DSA analysis of hepatic arteriovenous fistula concurrent with hepatic cancer and its clinical significance

Hepatic Arterioportal Fistula Is Associated with Decreased Future Liver Remnant Regeneration after Stage-I ALPPS for Hepatocellular Carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) patients often developed hepatic arterioportal fistula (APF). The aim of this study is to evaluate the impact of APF on future liver remnant (FLR) regeneration and surgical outcomes after the first stage of associating liver partition and portal vein ligation for staged hepatectomy (stage-I ALPPS).

METHODS

Consecutive HCC patients who underwent ALPPS at our center between March 2017 and May 2019 were retrospectively studied. Data for the association between APF and clinicopathological details, liver volume, and surgical outcomes were analyzed.

RESULTS

The enrolled 35 HCC patients were divided into three groups: 15 patients with preoperative APF were classified as the APF I group, 10 patients developed APF after stage-I ALPPS as the APF II group, whereas the other 10 patients without APF before and after stage-I ALPPS as the control group. After stage-I ALPPS, patients in the APF I and APF II groups had lower kinetic growth rate (KGR) of FLR volume (6.1±3.2%, 11.4±8.4%, 25.0±8.8% per week, respectively, P<0.001) and took longer median time to reach the sufficient FLR volume for stage-II ALPPS (17.5 days, 12 days, 6 days, respectively, P<0.001) than those in the control group. Meanwhile, the incidence of posthepatectomy liver failure (PHLF) in the APF I and APF II groups was significantly higher than that of the control group (P=0.007). There are 27 (77.1%) patients who completed stage-II ALPPS. The overall survival (OS) rates at 1 and 3 years were 59.3% and 35.1%, whereas the disease-free survival (DFS) rates at 1 and 3 years were 44.4% and 22.9%, respectively.

CONCLUSIONS

Hepatic APF is significantly associated with decreased FLR regeneration and a higher risk of PHLF after stage-I ALPPS. HCC patients who are to undergo ALPPS may benefit from the timely perioperative intervention of APF.

Study on hepatocelluar carcinoma-associated hepatic arteriovenous shunt using multidetector CT

AIM: To investigate multidetector CT (MDCT) findings of hepatocelluar carcinoma (HCC)- associated hepatic arteriovenous shunt (HAVS) and to evaluate their clinical significance.

METHODS: Thin-slice and dynamic enhancement MDCT of HAVS was performed on 56 patients with HCC. MDCT findings, including those of portal veins, hepatic veins, superior mesenteric veins, splenic veins, HCC foci, liver parenchyma without HCC foci, spleens, and thromboses in portal veins and hepatic veins, were all confirmed by digital subtract angiography and analyzed.

RESULTS: MDCT demonstrated earlier enhancement of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n = 31). One patient had strong early enhancement of left hepatic vein with thromboses in left hepatic vein and upper part of inferior vena cava and 1 patient had transient patchy enhancement peripheral to HCC foci in late hepatic arterial phase among them. It demonstrated stronger opacification of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins (n = 18), and earlier enhancement of the second order and smaller branches of portal veins than that of main portal trunks (n = 4), stronger opacification of the second order and smaller branches of portal veins than that of main portal trunks (n = 3), with transient patchy enhancement (n = 3) or wedge-shaped enhancement (n = 4) peripheral to HCC foci in late hepatic arterial phase. Enhancement degree of HCC foci was all decreased. As for 49 patients with severe or moderate shunts, enhancement degree of liver parenchyma without HCC foci was increased with heterogeneous density, but enhancement degree of spleens was decreased. There were thromboses in main portal trunks and/or the first order branches in 32 patients.

CONCLUSION: The main MDCT findings of HCC-associated HAVS are earlier enhancement and stronger opacification of portal veins and/or hepatic veins. Understanding of these findings will contribute to the diagnosis and prognosis of the disease and improve therapy for the patients.

Hepatic artery infusion of adriamycin combined with hemoperfusion in dogs

AIM

To observe the concentration of circulating ADM and its side effects by hepatic artery infusion of Adriamycin(ADM) combined with hemoperfusion (HP).

METHODS

ADM was infused through the dogs hepatic artery. At the same time, the femoral artery and femoral vein catheters were inserted and HP(NK-107 resin (HPI) and Japanese activated charcoal(HP II) as adsorbents) was performed. The concentration of circulating blood ADM was determined and blood routine, myocardiac enzymes, liver and kidney function were observed.

RESULTS

The plasma concentration of ADM at 1 h, 2 h; 3 d and 14 d in HP I, II groups (89±9, 60±15, 21±5, 10±2; 99±14, 61±13, 26±5, 12±2 mg.l^-1) were decreased apparently as compared with the control group (312±23, 237±12, 116±15, 58±8 mg.l^-1) (P<0.01). After HP 24 h (0.9±0.4, 11.9±6.4, 1.0±0.3; 1.1±0.3, 4.3±3.7, 1.9±0.6 μkat.l^-1) and 72 h (0.9±0.4, 8.2±4.5, 0.8±0.3; 1.1±0.1, 2.6±2.3, 2.7±2.3 μkat.l^-1), myocardiac enzymes (LDH, CPK-MB, α-HBDH) had no change (P>0.05). But in control group, after HP 24 h (1.6±0.2, 23.9±12.9, 2.7±0.3 μkat.l^-1), they began to increase (P<0.05) and increased markedly after 72 h (3.1±0.1, 33.7±10.4, 8.5±0.3 μkat.l^-1) (P<0.01) as compared with before HP (0.8±0.1, 11.1±10.7, 1.4±0.1 μkat.l^-1). Before and after HP, the peripheral WBC, RBC, Hb and Pt at 3, 7 and 14 d had no significant change (P >0.05). But in the control group WBC, Pt, RBC and Hb were lower than before (16.3±4.2×10⁹/L, 131±38×10⁹/L, 5.9±1.6×10¹²/L, 131±28 g/L) at 7 d (8.5±5.4×10⁹/L, 77±35×10⁹/L, 4.8±1.2×10¹²/L, 94±27 g/L) (P<0.05) and much lower than before at 14 d (6.2±4.4×10⁹/L, 69±39×10⁹/L, 5.2±1.6×10¹²/L, 109±28 g/L P<0.01). Before and after HP, no obvious changes were found in liver function (ALT, AST and TBil) and kidney function (BUN and Cr) (P>0.05).

CONCLUSION

ADM hepatic artery infusion combined with HP, using NK-107 resin and Japanese activated charcoal as adsorbents, can decrease the concentration of circulating blood ADM and its side effects.

Preparation of monoclonal antibody against apoptosis-associated antigens of hepatoma cells by subtractive immunization

AIM: To elucidate the expression of the apoptosis-associated molecules in human primary hepatocellular carcinoma (HCC) cells, and prepare the monoclonal antibodies (mAb) against the apoptosis-associated antigens of HCC cells.

METHODS: Human HCC cell line HCC-9204 cells were induced apoptosis with 60 mL•L^-1 ethanol for 6 h and their morphological changes were observed by transmission electron microscope. The cell DNA fragmentations were detected by Terminal Deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and the cell DNA contents by flow cytometry. Ten mice were immunized with ethanol-induced apoptotic HCC-9204 cells with the method of subtractive immunization, while the other 10 mice used as the control were immunized by the routine procedures. The tail blood of all the mice were prepared after the last immunization, and the produced antibodies were determined by the immunocytochemical ABC staining. The splenic cells of the mice whose tail blood sera-HCC-9204 cells serum reactions were most different between the apoptotic and the non-apoptotic were prepared and fused with the mouse myeloma cell line SP2/0 cells. The positive antibodies were selected by ELISA assay. The fusion rates of hybridoma cells and the producing rates of antibodies were calculated. The fused cells that secreted candidate objective antibody were cloned continually with the of limited dilution method, and then selected and analyzed further by the immunocytochemical ABC staining. The chromosomes of the cloned hybridoma cells that secreted objective mAb and the mAb immunoglobulin (Ig) subtype of the prepared mAb were also determined. The molecular mass of the mAb associated antigen was analyzed by Western blot assay.

RESULTS: HCC-9204 cells treated with 60 mL•L^-1 ethanol for 6 h, manifested obvious apoptotic morphological changes, the majority of the cells were TUNEL-positive, and the sub-G1 apoptotic peak was evident. There were 2 mice in the experimental group whose tail blood serum reacted strongly with the apoptotic HCC-9204 cells, but weakly with their non-apoptotic counterparts. In the fusion rates of hybridoma cells as well as the producing rates of the antibody deseribed above, there did not show significant difference between the experimental and the control group, but weakly with non-apoptotic HCC-9204. However, the total producing rate of antibodies in the experimental group was significantly lower compared with the control (P < 0.01), and so was the producing rate of the antibodies which reacted strongly with both apoptotic and non-apoptotic HCC-9204 cells (P < 0.01). After cloned continually for several times the cell that produce mAb which reacted strongly with the nuclei of ethanol-induced apoptotic HCC-9204 cells, but very weakly with that of non-apoptotic cells was selected out. Chromosome analysis revealed that the selected cell was with the universal characteristics of the monoclonal hybridoma cells which secreted mAb, and the Ig subtype of the prepared mAb was IgG1. The molecular mass of this mAb associated antigen of was about 75 ku.

CONCLUSION: Subtractive immunization is a useful method to prepare the mAb against the apoptosis-associated antigens of cells. The expression of some molecules increases to some extent in HCC-9204 cells in the process of apoptosis induced by low-concentration ethanol. The mAb that may be against ethanol-induced apoptosis-associated antigens of HCC cells was successfully prepared and primarily identified.