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Biomedical subjects

Y Q Yu

Publications and source records attributed to Y Q Yu.

At least 37 records · Page 2Linked to original sources
PubMed1995

Multimodality treatment in advanced primary liver cancer.

This paper reports the long-term results of multimodality treatment in 1639 patients with pathologically proven primary liver cancer (PLC) over the past three decades. In this series, patients in subclinical stage constituted 23.9% (391/1639), moderate stage 63.0% (1032/1639), and late stage 13.2% (216/1639). There were 381 patients (23.2%) with small PLC (< = 5 cm). The PLC was coexistent with liver cirrhosis in 86.4% (1416/1639). The 5-year survival after resection of PLC was 45.5% for the whole series (n = 896), and 62.7% for patients with a tumor < = 5 cm (n = 345). The 5-year survival after hepatic artery ligation (HAL) and hepatic artery infusion (HAI) (n = 124) was 18.1%, while the 5-year survival after palliative resection (n = 175) was 12.5%. The 5-year survival of 40 patients receiving second-look resection after cytoreduction therapy was 68.4%. Cryosurgery was performed on 107 PLC patients, the 5-year survival being 22.0% for the whole series, and 48.8% for the 32 patients with small PLC. The 5-year recurrence rate after resection was 55.3%. The 5-year survival after reoperation for recurring tumor (n = 90) was 40.8%. It is suggested that surgery remains the modality of choice, and it plays a more important role in the treatment of PLC. The results of palliative surgery (HAL + HAI) seem better than those of palliative resection; combined multimodality treatment and second-look resection, and new surgical techniques might offer hope for unresectable advanced PLC.

Adolescent↗
PubMed1994

Recurrence after resection of alpha-fetoprotein-positive hepatocellular carcinoma.

The long-term prognosis of surgery for hepatocellular carcinoma (HCC) is not yet satisfactory, the main reason being the high recurrence rate. The authors report the results of a long-term follow-up of 308 patients with HCC who became alpha-fetoprotein-(AFP)-negative after resection between 1975 and 1991. By March 1992, there was recurrence in 134 patients (43.5%). The 1-, 3-, 5- and 10-year recurrence rates were 9.2%, 38.8%, 54.9% and 85.0%, respectively. The 5-year survival rate was 49.7% for patients who had undergone a second hepatic resection (n = 48). Analysis of factors influencing postoperative recurrence indicated that patients subjected to mass survey, with a lower gamma-glutamyltransferase level, at an early stage of TNM classification, with a tumour of less than 5 cm, without tumour embolus, and with postoperative immunotherapy had a lower incidence of recurrence. It is concluded that the earlier the disease is diagnosed, the less the recurrence rate; adjuvant immunotherapy may reduce postoperative recurrence, and the early detection and resection of a recurrent tumour are important to prolonging survival further after curative resection of HCC.

Adult↗
PubMed1993

Experience with liver resection after hepatic arterial chemoembolization for hepatocellular carcinoma.

The use of percutaneous transcatheter hepatic arterial chemotherapy and embolization in the treatment of primary liver cancer has become increasingly popular in recent years. The authors employed this method, using a combination of cisplatin, mitomycin C, 5-fluorouracil, and ethiodized oil (Lipiodol) or absorbable gelatin sponge in 30 patients with huge liver cancers (diameter range, 5.6-12.0 cm) as a preliminary treatment before liver resection. Significant tumor regression occurred after this treatment, converting these tumors into resectable lesions that were excised successfully later. Before surgery, chemoembolization was done once every 4-6 weeks. The patients underwent 1-5 treatment sessions (mean, 2.9) and then waited 1-4 months (mean, 2.4 months) before undergoing surgery. Alpha-fetoprotein levels decreased to normal in seven patients. The tumor diameters were reduced by 31.6 +/- 15.2% (2.3 +/- 1.2 cm) and the percent tumor necrotic area ranged from 40-100%. Adhesions of the tumor to the diaphragm and thickening of the hepatoduodenal ligament and gallbladder wall were the primary operative findings, but they did not significantly complicate the surgery. There was one postoperative death from acute pulmonary embolism. The 1-year, 2-year, and 3-year survival rates were 88.89%, 77.03%, and 77.03%, respectively. Although these patients still are being followed to assess their long-term survival, this treatment appears promising for patients with advanced huge liver cancers who hitherto have been denied surgery on grounds of unresectability.

Adult↗
PubMed1993

Resection of segment VIII of liver for treatment of primary liver cancer.

The close relationship of hepatic segment VIII to the right and middle hepatic veins and to the inferior vena cava makes liver cancer resection in this region extremely difficult. Resection of segment VIII was performed in 25 patients with primary liver cancer between January 1970 and May 1990. Most resections were performed with just porta hepatis occlusion, but some cases required the technique of total hepatic vascular exclusion, otherwise known as "bloodless hepatic resection." It involved control of both the suprahepatic and infrahepatic inferior vena cavae in addition to control of the porta hepatis. Major modifications to the original technique were made, and the 1-, 3-, and 5-year survival rates were 90.5%, 50.0%, and 37.5%, respectively. Two patients have survived 12 and 15 years, respectively. Both of them are alive to date and have returned to work.

Adult↗
PubMed1993

Subclinical hepatocellular carcinoma: an analysis of 391 patients.

Subclinical hepatocellular carcinoma (SCHCC) is defined as HCC without obvious HCC symptoms and signs. During 1958-1991, 391 patients with SCHCC were analyzed. In the entire series, 1) 67.3% was detected by natural population screening using alpha-fetoprotein (AFP) serosurvey, while the others were discovered by high-risk population screening or regular health checkup using AFP and/or ultrasonography (US); 2) AFP > 20 micrograms/L was found in 77.6% of patients; 3) serum hepatitis B surface antigen (HBsAg) was positive in 68.9%; 4) associated liver cirrhosis occurred in 89.1%; 5) the median tumor size was 5 cm, and small HCC (< or = 5 cm) amounted to 61.1%; 6) resection was done in 81.4%, and limited resection was performed in the majority (71.3%); 7) re-resection for subclinical recurrence was done in 44 patients; and 8) cytoreduction and sequential resection was carried out in 13 patients with unresectable SCHCC. Comparison between SCHCC and clinical HCC (n = 1,251) revealed higher resectability (81.4% vs. 46.8%), lower operative mortality (1.9% vs. 6.0%), and higher 5-year survival (entire series: 50.7% vs. 20.6%; resection: 60.5% vs. 36.8%). It is concluded that the study of SCHCC has resulted in marked improvement of ultimate outcome of HCC; screening in high-risk populations using AFP and/or US, limited resection, and re-resection for subclinical recurrence are some of the key features.

Adult↗
PubMed1993

The role of cryosurgery in the treatment of hepatic cancer: a report of 113 cases.

From November 1973 to June 1992, cryosurgery with liquid nitrogen (-196 degrees C) was performed on 113 patients with hepatic cancer, including 107 patients with primary liver cancer (PLC) and 6 patients with secondary liver cancer (SLC). Of the 107 PLC patients, the subclinical stage constituted 30.8% (33/107), the moderate stage 61.7% (66/107), and the late stage 7.5% (8/107). There were 32 cases with small PLC (up to 5 cm). Liver cirrhosis was observed in 86.0% (92/107). We designed flat cryoprobes for freezing tumors deep within the hepatic parenchyma. Intraoperative ultrasound was used for monitoring hepatic cryolesions. There were no operative mortalities and complications, such as rupture of a tumor, delayed bleeding, or bile leakage. The 5-year and 10-year survival rates were 22.0% and 8.2%, respectively, for the 107 PLC patients and 48.8% and 17.1%, respectively, for the 32 patients with small PLC. Of the 6 SLC patients, survival ranged from 2 months to 90 months (average, 23.2 months). One SLC patient has been well for 7 years and 6 months after cryosurgery. These results indicate that cryosurgery, the in situ freezing of cancer, is a safe and effective treatment for unresectable hepatic cancer.

Adult↗
PubMed1993

Surgical treatment of recurrent hepatocellular carcinoma.

During the last 16 years, radical resection was performed in 392 patients with hepatocellular carcinoma (HCC). Eight patients died within 30 days after resection. The other 384 patients were discharged from hospital and closely followed for 6 to 195 months. By December 1991, 185 patients had developed a recurrent tumor, the 1-, 3-, and 5-year recurrence rates being 15.0%, 45.4%, and 55.3%, respectively. Ninety of the 185 patients underwent reoperation, including second hepatic resection (65 cases), cryosurgery (8 cases), resection of lung metastasis (6 cases), hepatic artery ligation and infusion chemotherapy (2 cases), intratumor ethanol injection (3 cases), microwave coagulation plus intratumor ethanol injection (2 cases), and exploration (4 cases). The survival rate of these 90 patients was significantly better than that of 95 patients who were treated by other palliative methods, the 5-year survival rate being 63.4% as compared with 28.6% after the first resection (P < 0.01), and 40.8% vs. 2.2% after recurrence (P < 0.01), respectively. These results suggest that reoperation for recurrent HCC might be an important approach to prolonging survival further after hepatic resection.

Adult↗
PubMed1992

Analysis of one hundred and twenty five patients with primary liver cancer surviving more than five years.

During the period of 1958-1986, a series of 125 patients with pathologically proven hepatocellular carcinoma (HCC) surviving more than 5 years was collected in authors' institute. Thirty seven of them survived more than 10 years, the longest being 30 years. Of the entire series, 55.2% of patients was discovered by screening, 48.0% of patients was subclinical HCC, 80.0% of patients had solitary tumor, and 53.6% of patients had tumor size smaller than 5 cm. Pathological findings revealed that 90.2% of tumor was grade I and II (Edmondson grading) and 81.6% of patients associated with cirrhosis. The serum HBsAg was positive in 63% and anti-HBc in 80% of the patients who had checked the HBV markers. Of the 125 patients, 108 patients received resection, 67 patients were small HCC resection, 41 patients were non-small HCC resection, re-resection for subclinical recurrence or solitary lung metastasis was done in 26 patients with resection. Limited resection amounted to 54.6% of patients with resection. Of the 125 patients, 17 patients received palliative surgery other than resection, including hepatic artery ligation, cannulation, or their combination, etc. Eight out of the 17 patients received second stage resection due to marked shrinkage of tumor. It is concluded that early resection remained the major approach to get a long-term survivor, re-resection for subclinical recurrence is also of proved merit. Resection of huge tumor is still useful but less effective. Cyto-reduction and sequential resection is a new trend. Primary liver cancer (PLC) has long been recognized as incurable malignancy with extremely low 5-year survival rate. According to the cancer statistics in the United States, the relative 5-year survival rates for patients with PLC was 2% in 1960-1963, 3% in 1970-1973, 4% in 1974-1976, 3% in 1977-1980 and 5% in 1981-1986. Patients with PLC survived more than 5 years were rarely reported in the literature. In 1971, Curutchet collected worldwide data from 45 authors covering the period for 65 years (1905-1970), only 45 patients with PLC were found to be 5-year survivors. Thanks to the progress in tumor markers, particularly alpha fetoprotin (AFP) and new localization measurements, diagnosis and treatment are possible in subclinical stage. Based on combined strategies to the treatment of PLC including resection of small liver cancer, re-resection of subclinical recurrence after curative resection, multimodality treatment, and sequential resection after shrinkage of tumor, the 5-year survival of PLC has gradually increased.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Solitary minute hepatocellular carcinoma. A study of 14 patients.

Fourteen patients with clinical Stage I hepatocellular carcinoma (T1N0M0) were studied. All patients were asymptomatic, and their conditions were detected by alpha-fetoprotein (AFP) serosurvey and/or ultrasonography (US) either in the natural population in the early years of the study or in the high-risk population in the later years of the study. Cirrhosis was present in all patients. Radical resection was performed in all patients. There were no operative deaths or hospital deaths in this series. The 5-year survival rate after resection was 100%. There were seven long-term survivors in this series (14.2 years (alive), 11.3 years (alive), 8.8 years (alive), 8.8 years, 7.9 years, 7.6 years (alive), and 7.2 years after resection). The authors discuss aspects concerning early diagnosis, treatment, and prognosis of hepatocellular carcinoma (HCC).

Adult↗
PubMed1991

Resection of the primary liver cancer of the hepatic hilus.

Primary liver cancer (PLC) of the hepatic hilus was designated as a tumor situated at the main branch of the portal vein or pedicle of the hepatic veins in contact with the intrahepatic vena cava. That is, the main tumor located at segment I, IV, V, or VIII and concentrating on the central part of the liver was called "the central type of PLC," which differed from a tumor located at segment II, III, VI, or VII; the latter was called "the peripheral type of PLC." Surgical treatment of the PLC has been significantly improved in the past two decades, but the resection of the central type of PLC is difficult and hazardous. This institution admitted 903 PLC from January 1970 to April 1988, of which 118 cases were the central type; 65 cases were resected successfully, a resectability of 55.1%. One patient died from sepsis within 1 month of operation (mortality 1.53%). The modes of operation for the different segments are described, and suggestions for improvements are presented. The survival rates were compared with a similar number of patients with the peripheral type of tumor in the same period and treated by the same surgeons. The results show noticeable differences. The one-year, three-year, and five-year survival rates after resection were 70.9%, 43.2%, and 39.2% in the central type of PLC; they were 98.3%, 85.0%, and 76.4% in the peripheral type of PLC (P less than 0.001). Further discussion of improvements in surgical techniques and mental awareness are suggested.

Adenoma, Bile Duct↗
PubMed1991

Cytoreduction and sequential resection: a hope for unresectable primary liver cancer.

For decades, unresectable primary liver cancer (PLC) determined by operation was incurable. However, a retrospective study of 24 years' materials with unresectable PLC indicated that 5-year survival of unresectable PLC has increased from 0% in 1966-1977 (n = 137) to 16.9% in 1978-1989 (n = 345). This encouraging improvement was mainly a result of cytoreduction therapy followed by sequential resection. Multimodality combination treatment with hepatic artery ligation, plus hepatic artery infusion with chemotherapy, plus radioimmunotherapy (or radiotherapy) yielded the highest sequential resection rate (30.6%) and 5-year survival (28.0%) as compared with double combination and single modality treatment. The 5-year survival of 33 patients receiving sequential resection after cytoreduction therapy was 63.2%. It is suggested that cytoreduction and sequential resection might offer a hope for surgically verified unresectable PLC.

Adolescent↗
PubMed1991

Hepatic artery ligation and infusion chemotherapy for unresectable primary liver cancer.

During the period of 1958-1989, 356 patients with pathologically proven primary liver cancer (PLC) were determined by laparotomy to be unresectable. Of the 356 patients, 51 (14.3%) were of subclinical stage, 287 (80.6%) of moderate stage and 18 (5.1%) of late stage. The association of liver cirrhosis was present in 310 patients (87.1%). Treatment modalities in 356 patients were divided into 4 groups: hepatic artery ligation (HAL) (51), hepatic artery infusion (HAI) of chemotherapeutic agents (114), HAL + HAI (117), and HAL + HAI + radiotherapy (74). The 5-year survival rate was zero in the 4 groups in the period of 1958-1977. During 1978-1989, however, the 5-year survival rate was zero in HAL, 7.9% in HAI, 24.4% in HAL + HAI (with second look resection in 10 patients), and 36.5% in HAL + HAI + radiotherapy (with second look resection in 19). The marked improvement in survival in later period was attributable to the accurate site of hepatic artery catheter, longer infusion chemotherapy, and combination treatment, particularly second look resection in some of the patients. These results indicate that HAL + HAI + combination treatment might provide a possible prolongation of survival or even resection in some patients with original unresectable PLC.

Adolescent↗
PubMed1991

Current management of hepatocellular carcinoma.

After a long, hopeless period in the management of hepatocellular carcinoma (HCC), the diagnosis and treatment of HCC have progressed remarkably in the past decade. In particular the discovery of asymptomatic HCC in the early 1970s opened up a new era in clinical research of HCC. With the progress in the diagnostic imaging of liver tumors, a 1 cm hepatic mass can now be detected. It is especially worth noting that a 5-year survival rate of 72.9% has been achieved after the resection of the tumor in asymptomatic HCC patients. The role of surgery in the treatment of HCC has become more important. Various modalities of medical treatment and combination therapy have been recommended and used. Despite the progress in the early diagnosis and treatment of HCC, a complete cure is very rare. Problems to be studied include new tumor markers for the early detection of alpha-fetoprotein (AFP)-negative HCC, the development of more specific treatments for unresectable HCC with uncompensated cirrhosis, and an effective approach to preventing recurrence and metastasis after radical resection.

Carcinoma, Hepatocellular↗
PubMed1990

Radioimmunotherapy in the multimodality treatment of hepatocellular carcinoma with reference to second-look resection.

Experimental study using nude mice human hepatocellular carcinoma (HCC) xenograft indicated that the combination treatment with iodine 131 (131I)-anti-human HCC isoferritin (131I-isoFtAb), cisplatin, and mixed bacterial vaccine (MBV) yielded better inhibition rate as compared with double combination or 131I-isoFtAb alone. Based on these findings, 25 patients with surgically proven nonresectable and pathologically proven HCC have been treated by radioimmunotherapy using 131I-isoFtAb intrahepatic arterial infusion as a part of multimodality treatment. Of the 25 patients, seven (28.0%) received second-look resection after marked shrinkage of tumor. The 1-year survival was 52.5% (12/23) and 2-year survival 27.7% (five of 18) in the entire series. Of the five patients with 2-year survival, four were in the second-look resection group. Patients with tumor less than or equal to 8 cm showed higher second-look resection rate (62.5% versus 11.8%) and 1-year survival (85.7% versus 37.5%) as compared with tumor greater than 8 cm. Mixed bacterial vaccine as adjuvant immunotherapy seemed effective to prolong survival. The 2-year survival was higher in patients with second-look resection as compared with those without (75.0% versus 14.3%). Thus, radioimmunotherapy using 131I-isoFtAb might be one of the modalities of choice, particularly in the conversion of nonresectable to resectable HCC in a well-designed multimodality treatment regimen.

Animals↗
PubMed1990

Human pituitary somatotroph adenoma and prolactinoma: an ultrastructural and immunoelectron microscopical study.

17 cases of pituitary somatotroph adenoma and 38 cases of prolactinoma were studied with electron microscopy and immunoelectron microscopy using protein A-gold complex. 4 adenomas were shown by immunoelectron microscopy to contain simultaneously growth hormone (GH)-producing and prolactin (PRL)-producing cells. 6 cases were classified as densely granulated GH adenomas and 11 as sparsely granulated variant, whereas only 3 adenomas out of 38 prolactinomas were identified as densely granulated adenomas. The present study showed that not all cells with fibrous bodies possessed secretory granules positive for GH, and in some cells with fibrous bodies PRL-producing granules were also detected. Misplaced exocytosis was found frequently in the sparsely granulated prolactinomas. From these findings it may be suggested that fibrous bodies are not a morphological feature characteristic of pituitary somatotroph adenomas.

Adenoma↗
PubMed1989

Surgery of small hepatocellular carcinoma. Analysis of 144 cases.

A long-term follow-up study of 144 cases with surgically and pathologically proved small hepatocellular carcinoma (less than or equal to 5 cm) from 1967 to 1987 is reported. One hundred eight cases (75.0%) were detected by alpha-fetoprotein serosurvey and/or ultrasonography mainly in a high-risk population; 129 cases (89.6%) coexisted with cirrhosis. Resection was done in 132 cases (91.7%) with three (2.3%) operative deaths; cryosurgery, laser vaporization, and hepatic arterial chemotherapy were used in the rest. Limited resection was done in 67.4% of resections. Reresection of subclinical recurrence or solitary pulmonary metastasis was done in 21 cases. The 5-year and 10-year survival rates were 67.9% and 53.4% in the resection group but zero in the nonresection group. Survival was correlated negatively with tumor size, 5-year survival after resection was 84.6% in tumors less than or equal to 2 cm but 59.5% in tumors of 4.1 to 5 cm. The increase of resectability and reresection resulted in marked improved of 5-year survival from 43.5% in 1973 to 1977 to 63.3% in 1978 to 1982 in the entire series. No significant difference was found between survival of limited resection and lobectomy. Resection may be the modality of choice for treatment of small hepatocellular carcinomas with compensated liver function. Limited resection instead of lobectomy was the key to increased resectability and decreased operative mortality in cirrhotic livers. Reresection of subclinical recurrence was important to prolong survival further.

Adult↗
PubMed1989

Long-term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years.

From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people's Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow-up varied from 10 years and 1 month to 26 years and 7 months, with a mean follow-up of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 X 8 X 6 cm in size and underwent local resection. Upon follow-up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha-fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long-term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.

Adult↗