(2) and overall liver ischemic times were greater than 60 minutes. The amount of operative blood loss and incidence of blood transfusion were significantly greater in group T because of greater blood loss during declamping. Overall liver ischemic and total operative times, postoperative morbidity, and postoperative changes in liver enzyme levels were not significantly different between groups. No in-hospital deaths occurred in either group. CONCLUSIONS: Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm(2), hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.
Adult↗
Roles of the glucocorticoid receptor in resectable hepatocellular carcinoma.
BACKGROUND: The glucocorticoid receptor (GR) was discovered in the cytosol of hepatocellular carcinoma (HCC) cells more than 10 years ago. However, the influence of the GR on the prognosis of HCC after liver resection remains unclear. METHODS: Ninety-two consecutive patients with HCC who survived liver resection and who did not receive any preoperative neoadjuvant therapy were enrolled in this study. The GR level in cytosol of cancerous tissue was determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term prognosis of patients with GR-positive tumors (GR-positive group) were compared with those of patients with GR-negative tumors (GR-negative group). RESULTS: GR was found in 63 patients (68.5%) with a mean +/- SEM concentration of 26.97 +/- 4.05 fmol/g protein. There were no significant differences in patient clinicopathologic characteristics between GR-positive and GR-negative groups. The 5-year disease-free and actuarial survival rates for GR-positive and GR-negative groups were 21.6% and 44.4% (P =.002) and 57.2% and 83.3% (P =.0003), respectively. After multivariate analysis was performed, GR positivity was found to be an independent prognostic factor of disease-free and actuarial survival after liver resection for HCC. CONCLUSIONS: The GR can be found in the cytosol of most HCCs and is an independent prognostic factor of HCC after liver resection. Patients with GR-positive HCC have lower survival rates than those with GR-negative HCC.
Carcinoma, Hepatocellular↗
Reduction of dihydrodiol dehydrogenase expression in resected hepatocellular carcinoma.
Dihydrodiol dehydrogenase (DDH) is one of the major enzymes catabolizing polycyclic aromatic hydrocarbons in the liver. Although four DDH isoforms have been detected in the normal liver, only DDH1 and DDH2 have been detected in cancer cells of lung and esophagus. Moreover, the available information about hepatic pathophysiological regulation of DDH expression is limited. Therefore we addressed the question of DDH expression in patients with liver disorders, in particular, patients with hepatocellular carcinoma (HCC). Expression of DDH1/2 was determined by immunohistochemistry, immunoblotting and reverse transcription-polymerase chain reaction (RT-PCR) in 52 patients with resected HCC. DDH1/2 expression was detected in 31 (59.6%) of 52 pathological sections. Frequency of DDH1/2 expression was significantly higher in patients with tumor size >2 cm, and in those who had early local recurrence. In addition to the tumor size and frequency of local recurrence, our results further indicated that expression of DDH1/2 was correlated with those of cyclooxygenase 2 (COX-2), interleukin-6 (IL-6), microsomal epoxide hydrolase (mEpH) and soluble epoxide hydrolase (sEpH) in HCC patients. Interestingly, the expression of DDH1/2 was found inversely correlated with that of glutathione S-transferase (GST) and NADPH p450 reductase (NPR). In conclusion, these results indicate that DDH expression was significantly decreased in about 40% of HCC patients. However, in the bordering non-neoplastic region of liver DDH1/2 expression increased, and the increased DDH1/2 expression correlated with tumor size and the disease progression.
Carcinoma, Hepatocellular↗
Surgical results of hepatic resection for hepatocellular carcinoma with gross diaphragmatic invasion.
BACKGROUND/AIMS: Gross diaphragmatic invasion is not uncommon in patients undergoing hepatectomy for hepatocellular carcinoma. The aim of the study is to evaluate retrospectively the surgical results of hepatocellular carcinoma with gross diaphragmatic invasion undergoing en-bloc resection of diaphragm. METHODOLOGY: Between January 1989 and December 2002, 640 patients underwent curative resections for hepatocellular carcinoma in our hospital. Fifty-three patients (8.3%) who had hepatocellular carcinoma with gross diaphragmatic invasion found during operation undergoing en-bloc resection of diaphragm were assigned to group A. The other 587 patients who had hepatocellular carcinoma without gross diaphragmatic invasion were assigned to group B. The clinicopathological features, operative mortality and morbidity and long-term result of the patients between group A and B were compared. RESULTS: Of the 53 patients in group A with gross diaphragmatic invasion of hepatocellular carcinoma undergoing en-bloc resection of diaphragm, seven (13.2%) were pathologically proved to have muscular invasion of diaphragm and the other 46 (86.8%) were fibrous adhesion only or free of tumor. Primary repair of diaphragm was adequate in 52 patients (98.1%) and one required a mesh repair, Thirteen patients (24.5%) developed postoperative complication but no operative mortality occurred. There was no significant difference in operative mortality and postoperative complication rate between the two groups of patients with (group A) and without (group B) gross diaphragmatic invasion. If compared by each TNM staging (stage I, II and III) there was no significant difference between the patients of group A and B in five-year cumulative and disease-free survival. Among the 53 patients in group A, the long-term prognosis was also not significantly different between the patients with (group A1) and without (group A2) histological muscular invasion. CONCLUSIONS: En-bloc resection of diaphragm in patients with gross diaphragmatic invasion of hepatocellular carcinoma is justified since it does not significantly increase the operative mortality or postoperative complication rate and the long-term prognosis at each TNM staging is comparable to that of patients without gross diaphragmatic invasion.
Carcinoma, Hepatocellular↗