Objective: To investigate the indication and value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The clinicopathologic and follow-up data of 335 patients with HCC and PVTT were retrospectively analyzed. Of the patients, 273 cases underwent surgical treatment that included anatomic or non-anatomic liver resection (HR) plus PVTT removal (HR group), and 62 cases were subjected to transcatheter arterial chemoembolization (TACE) treatment (TACE group). The post-treatment survival between the two groups of patients was compared. Results: The median survival time for HR group and TACE group was 4.46 and 5.65 months, respectively, which had no significant difference (P=0.455); the 6- and 12-month survival rate for HR group was 30.7% and 12.1%, for TACE group was 38.7% and 19.2% respectively, which also showed no significant difference (both P>0.05). Conclusion: Concomitant PVTT in HCC is not a surgical contraindication, for which HR is safe and feasible, but offers no obvious survival advantage, so the option of surgical treatment should be considered cautiously according to the individualized assessments. The overall therapeutic effectiveness on this condition can be improved by the development of multi-disciplinary team (MDT) and precise medicine model in HCC treatment.

Objective: To investigate the surgical treatment for patients with hepatocellular carcinoma (HCC) and concomitant portal vein tumor thrombus (PVTT) and the efficacy. Methods: The clinical data of 68 HCC patients with PVTT treated from January 2010 to January 2013 were retrospectively analyzed. Of the patients, 50 cases underwent surgical treatment (regular hemihepatectomy plus involved portal vein resection, or irregular liver resection and PVTT removal) followed by transcatheter arterial chemoembolization (TACE) (combination treatment group), and 18 cases received treatment of oral sorafenib only (sorafenib treatment group). PVTT involved the second- or lower-order portal vein branches in 11 cases, and involved the first-order portal vein branches in 39 cases in combination treatment group, and all cases in sorafenib treatment group had PVTT in the first-order portal vein branches. The 0.5-, 1-, 2-, and 3-year survival rate, overall survival (OS) and time to tumor progression (TTP) of the patients were analyzed. Results: In combination treatment group, the 0.5-, 1-, 2-, and 3-year survival rate for patients with the second- or lower-order portal vein branch involvement was 100%, 90.9%, 18.2% and 9.1%, and for patients with the first-order portal vein branch involvement was 87.2%, 51.3%, 15.4% and 5.1%, which for patients in sorafenib treatment group was 83.3%, 33.3%, 0% and 0%, respectively. In combination treatment group, the median OS and TTP for patients with the second- or lower-order portal vein branch involvement was 16 and 7 months, and for patients with the first-order portal vein branch involvement was 12 and 5 months, which for patients in sorafenib treatment group was 9 and 4 months, respectively. Statistical analysis showed that both median OS and TTP for patients either with the second- or lower-order portal vein branch involvement, or the first-order portal vein branch involvement were significantly longer than those for patients in sorafenib treatment group (all P<0.05). Conclusion: Surgical resection followed with TACE treatment can be performed in patients with advanced HCC and PVTT involving the first- or lower-order portal branches, which may offer better efficacy than lone sorafenib administration.

Objective: To investigate the efficacy of anatomic right trisegmentectomy for huge or multifocal right hepatic hepatocellular carcinoma (HCC). Methods: Twelve patients with huge or multifocal right hepatic HCC tumors underwent anatomic right trisegmentectomy with preservation of segment V or VIII, in whom the preoperative CT-based liver volumetry suggested that the percentage of future liver remnant volume (%FLRV) would be insufficient for them after right hemihepatectomy, which could be increased by an average of 14.3% by right trisegmentectomy instead. During operation, the segment V or VIII was identified by use of selective hepatic inflow occlusion, and then a “┏┛” or “┕┓”shaped resection line was marked on the diaphragmatic surface of the liver; right hemihepatic or total hepatic inflow occlusion was used according to different resection plane to avoid ischemia/reperfusion injury during parenchymal transection. Results: Anatomic right trisegmentectomy was successfully completed in all patients, with an average operative time of 285 min and intraoperative blood loss of 720 mL. The tumors in all patients were completely resected, the inflow and outflow of segment V or VIII remained intact, no perioperative death occurred, and AFP level in all patients returned to normal range within 2 months after operation. Of the whole group of 12 patients, 10 cases were alive so far with a longest tumor-free survival for 3 years in one case; one case died of obstructive suppurative cholangitis, and one case died of multiple intrahepatic metastases and liver failure, while one case with left hepatic recurrence and 2 cases with lung metastases lived with tumor under comprehensive therapy, but in the remaining cases, no tumor recurrence or metastasis occurred, and liver function parameters and AFP level were in normal ranges. Conclusion: Anatomic right trisegmentectomy guarantees the maximum preservation of remnant functional liver tissue, so it can be a conventional operation for patients with huge or multifocal right hepatic HCC without segment V or VIII involvement, and thereby improves the overall resection rate of HCC.

Objective: To evaluate the efficacy of percutaneous thermal ablation in treatment of very early stage hepatocellular carcinoma (HCC) and the prognostic factors. Methods: The clinical data of 139 patients with very early stage HCC undergoing ultrasound-guided percutaneous thermal ablation from January 2007 to January 2010 were reviewed. The complete ablation rate, overall survival rate and disease-free survival rate were determined and the influential prognost0ic factors were analyzed. Results: In whole group of patients, the complete ablation rate was 97.84%; the average survival time was (70.10±28.87) months, and the 1-, 3-, and 5-year overall survival rates was 94.90%, 87.70% and 73.10%, respectively; the average disease-free survival time was (44.70±24.21) months, and the 1-, 3-, and 5-year disease-free survival rate was 90.60%, 61.90% and 43.20%, respectively. The results of univariate and multivariate analysis showed that age more than 60 years, disease-free survival time less than 2 years and extrahepatic metastases were independent risk factors for overall survival (all P<0.05); hepatitis C infection and preoperative high AFP level were unfavorable factors for disease-free survival (all P<0.05). Conclusion: Percutaneous thermal ablation is a safe and effective treatment modality for very early stage HCC. However, patients with an old age, short-term recurrence after operation, extrahepatic metastases, high preoperative AFP level and hepatitis C infection may face poor outcomes.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. At present, immunotherapy has become the fourth treatment for HCC following surgery, radiotherapy and chemotherapy. Many studies have proven that immunotherapy can improve the systemic immunological function to reduce the recurrence and metastasis of HCC and prolong the survival time for HCC patients. Dendritic cells (DC) are the most powerful antigen-presenting cells in vivo and play an important role in anti-tumor immune response. The DC-based immunotherapy including DC anti-tumor vaccine, DC-cytokine induced killer cells immunotherapy and DC immunotherapy combined with transcatheter arterial chemoembolization or photodynamic therapy has become the research focus in immunotherapy of HCC and also shown a promising direction. This review concentrates on the research progress of DC-based immunotherapy for HCC in recent years.

With the development and improvement in technology of diagnosis and therapy, the detection rate of liver fibrosis has been greatly improved and its reversibility has also been recognized by relevant studies. Here, the authors, based on the literature review and extraction, present the current advances in diagnosis and treatment of liver fibrosis.