Application Of Non-anatomical Hepatectomy Combined With Iodine-125 Seed Implantation In Liver Cancer With Microvascular Invasion

Hepatocellular carcinoma（HCC）,the fifth most common cancer in the world,is the second leading cause of cancer-related death.At present,hepatectomy and liver transplantation are the main treatments.The development of liver transplantation is limited due to the limitation of medical center conditions and organ shortage.At present,the main treatment of HCC is still hepatectomy.The hepatectomy is divided into anatomical resection and non-anatomical resection.There is no uniform standard for AR and NAR in clinical practice.Academician Liu Yunyi of the Medical College of the Chinese University of Hong Kong believes that hepatectomy should not only ensure sufficient incision margin,but also ensure sufficient residual liver tissue to avoid the influence of incomplete compensatory liver function on the postoperative recovery of patients.He believes that besides the tumors located around the liver and smaller or larger,they are in several segments of the liver.Non-anatomical resection was performed at the boundary,and anatomical resection should be performed in other cases.However,the current situation of HCC with cirrhosis restricts the development of AR in China,because AR needs more liver tissue resection than NAR,and whether there will be decompensation of liver function after the operation of residual liver tissue has become a problem to be considered.Microvascular invasion（MVI）is an important cause of high recurrence rate and poor prognosis.Because it can only be observed directly through a microscope,the post-operative pathological diagnosis is still the gold standard for its diagnosis.MVI occurs when cancer cells infiltrate the surrounding matrix and produce tumor-related cytokines.The secretion of cytokines changes the surrounding microenvironment of cancer cells,promotes the invasion of tumor cells into surrounding tissues,destroys vascular endothelial cells and invades microvessels.Then cancer cells colonize in vascular endothelium and form micro-cancer thrombus.With the increase,exfoliation and metastasis of cancer thrombus,metastatic foci are formed.The formation of new microvasculature is the pathway of cancer cell metastasis.Studies have shown that the concentration of vascular endothelial growth factor（VEGF）around hepatocellular carcinoma tissues is significantly increased,and vascular endothelial growth factor is beneficial to the formation of neovascularization and increases vascular permeability,which in turn increases the risk of tumor invasion.Because of the limitation of MVI detection before operation,the treatment of HCC combined with MVI mostly adopts AR or NAR with wide incision margin（the incision margin is greater than 1 cm）.NAR combined with radiofrequency ablation of liver section（RFA）is also applied.Postoperative remedies include transcatheter arterial chemoembolization（TACE）,TACE combined with 125I seed implantation,oral targeted drug Sofirani,etc.Antiviral therapy,interferon therapy,immunotherapy and biotherapy are also applied according to specific conditions.¹²⁵I seed implantation is a new method in the treatment of HCC in recent years.Studies have shown that ¹²⁵I seed implantation not only has long-term local killing effect on hepatocellular carcinoma tissue,but also can strongly stimulate the anti-tumor immune response of patients with hepatocellular carcinoma.In addition,125I seed can inactivate the signal of VEGF-A/ERK and inhibit the formation of neovascularization.This also provides a theoretical basis for 125I seed implantation in the treatment of HCC combined with MVI.In this study,we retrospectively analyzed the effect of NAR combined with 125I seed implantation on the prognosis of HCC patients with MVI.Objective:To explore whether combined ¹²⁵I seed implantation in Non-anatomical resection can prolong the survival time of HCC patients with MVI.Methods:A total of 184 cases of hepatocellular carcinoma patients were screened in our hospital from January 2010 to December 2012.Only 80 cases of Non-anatomical resection were performed,and 104 cases of liver cancer patients were treated with Non-anatomical resection combined with ¹²⁵I implantation.According to the standardized guidelines for diagnosis of primary liver cancer（2015 edition）,MVI was divided into M0 group,M1 group and M2 group.The preoperative gender,AFP,tumor number,Child-Pugh grading,intraoperative and postoperative status were compared,and the survival time of the patients were followed up.Results:There was no statistical significance in the preoperative,intraoperative and postoperative conditions of the three groups（P>0.05）.There was no statistically significant difference in the total survival time between the M0 group and the ¹²⁵I group（P>0.05）,and the difference in the total survival time between the M1 and M2groups（PM1=0.010 and PM2<0.001,respectively）.Conclusion:Non-anatomical resection combined with 125I implantation can prolong the survival time of HCC patients with MVI.