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Objectives Portal vein tumour thrombus (PVTT)–related symptomatic portal hypertension (SPH) leads to a poor prognosis in hepatocellular carcinoma (HCC) patients. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively relieve SPH but its effect remains unclear in PVTT-related SPH. This study aimed to evaluate the clinical value of the TIPS procedure combined with sequential systemic therapy in advanced HCC patients with PVTT-related SPH. Methods After 1:1 propensity score matching (PSM), this retrospective study analysed 42 patients who underwent TIPS placement plus sequential systemic therapy (group A) and 42 patients who received only symptomatic and supportive treatment (group B). The evaluated outcomes were overall survival (OS) and SPH control rate. Cox proportional hazards regression analysis was used to compare OS in the two groups. Results In group A, the technical success rate of the TIPS procedure was 95.2%, and no severe complications occurred. The rebleeding rates in group A and group B were 5.0% and 73.7%, respectively (p < 0.001), and the ascites control rates were 92.0% and 28.0%, respectively (p < 0.001). The median OS of group A was significantly better than that of group B (9.6 [95% CI: 7.1, 12.0] vs. 4.9 [95% CI: 3.9, 5.8], months, p < 0.001). Multivariable analysis showed that TIPS plus sequential systemic therapy (hazard ratio [HR] = 5.799; 95% CI: 3.177, 10.585; p < 0.001) was an independent prognostic factor related to OS. Additionally, PVTT degree (I+II) (p = 0.008), AFP ≤ 400 ng/ml (p = 0.003), and Child–Pugh class A (p = 0.046) were significant predictors of OS. Conclusion TIPS plus sequential systemic therapy is safe and feasible for treating advanced HCC with tumour thrombus-related SPH. Key Points • Portal vein tumour thrombus (PVTT) is common in advanced hepatocellular carcinoma (HCC) and transforms compensated portal hypertension into symptomatic portal hypertension (SPH). • HCC patients with PVTT-related SPH have a very poor prognosis, and there are no effective treatments recommended by the guidelines. • Therefore, a treatment strategy that utilises a transjugular intrahepatic portosystemic shunt (TIPS) to manage SPH combined with sequential systemic therapy in advanced HCC patients is explored in this study for its feasibility and clinical value. This research can fill the gap in current research data to provide clinically meaningful treatment options.

Purpose To compare the safety and efficacy of left versus right internal jugular vein access for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with a small liver and short vertical puncture distance. Materials and Methods The vertical distance from the hepatic vein orifice to the puncture point of the portal vein was measured by CT and DSA. A distance ≤ 30 mm is defined as a short vertical puncture distance. After 1:1 propensity score matching (PSM), 29 patients of left internal jugular vein-TIPS (LIJ-TIPS) and 29 patients of right internal jugular vein-TIPS (RIJ-TIPS) were included. The number of needle punctures, fluoroscopy time, and radiation dose during the puncture process were statistically analyzed. Results There was no significant difference in the average vertical puncture distances on CT or DSA between LIJ-TIPS and RIJ-TIPS (19.10 ± 0.60 mm vs. 19.30 ± 0.60 mm, P = 0.840; 22.02 ± 0.69 mm vs. 22.23 ± 0.64 mm, P = 0.822, respectively). The average number of needle punctures, fluoroscopy time, and radiation dose in LIJ-TIPS were significantly lower than those in RIJ-TIPS (2.07 ± 0.20 vs. 4.10 ± 0.24, P vs. 201.16 ± 23.71 s, P vs. 136.69 ± 16.38 mGy, P vs. 27.6%, P vs. 13.8%, P = 0.038). Conclusion The left internal jugular vein could be used as primary access for TIPS creation in patients with a small liver and short vertical puncture distance.

Background The effectiveness and safety of hepatic arterial infusion chemotherapy (HAIC) or trans-arterial chemoembolization (TACE) for cases with single pseudo-capsuled hepatocellular carcinoma (pHCC), as well as their survival outcomes were investigated. Methods 196 cases with single pHCC (diameter > 5 cm) receiving initial HAIC (n = 92) and TACE (n = 104) were enrolled. The propensity score match (PSM) approach based on Cox models was employed to tune any possible imbalance in treatment assignment. The overall survival (OS), objective response rate (ORR), progression-free survival (PFS), and partial response rate (PRR) of the subjects were investigated by using the Log-rank test. The independent risk factors for outcomes were investigated by univariate and multivariate analyses and the results were analyzed by using the Cox regression model. Results The median follow-up of the subjects was 22.3 months. After PSM, no significant difference was found in OS of the HAIC and TACE groups (OS, 16.8 vs. 12.0 months; P = 0.267), while the median PFS of the TACE group was enhanced compared with the HAIC group (PFS, 5.7 vs. 2.8 months; P = 0.003). Moreover, PRR and ORR of the TACE group were enhanced compared with the HAIC group (PRR, 34.6% vs. 21.7%; P = 0.046; ORR, 35.6% vs. 21.7%; P = 0.033). The nomogram model showed high predictive accuracy and significant discrimination. Conclusions TACE therapy could improve the control of tumor progression compared with HAIC for cases with single pHCC.

Objectives To develop a clinicopathological‐based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC). Methods A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C‐index and receiver operating characteristic curve (AUC). Results The median follow‐up time was 30.3 months (range, 3.2‐115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α‐fetoprotein (AFP), and international normalized ratio (INR). The 1‐, 2‐, and 3‐year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low‐risk group, and 1.7%, 6.3% and 6.3% in the high‐risk group, respectively, showing significant statistical difference (P, Seeding on the thoracoabdominal wall from primary liver carcinoma is a potential complication after percutaneous thermal ablation. Seeding risk is a liver ablation complication that affects future oncology management. A calibrated and objective model to predict seeding risk after liver ablation may guide patient selection and ablation treatment.

In China interventional therapy of liver cancer started in the 1980s. It is well-known that Professor Lin Gui is the founding father of Interventional radiology. Under the leadership of Lin Gui and other professors, interventional therapy of liver cancer has swiftly progressed in China. Indeed, TAI, TAE, TACE and ablation therapy have witnessed great innovations in hardware facilities, technical means, and therapeutic philosophy, while incorporating Chinese characteristics. As with the development of combined interventional therapy in China, interventional treatment of liver cancer has gradually started the process of precision and individualization. Actually, multidisciplinary, multimodal, and polymorphic treatments will be the most suitable pattern for liver cancer in the future, among which combination of interventional therapy with targeted, immunological treatments and information technology (IT) tools may bring a revolutionary breakthrough in liver cancer treatment. Keywords:: liver cancer, history, interventional therapy, embolization, ablation, multi-modal individualized treatment

Zhimei Huang,1 Mengxuan Zuo,1 Jiayan Ni,1 Yangkui Gu,1 Tianqi Zhang,1 Yiquan Jiang,1 Shuiqing Zhuo,2 Chao An,1 Jinhua Huang1 1Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 2Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of ChinaCorrespondence: Jinhua Huang; Chao AnDepartment of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, People’s Republic of ChinaTel/Fax +86-20-87343447Email huangjh@sysucc.org.cn; anchao@sysucc.org.cnObjective: Based on the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to assess the long-term outcomes of patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with cryoablation (TACE-CRA).Materials and Methods: We studied 86 patients with HCC nodules (up to 3 HCCs with maximum diameters of 4.1– 12.0 cm) who subsequently underwent TACE-CRA from July 2007 to August 2018. The overall survival (OS) was compared between groups classified by ALBI and PALBI grade. Baseline characteristics were collected to identify the risk factors for determination of poor OS after TACE-CRA. The prognostic performances of CTP class, ALBI and PALBI grade were compared.Results: After a median follow-up time of 33.8 months, 41 patients had died. The cumulative1-, 3- and 5-year OS rates were 74.5%, 38.0% and 29.3%, respectively. Stratified according to ALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 41.2% in grade 1, respectively, and 20.9% and 9.8% in grades 2– 3, respectively (P < 0.001). Stratified according to PALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 37.5% in grade 1, respectively, and 36.3% and 21.2% in grades 2– 3, respectively (P = 0.002). Multivariate analysis results showed that older age, and ALBI grade 2– 3 were associated with overall mortality. ALBI grade demonstrated significantly greater area under the curve values than CTP class and PALBI in predicting 1-, 3- and 5-year OS.Conclusion: ALBI grade offers accurate prediction of long-term outcome for patients with HCC (diameter > 4 cm) after TACE-CRA.Keywords: hepatocellular carcinoma, transarterial chemoembolization, cryoablation, albumin-bilirubin, platelet-albumin-bilirubin

Objective To assess the clinical efficacy and safety of computed tomography-guided radiofrequency ablation(CT-RFA) combined with transarterial embolization(TAE) assisted by a three-dimensional visualization ablation planning system(3DVAPS) for hepatocellular carcinoma(HCC) in challenging locations. Methods Data from 62 treatment-naive patients with hepatocellular carcinoma(HCC), with 83 lesions in challenging locations, and who met the Milan criteria and underwent CT-RFA between June 2013 and June 2016 were reviewed. Patients were divided into one of two groups according to different treatment modalities: study group (TAE combined with RFA assisted by 3DVAPS [n = 32]); and control (RFA only [n = 30]). Oncological outcomes included ablation-related complications, local tumor progression (LTP), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression analyses were performed to assess risk factors associated with LTP and OS. Results HCC lesions (mean size, 1.9 ± 1.0 mm in diameter) abutting the gastrointestinal tract (n = 25), heart and diaphragm (n = 21), major vessels (n = 13), and gallbladder (n = 3) were treated. A significant difference was detected in LTP between the two groups (P = 0.034), with no significant difference in OS between the two groups (P = 0.193). There were no severe complications related to ablation. Univariate analysis revealed that sex (P = 0.046) and child-turcotte-pugh (CTP) grade (PPP = 0.005) was independently associated with poor OS, and RFA alone (P Conclusion CT-RFA combined with TAE assisted by a 3DVAPS provided ideal clinical efficiency for HCC in challenging locations and was a highly safe treatment modality.

Objective: This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience. Materials and methods: A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018. Results: Technical success was achieved in all patients; however, 3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage. No serious complications occurred during the follow-up. Conclusions: Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy. To improve the success rate of surgery, attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries. Keywords: Renal tumor, Postoperative hemorrhage, Selective arterial embolization

Objective: To investigate the safety and therapeutic efficacy of adjuvant cytokine-induced killer (CIK) cells to minimally invasive therapies in unresectable hepatocellular carcinoma (u-HCC). Materials and Methods: Hundred patients diagnosed with having u-HCC in our department from January 1, 2001, to July 31, 2018, were recruited. Forty-three patients received microwave ablation (MWA) and transcatheter arterial chemoembolization (TACE) together with autologous CIK cell treatment (TACE + MWA + CIK group), whereas 57 patients received TACE and MWA only (TACE + MWA group). Postprocedural complications and cumulative therapeutic effects were assessed in all patients. The disease control rate, median survival time (MST), and cumulative survival rate were compared between the cohorts using the Kaplan–Meier method and unpaired Student's t-tests. Results: The overall response (complete response [CR] + partial response [PR]) rate was 74.42% (32/43) and 77.19% (44/57) for TACE + MWA + CIK and TACE + MWA groups, respectively (P = 0.243). Those of the TACE + MWA + CIK group had better rates of disease control (CR + PR + stable disease) in contrast to the TACE + MWA group (87.72% vs. 79.07%, respectively) but this failed to achieve statistical significance (P = 0.748). Based on the Kaplan–Meier survival graphs, those of the TACE + MWA + CIK groups possessed markedly increased overall survival (41 months vs. 24 months, P = 0.002) and progression-free survival (17 months vs. 10 months, P = 0.023) rates in compared to the TACE + MWA group. Survival rates were raised also TACE + MWA + CIK group than in TACE + MWA group (P = 0.002), with a MST of 6.13 ± 0.83 months and 11.61 ± 1.59 months in the TACE + MWA + CIK and TACE + MWA groups, respectively. Patients in the TACE + MWA + CIK group were not reported to have any severe complications. Conclusion: CIK cell immunotherapy as an adjuvant to TACE and MWA enhanced long-term prognosis and improved quality of life in patients with u-HCC. This regimen may be recommended as a novel treatment regime in u-HCC patients.

Background: To assess the safety and efficacy of a combination therapy consisting of hepatic arterial infusion chemotherapy (HAIC) of Oxaliplatin, Fluorouracil, and Leucovorin (FOLFOX), tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) (TRIPLET) for patients with advanced hepatocellular carcinoma (HCC) in BCLC Stage C. Methods: This retrospective study was approved by the ethical review committee, and informed consent was obtained from all patients. 22 patients with initial presentation or recurrent HCC in BCLC Stage C received HAIC plus TKI plus ICI (TRIPLET) treatment from April 1, 2019, to April 30, 2020. The primary endpoint was objective response. The second endpoint were survival outcomes and safety. Findings: The best overall response was 59.1% per RECIST 1.1 and 81.8% per mRECIST. The median duration of response was 9.83 months per mRECIST. The DCR was 100% per both RECIST and mRECIST. Complete response (CR) was achieved in 7 patients (31.8%) per mRECIST. The median overall progression free survival (PFS) time in the cohort was 11.17 months (95% CI 5.87 - 16.46) per mRECIST. The estimated 6- and 12-month overall PFS rates were 82.7% and 42.7%, respectively. The estimated 6- and 12-month OS rates were 93.8% and 93.8%, respectively. Grade 3 adverse events occurred in 15 patients (68.2%) and were all reversible. Grade 4 adverse events occurred in 4 patients (18.2%) all with transient bone marrow suppression. Conclusion: HAIC plus TKI plus ICI (TRIPLET) has promising survival benefits in the management of advanced hepatocellular carcinoma in BCLC Stage C with tolerable safety. Funding Statement: This work was supported by the Guangzhou Science and Technology Program, civic technology research plan (No. 201903010037). Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: The informed consent was obtained from all patients. All patients were followed up under the hospital ethics committee approval of SYSUCC (B2020-243-01). The principles of the Declaration of Helsinki were followed.

To evaluate the incidence, risk factors and clinical significance of four types of tumor progression (TP) after microwave ablation (MWA) of single hepatocellular carcinoma (HCC) of p = 0.492, 0.971, 0.681 and 0.219). Univariate analysis showed that age (p < 0.001, hazard ratio [HR] = 2.783), comorbidities (p = 0.042, HR = 1.864), IDR, AIR and EDR (p = 0.027, HR = 1.719; p = 0.001, HR = 3.628; p = 0.009, HR = 2.638) were independently associated with OS. Multivariate analysis showed older age (p < 0.001, HR = 2.478), the occurrence of AIR (p < 0.001, HR = 2.648) and the occurrence of EDR (p = 0.002, HR = 2.222), were associated with poor OS. The occurrence rate of IDR is the highest of all TPs following MWA of a single HCC of

BACKGROUND To report on the use of percutaneous hydrochloric acid (HCl) enhanced radiofrequency ablation (HRFA) for the treatment of large (maximum diameter ≥ 5 cm) hepatocellular carcinoma (HCC) in the caudate lobe. CASE SUMMARY Between August 2013 and June 2016, three patients with a large HCC (maximum diameter: 5.0, 5.7, and 8.1 cm) in the caudate lobe were treated by transarterial chemoembolization followed by computer tomography (CT) guided RFA using a monopolar perfusion RF electrode, which was enhanced by local infusion of 10% HCl at 0.2 mL/min (total volume, 3 to 12 mL). The output power of HRFA reached 100 W, and the average ablation time was 39 min (range, 15 to 60 min). Two patients each underwent one session of HRFA and one patient two sessions. After treatment, CT/magnetic resonance imaging showed that all the three lesions were completely ablated. There was no major complication. Two patients had asymptomatic bile duct dilatation. One patient died of tongue cancer 24 mo after ablation. The remaining two patients were alive and no area of enhancement is detected in the caudate lobe at 28 and 60 mo after ablation, respectively. CONCLUSION Percutaneous CT-guided HRFA is safe and efficacious in treating large HCC in the caudate lobe.

Objectives To develop a nomogram for the local tumor progression (LTP) in patients with early‐stage hepatocellular carcinoma (HCC) after computed tomography‐guided percutaneous microwave ablation (CT‐PMWA) and to assess clinical‐pathologic risk factors for individual LTP estimation. Furthermore, we compared the prognostic predictive ability for LTP between the nomogram and the traditional staging systems. Methods This retrospective study was approved by the institutional review board. Five hundred and forty treatment‐naïve patients with HCC according to the Milan criteria, who subsequently underwent CT‐PMWA were reviewed from 2009 to 2019. Baseline characteristics were collected to identify the risk factors for the determination of LTP after CT‐PMWA. The multivariate Cox proportional‐hazards model based on significant prognostic factors of LTP was used to construct the nomogram, which was then assessed for its predictive accuracy using mainly the Harrell's C‐index and time‐dependent area under the curve (tAUC). Results After a median follow‐up time of 28.7 months, 6.5% (35/540) patients had LTP. The nomogram was developed based on the tumor size, tumor number, Child‐Turcotte‐Pugh (CTP) grade, platelet, and alanine aminotransferase (ALT). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.799 (95% confidence interval (CI): 0.738, 0.860), and tAUCs of 0.844 (CI: 0.728, 0.895), that were greater than those of traditional staging systems. Internal validation with 1000 bootstrap resamples had a good C‐index of 0.735 (CI: 0.648, 0.816). Conclusions The nomogram model can be used to predict accurately LTP after CT‐PMWA for early‐stage HCC, as well as to assist physicians during the therapeutic decision‐making process., Local tumor progression (LTP) is a key criterion for evaluating the technical success of various thermal ablation techniques. Insufficient ablation margin is an independent risk factor associated with LTP, however, it is difficult to measure accurately. This normogram demonstrated higher predictive accuracy compared with traditional staging systems and may prove to be useful in centers that do not have the facilities for measuring ablation margin.

The aim of the study was to investigate the relationship between PD‐1 expression on the surface of CD4+ T cells and prognosis of patients with diffuse large B‐cell lymphoma (DLBCL). Sixty patients who were newly diagnosed with DLBCL and 39 healthy controls were enrolled. In CD4+ T cells of DLBCL patients, the median MFI of PD‐1 were 541.5 (range: 348.25–758.75), significantly higher than 250 (range: 211–326) in healthy controls (P

The aim of study was to explore the PD-1 expression on Treg cells and its association with T-NHL.137 patients newly diagnosed with T-NHL and 115 healthy controls were enrolled. The expression level of PD-1 was measured by flow cytometry at the time of diagnose and 3-8 course of treatment.Median fluorescence intensity (MFI) of PD-1 on Treg cells in T-NHL patients was significantly higher than that in healthy controls (P 0.001). MFI of PD-1 in medium/high-risk T-NHL patients were higher than that in low-risk patients (P 0.05). After treatment with Chidamide combined with chemotherapy, MFI of PD-1 significantly decreased (P 0.05). In patients with high PD-1 expression (percentage19.6% and MFI 580), EFS was significantly lower than patients with low PD-1 expression (percentage19.6% and MFI 580).The PD-1expression on peripheral blood Treg cells of T-NHL patients is related to the diagnosis, prognosis and treatment of disease.

// Xiao Han 1, * , Jing Ruan 1, * , Wei Zhang 1 , Daobin Zhou 1 , Dongsheng Xu 2 , Qiang Pei 1 , Mingqi Ouyang 1 and Mengxuan Zuo 1 1 Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730 2 Department of Hematopathology, CBLPath, Sonic Healthcare, Rye Brook, NY 10573, USA * These authors have contributed equally to this work Correspondence to: Wei Zhang, email: vv1223@vip.sina.com Keywords: diffuse large B-cell lymphoma, prognosis, CD16- monocyte/CD16+ monocyte ratio, mature neutrophil/cytotoxic NK&T cell ratio, CytoDiff flow cytometric system Received: November 02, 2016 Accepted: March 08, 2017 Published: May 12, 2017 ABSTRACT Background: Recent studies have suggested that variables related to host adaptive immunity and the tumor microenvironment may predict the outcome in patients with non-Hodgkin’s lymphoma. This study was undertaken to determine the prognostic value of peripheral blood leucocyte subpopulations in diffuse large-B-cell lymphoma patients. Methods: We prospectively analyzed the 16 leukocyte subpopulations using Cytodiff flow cytometric technique in a cohort of 45 diffuse large-B-cell lymphoma patients at a single institution between February and December 2014. The Cox proportional hazards model was used to evaluate prognostic factors for overall survival and progression free survival. Results: Diffuse large-B-cell lymphoma patients had decreased cytotoxic and non-cytotoxic NK&T cells as well as increased CD16+ monocytes, CD16- monocytes and mature neutrophils. The decreased CD16- monocyte/CD16+ monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio were related to poor progression-free and overall survival outcome in single and multivariate analysis. The co-constructed model using International Prognostic Index and mature neutrophil/cytotoxic NK&T cell ratio can also help discriminate the clinical outcome. Conclusions: The decreased CD16-monocyte/CD16+monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio predict poor prognosis in diffuse large-B-cell lymphoma patients. This finding provides a strong rationale for the study of cellular immunotherapy in B-cell lymphoma.