Biomedical subjects

Po-Huang Lee

Publications and source records attributed to Po-Huang Lee.

At least 37 records · Page 2Linked to original sources

PubMed2006

Primary intrathoracic goiter.

Nodular goiter is a common disease in Taiwan, and substernal or intrathoracic goiters are not infrequent. However, intrathoracic goiters are mainly of the secondary type and primary intrathoracic goiters are rarely seen. We report a 55-year-old woman who was incidentally found to have an ectopic goiter located in the anterior upper mediastinum with the initial presenting symptom of productive cough. Imaging studies including chest X-ray and computed tomography identified the lesion, and 131I-uptake scan showed weak uptake in the thorax. Surgical removal via thoracotomy was performed and the diagnosis was confirmed by pathology. A primary intrathoracic goiter, although rare, should also be considered in the differential diagnosis of mediastinal tumor.

Diagnosis, Differential↗

PubMed2006

Parenteral N-3 fatty acids modulate inflammatory and immune response in rats undergoing total gastrectomy.

This study investigated the effect of n-3 fatty acid (FA)-containing parenteral nutrition on the circulatory lymphocyte subpopulation, intracellular cytokine and leukocyte adhesion molecule expression, and phagocytic activity in rats undergoing total gastrectomy. Normal rats with internal jugular catheters were assigned to normal control (NC) and two experimental groups and received total parenteral nutrition (TPN). At the same time, a total gastrectomy was performed in the experimental groups, whereas the NC group underwent a sham operation. The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in fat emulsion contents. The NC and one of the experimental groups received a soybean oil emulsion (SO), and the other experimental group received 50% soybean oil and 50% fish oil emulsion (FO). Half of the rats in each respective group were sacrificed 1 or 3 days after surgery or the sham operation to examine their immune response. The results showed that the FO group had a higher CD4 proportion and CD4/CD8 ratio than those of the SO and NC groups postoperatively. The phagocytic activity of peritoneal macrophages was higher in the FO group than in the NC group, but no difference was found between the SO and NC groups 3 days after surgery. The intracellular interferon (IFN)-gamma distribution in the FO group was higher than that of the SO group on postoperative days. Leukocyte adhesion molecule expressions and peritoneal monocyte chemotactic protein-1 levels were lower in the FO group than in the SO group on postoperative day 3. These results suggest that parenterally infused FO did not result in immunosuppression. In addition, FO administration promotes lymphocyte Th1 cytokine production, enhances peritoneal macrophage phagocytic activity, and reduces leukocyte adhesion molecule expression in rats with total gastrectomy.

Animals↗

PubMed2006

Post-transplantation lymphoproliferative disorders localizing to the gastrointestinal tract after liver transplantation: report of five pediatric cases.

Post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication of organ transplantation. PTLD can occur in every kind of organ transplantation. From July 1992 to July 2004, five patients were diagnosed at our transplantation center with PTLD after pediatric liver transplantation. During this period, there were 52 pediatric patients (<18 yr) receiving an orthotopic liver transplantation (OLT) at our center. All five patients had transmural gastrointestinal (GI) PTLD, which occurred mostly in the stomach and duodenum. Epstein-Barr virus (EBV) in situ was demonstrated in each case. EBV viral load was noted to be an important risk factor. Treatment included dose reduction of immunosuppressants and anti-CD20 antibody infusion. Chemotherapy, including cyclophosphamide, doxorubicin, vincristine, and prednisolone, was given to three patients. Four patients have survived more than 10 months until now after treatment. The one who was unresponsive to chemotherapy and anti-CD20 antibody had diffuse metastasis and died of systemic candidiasis. In our series, each PTLD involved the GI tract. The mechanism of this phenomenon is unclear, but these five cases indicate the high incidence of PTLD in pediatric solid organ transplantation.

Antigens, CD20↗

PubMed2006

Comparison of angiogenic factor levels in tumor drainage and peripheral venous blood from colorectal cancer patients.

BACKGROUND: The main objective of this study was to determine whether there was a correlation in the levels of various angiogenesis-related factors between the tumor drainage and peripheral venous blood and whether appraisal of angiogenic factor levels in the tumor drainage venous blood could provide better prognostic information for patients with colorectal cancer than assessment of the peripheral venous blood. METHODS: Plasma levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and endostatin were measured and compared in both tumor drainage and peripheral venous blood from 52 patients with colorectal cancer. Plasma levels of angiogenesis-related factors were also correlated with tumor stage and clinical outcomes. RESULTS: The plasma endostatin level was significantly higher in peripheral blood than in tumor drainage venous blood (P < .001). The plasma VEGF level was significantly correlated with plasma endostatin levels (P = .028 in tumor drainage venous blood and P = .002 in peripheral venous blood). In both tumor drainage and peripheral venous blood, the VEGF level (but not the basic fibroblast growth factor or endostatin level) was significantly correlated with tumor stage and disease recurrence. However, in multivariate analysis, only plasma VEGF level in tumor drainage venous blood remained an independent predictor of disease recurrence. CONCLUSIONS: The plasma VEGF level in tumor drainage venous blood provided better prognostic information than that in peripheral venous blood. The plasma endostatin level was paradoxically significantly higher in peripheral than in tumor drainage blood, and this strongly suggests additional sources of endostatin in peripheral blood.

Adult↗

PubMed2006

A gene expression profile for vascular invasion can predict the recurrence after resection of hepatocellular carcinoma: a microarray approach.

BACKGROUND: Recurrence after hepatocellular carcinoma (HCC) resection is the major obstacle to improved survival. The presence of vascular invasion (VI) in pathology specimens is a well-known unfavorable prognostic factor for HCC recurrence. Though some VI-related genes have been reported, their association with recurrence-free survival is not known. We hypothesized that a gene expression profile for VI can predict the recurrence of HCC after liver resection. METHODS: Eighteen patients receiving complete HCC resection were included as a "training group". Genome-wide gene expression profile was obtained for each tumor using a microarray technique. Datasets were subjected to clustering analysis supervised by the presence or absence of VI to obtain 14 discriminative genes. We then applied those genes to execute pattern recognition using the k-Nearest Neighbor (KNN) classification method, and the best model for this VI gene signature to predict recurrence-free survival in the training group was obtained. The resulting model was then tested in an independent "test group" of 35 patients. RESULTS: A 14-gene profile was extracted which could accurately separate ten patients with VI and eight patients without VI in the "training group". In the "test group", significant difference in disease-free survival was found between patients predicted to have and not to have recurrence (P = .02823). In patients with stage_I disease, this model can also predict outcomes (P = .000205). CONCLUSIONS: Using the 14-gene expression profile extracted from microarrays based on the presence of VI can effectively predict recurrence after HCC resection. This approach might facilitate "personalized medicine" for HCC patients after surgical resection.

Aged↗

PubMed2005

Gene expression profile predicts patient survival of gastric cancer after surgical resection.

PURPOSE: This study was conducted to characterize gene expression profile of survival in patients with surgically curable gastric cancer by using an in-house membrane microarray and developing a survival prediction model. MATERIALS AND METHODS: Data of cDNA microarrays were obtained from 18 pairs of cancerous and noncancerous gastric tissues. Nine patients who survived > 30 months were identified as good survival, and the other nine, who survived < 12 months, were identified as poor survival. Supervised analysis was performed to identify a gene expression profile by good and poor survival. Semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to confirm the microarray data in 10 patients with sufficient RNA. Using these 10 patients and another 10 patients selected randomly from 40 newly enrolled patients as the training group, the RT-PCR status of the confirmed genes was used for predicting good versus poor survival. Finally, the prediction model was tested in the remaining 30 newly enrolled gastric cancer patients. RESULTS: A survival prediction model consisting of three genes (CD36, SLAM, PIM-1) was developed. This model could correctly predict poor or good survival in 23 (76.7%) of 30 newly enrolled patients, and yielded a specificity of 80% and a sensitivity of 73.3%. The survival rate of the patients predicted to have good survival was significantly higher than that of those predicted to have poor survival in the test group as a whole (N = 30; P = .00531) and in stage III patients (n = 16; P = .04467). CONCLUSION: The semiquantitative RT-PCR gene expression profiling of three genes extracted from microarray study can accurately predict surgery-related outcome in gastric cancer patients.

Gastrectomy↗

PubMed2005

Cyr61 induces gastric cancer cell motility/invasion via activation of the integrin/nuclear factor-kappaB/cyclooxygenase-2 signaling pathway.

PURPOSE: Cysteine-rich 61 (Cyr61/CCN1) is involved in many different types of tumor development and progression. Nonetheless, the role of Cyr61 in human gastric cancer has not yet been fully characterized. EXPERIMENTAL DESIGN: We addressed the issue by immunohistochemical staining of 81 gastric adenocarcinoma specimens. Liposome-mediated transfection was used to introduce a Cyr61 expression vector into gastric cancer AGS cell lines. Transfectants were tested in invasion assay by a Boyden chamber. Furthermore, a cyclooxygenase-2 (COX-2) reporter assay and gel mobility shift assay were done to investigate the potential signal pathway of Cyr61. RESULTS: Patients with gastric adenocarcinoma whose tumor displayed high expression of Cyr61 correlated well with aggressive lymph node metastasis, more advanced tumor stage, histologic diffuse type, and early recurrence. Stable transfection of Cyr61 into the AGS cell line strongly enhanced its invasive activity. The overexpression of Cyr61 into AGS cells significantly increased the expression of COX-2 mRNA, protein, and enzymatic activity. Gel mobility shift assays further showed that the nuclear factor-kappaB (NF-kappaB) pathway was evidently activated in Cyr61-expressing AGS cells. Function-neutralizing antibody to alphavbeta3 but not alphavbeta5 effectively suppressed Cyr61-mediated NF-kappaB activation, COX-2 gene expression, and cell invasiveness. CONCLUSIONS: Cyr61 may contribute to the malignant progression of gastric cancer by promoting tumor cell motility/invasion through up-regulation of the functional COX-2 via an integrin alphavbeta3/NF-kappaB-dependent pathway.

Adenocarcinoma↗

PubMed2005

Opposite roles of human pancreatitis-associated protein and REG1A expression in hepatocellular carcinoma: association of pancreatitis-associated protein expression with low-stage hepatocellular carcinoma, beta-catenin mutation, and favorable prognosis.

PURPOSE: Pancreatitis-associated protein (PAP) and regenerating protein 1 alpha (Reg1A) are up-regulated during the pancreas regeneration. This study is to investigate the clinicopathologic denotation of their expression in hepatocellular carcinoma (HCC). EXPERIMENTAL DESIGN: PAP and REG1A mRNA levels were measured in 265 surgically removed unifocal primary HCCs using reverse transcription-PCR. RESULTS: PAP and REG1A mRNAs were detected in 97 (36.6%) and 55 (20.8%) HCCs, respectively, including 46 with coexpression but in none of the 219 nontumorous livers. HCCs with PAP expression correlated with low-stage tumors without evidence of vascular invasion (P = 0.013) but the REG1A expression did not. By a combination analysis, HCCs with PAP expression alone showed the lowest frequency of p53 mutation (P < 0.036), the highest rates of grade 1 and low-stage tumors (P < 0.007 and P < 0.001, respectively), less frequent early tumor recurrence (P = 0.051), and hence a better 5-year survival (P = 0.044) than groups expressing PAP and REG1A, REG1A alone, and neither PAP or REG1A. Besides, PAP expressing HCCs had significantly frequent beta-catenin mutation, regardless of REG1A expression, P < 0.00001. In the subset of HCCs that has no mutations of p53 and beta-catenin but showed PAP expression, coexpression of REG1A and PAP was associated with more frequent vascular invasion than PAP expression alone (P < 0.005). CONCLUSIONS: These data suggest that PAP expression designate a subset of low-grade, low-stage HCC with frequent beta-catenin mutation and hence more favorable prognosis, whereas further genetic or epigenetic alterations, such as p53 mutation and REG1A expression, lead to more advanced HCCs.

Adolescent↗

PubMed2005

Multiple negative feedbacks on CD152 expression in allograft tolerance.

BACKGROUND: CD152 has been implicated in tolerance induction. This study investigated how CD80 and CD86 regulated CD152 expression in a low-responding cardiac transplant model with CD152-mediated long-term graft acceptance. METHODS: A low-responding cardiac transplant model from BALB/c to B10.A was used. Donor-specific stimulation and multiple antibody blockade of the CD80/CD86:CD28/CD152 co-stimulatory pathway was applied to the splenic T cells from B10.A recipients with 100-day grafts (B10.A-100). Proliferation assays, quantitative (Q) real-time polymerase chain reaction (PCR), flow cytometric analyses, and fluorescence microscopy were conducted to examine the roles of CD80 and CD86 in CD152 expression. RESULTS: B10.A-100 splenic T cells were hyporesponsive to donor-specific stimulation, and anti-CD80, anti-CD86, or anti-CD152 treatment significantly enhanced the proliferation response of the B10.A-100 splenic T cells. Proliferation assays and Q-PCR revealed that CD152 inhibited T-cell proliferation and, at the same time, decreased CD152 expression by secluding CD80 and CD86 from CD28 engagement. Flow cytometric analyses and fluorescence microscopy showed that CD28 engagement facilitated intracellular accumulation of CD152. Besides, CD152 engagement by CD80 decreased CD152 mRNA transcription, and CD152 engagement by CD86 inhibited surface expression of CD152. CONCLUSIONS: CD80 and CD86 controlled CD152-mediated allograft tolerance by multiple negative feedbacks on CD152 mRNA and surface expression.

Animals↗

PubMed2005

Quantitative gene expression analysis by cDNA microarray during liver regeneration after partial hepatectomy in rats.

PURPOSE: It is speculated that genetic regulation plays an important role during liver regeneration. We conducted this study to analyze quantitative gene expression during liver regeneration after partial hepatectomy. METHODS: Sixty male Wistar rats were randomly assigned into ten groups of six. One group of rats was killed preoperatively and the other nine groups were killed 2, 4, 6, 12, 24, 48, and 72 h, and 5 and 7 days after 70% partial hepatectomy, respectively. The remnant livers were isolated for mRNA extraction. A mass survey of gene expression by cDNA microarray carrying 6144 polymerase chain reaction-amplified cDNA fragments was prepared by an arraying machine. The microarray images were scanned, digitized, and analyzed using a flatbed scanner. RESULTS: The variations in gene expression were classified into 72 different patterns including a pattern with a single peak, 2, 4, 6, 12, and 72 h, and 5 and 7 days after partial hepatectomy. The other patterns included double peaks, enhancing trend, diminished trend, protruding curve, excavated curve, and various mixed types. Each category of gene expression pattern contained 40-218 different proto-oncogenes. CONCLUSION: The quantitative gene expression profiles have important implications, warranting further investigation of the genetic mechanisms involved in the process of liver regeneration.

Animals↗

PubMed2005

Progressive increase of bowel wall thickness is a reliable indicator for surgery in patients with adhesive small bowel obstruction.

PURPOSE: The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction. METHODS: The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall > or =3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings. RESULTS: There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1-99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7-100 percent). CONCLUSIONS: Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.

Adolescent↗

PubMed2005

Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy.

BACKGROUND: Most pancreatic leaks after pancreaticoduodenectomy were initially treated conservatively, and for the most part, they were self-limiting and closed spontaneously. But in a few patients, hemorrhage occurred 1 to 3weeks postoperatively and remained a fatal complication after pancreaticoduodenectomy. STUDY DESIGN: To identify possible risk factors for massive bleeding, the medical records of 402 patients who had pancreaticoduodenectomies were reviewed for leak complications and analyzed for associations between the occurrence of massive bleeding and preoperative, intraoperative, postoperative, and pathologic parameters. RESULTS: In univariate logistic regression analysis, infectious clinical signs (p=0.021, odds ratio [OR]=7.06, 95% CI=1.34, 37.12) and bile in the drainage fluid (p=0.036, OR=5.89, 95% CI=1.13, 30.86) were associated with the risk of developing massive hemorrhage. This combination provided the highest estimate of massive bleeding after pancreatic leak (p=0.005, OR=8.57, 95% CI=1.92, 38.35). CONCLUSIONS: Both infectious clinical signs and bile content in the drainage fluid considerably increase the risk of massive bleeding after pancreatic leak. Close observation of patients with these ominous signs is warranted.

Adolescent↗

PubMed2005

Plasma free amino acid profile in cancer patients.

Redistribution or translocation of plasma free amino acids (PFAAs) to support visceral or tumor protein synthesis is an essential feature in cancer patients. An abnormal PFAA profile might be presented via the total reflection of cancer-induced protein metabolism in tumors, skeletal muscle and the liver in cancer patients. Clinical data from 13 studies have demonstrated a cancer-related PFAA profile, especially in digestive organ cancers. The PFAA profile can differ between the early and late stages of cancer. The profile is also affected by the type of cancer. Therefore, it is postulated that a detailed analysis of the PFAA profile may serve as one of the biological markers for cancer patients.

Amino Acids↗

PubMed2005

Solid pseudopapillary neoplasms of the pancreas: is there a pathologic basis for the observed gender differences in incidence?

BACKGROUND: The fact that solid pseudopapillary neoplasms of the pancreas (SPNP) occur predominantly in young women suggests that genetic and/or gender-specific factors may play a role in the pathogenesis. Therefore, SPNP derived from male patients may exhibit different molecular or clinicopathologic characteristics compared to SPNP derived from female patients. METHODS: We compared the immunohistologic staining patterns and presence of sex hormone receptors of SPNP obtained from 4 male and 11 female patients. In addition, we analyzed the clinical data from 285 (21 male and 264 female) previously reported patients with SPNP and our 15 patients. RESULTS: All 15 of the neoplasms were positive for progesterone, but negative for estrogen and androgen receptors. There were no immunohistologic differences between the genders. An analysis of all reported patients revealed no significant differences in patient age, size or location of the neoplasm, or malignancy rate. CONCLUSIONS: Although female patients with SPNP outnumbered male patients with SPNP, there were no gender-specific trends in expression of sex hormone receptor protein or clinicopathologic characteristics.

Adolescent↗

PubMed2005

Liver steatosis classification using high-frequency ultrasound.

High-frequency B-mode images of 19 fresh human liver samples were obtained to evaluate their usefulness in determining the steatosis grade. The images were acquired by a mechanically controlled single-crystal probe at 25 MHz. Image features derived from gray-level concurrence and nonseparable wavelet transform were extracted to classify steatosis grade using a classifier known as the support vector machine. A subsequent histologic examination of each liver sample graded the steatosis from 0 to 3. The four grades were then combined into two, three and four classes. The classification results were correlated with histology. The best classification accuracies of the two, three and four classes were 90.5%, 85.8% and 82.6%, respectively, which were markedly better than those at 7 MHz. These results indicate that liver steatosis can be more accurately characterized using high-frequency B-mode ultrasound. Limitations and their potential solutions of applying high-frequency ultrasound to liver imaging are also discussed.

Fatty Liver↗

PubMed2005

Connective tissue growth factor inhibits metastasis and acts as an independent prognostic marker in colorectal cancer.

BACKGROUND & AIMS: Connective tissue growth factor (CTGF) has been shown to be implicated in tumor development and progression. The aim of this study was to investigate the role of CTGF in progression of colorectal cancer (CRC). METHODS: Immunohistochemical staining of specimens from 119 patients with CRC was performed. Liposome-mediated transfection was used to introduce a CTGF expression vector into CRC cell lines. Transfectants were tested in invasive ability and experimental hepatic metastasis in BALB/c mice. Furthermore, a FOPflash/TOPflash reporter assay was performed to investigate CTGF on the beta-catenin/T-cell factor signaling pathway. RESULTS: Patients with stage II and stage III CRC whose tumors displayed high CTGF expression had a significantly higher overall survival and a disease-free advantage over patients with CRC with low CTGF expression. Alterations in the CTGF level in CRC cell lines modulated their invasive ability with an inverse correlation. In addition, a reduction in the CTGF level of CT26 cells after stable transfection with antisense CTGF resulted in increased liver metastasis in BALB/c mice. The activity of the beta-catenin/T-cell factor signaling pathway and its downstream effector gene matrix metalloproteinase 7 in these CTGF-transfected cells was strongly attenuated. Blockage of matrix metalloproteinase 7 with its neutralizing antibodies inhibited increased invasiveness in antisense CTGF-transfected CT26 cells. CONCLUSIONS: Our results implicate CTGF as a key regulator of CRC invasion and metastasis, and it appears to be a useful and better prognosis factor for patients with stage II and stage III CRC.

Adenocarcinoma↗

PubMed2005

Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia.

OBJECTIVE: Manual reduction is the standard procedure for incarcerated inguinal hernia reduction. The role of ultrasound in incarcerated inguinal hernia reduction has not been defined. The aim of this study was to determine whether ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and thereby decrease the emergency surgery rate. MATERIAL AND METHODS: Between January 1994 and December 2003, 112 adult patients with incarcerated inguinal hernias were admitted to a university medical center and classified into two groups. Group I consisted of 61 patients who received emergency surgical reduction after the failure of two attempts at manual reduction. In Group II, comprising 51 patients, ultrasound-guided reduction was performed when two attempts at manual reduction failed. Emergency surgical reduction was scheduled if both ultrasound-guided reduction and two attempts at manual reduction failed. The difference in emergency surgery rates between groups I and II was compared. RESULTS: In group I, manual reduction was successful in 55 cases (90.2%) and 6 patients underwent emergency surgery. In group II, manual reduction was successful in 45 cases, ultrasound-guided reduction in 4 cases, 1 reduction was avoided after ultrasonic examination, and 1 patient underwent emergency surgery. The emergency surgery rates in groups I and II were 9.8% and 2.0%, respectively. CONCLUSIONS: Ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and may decrease the rate of emergency surgery.

Adult↗

PubMed2005

Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma: a prospective study.

OBJECTIVE: To compare disease recurrence and survival among patients with small hepatocellular carcinoma after surgical resection or percutaneous ethanol injection therapy, 2 treatments that have not been evaluated with a prospective study. METHODS: A total of 76 patients were randomly assigned to 2 groups based on treatment; all had one or 2 tumors with diameter </=3 cm, with hepatitis without cirrhosis or Child class A or B cirrhosis without evident ascites or bleeding tendency. RESULTS: Follow-up ranged from 12 to 59 months. Among percutaneous injection patients, 18 had recurrence 1 to 37 months after treatment (true recurrence, 11; original safety margin inadequate, 3; limitation of imaging technology to detect tiny tumors, 4). Three injection therapy patients died of cancer 25, 37, and 57 months after treatment. For the surgical resection group, 15 had recurrence 2 to 54 months after treatment (true recurrence, 12; limitation of imaging, 2; neck metastasis, 1). Five resection patients died of cancer at 11, 20, 23, 26, and 52 months, respectively. By Cox regression model and Kaplan-Meier survival analysis, there is no statistical significance for recurrence and survival between treatment groups. However, tumor size larger than 2 cm and alpha-fetoprotein over 200 ng/mL correlated with higher recurrence rate, and Child class B liver cirrhosis correlated with shorter survival. CONCLUSIONS: Percutaneous ethanol injection therapy appears to be as safe and effective as resection, and both treatments can be considered first-line options for small hepatocellular carcinoma.

Administration, Cutaneous↗