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Kakish H, Suraju MO, Davis ES, Seth A, Kwon YK, Aziz H. Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma. J Surg Oncol 2024; 129:1113-1120. [PMID: 38333997 DOI: 10.1002/jso.27599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The management of T2 multifocal hepatocellular carcinoma (MHCC) is controversial, and the comparative impact of liver resection (LR) versus tumor ablation (TA) on survival continues to be debated. The aim of our study was to examine short- and long-term survival for LR and TA in a nationally representative cohort. We hypothesized that patients who underwent LR would have improved survival. METHODS We utilized the National Cancer Database (2004-2015) to identify patients diagnosed with non-metastatic T2 MHCC. Kaplan-Meier survival curves were generated to compare 10-year overall survival (OS) between LR and TA patients. Kaplan-Meier analysis with stratification was also performed based on lymphovascular invasion, resection margin status, and Charlson-Deyo score. Cox proportional hazard models were used in multivariable analyses. RESULTS A total of 1225 patients met the inclusion criteria. 991 patients received LR, and 234 received TA. The majority of patients were male, White, and older than ≥60 years old. Clinicodemographic characteristics were generally similar between LR and TA patients. Among patients who underwent LR, 84% had negative margins, and 17% had lymphovascular invasion. Mortality at 30 days was significantly higher among LR patients compared to TA patients (5.4% vs 0.0%, p < 0.001), with those having a Charlson-Deyo score ≥2 facing the highest risk at 7.3%. Nevertheless, 10-year OS for the LR cohort was 27.5% (95% confidence interval [CI]: 24.4%-30.8%) versus 14.7% (95% CI: 9.8%-20.7%, p < 0.001) for TA patients. In stratified analysis, survival benefit was statistically significant only among those with negative resection margin, no lymphovascular invasion, and Charlson-Deyo score ≤1. In multivariable Cox analysis, LR was independently associated with improved survival compared to TA (hazard ratio: 0.80; 95% CI = 0.67-0.95). CONCLUSION LR poses a higher long-term survival benefit than TA. Prospective studies are warranted to confirm these findings. Although our study patients are a highly selected group of multifocal T2 patients, it gives us a good insight into the fact that LR provides better outcomes if a transplant option is unavailable.
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Affiliation(s)
- Hanna Kakish
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mohammed O Suraju
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Erik S Davis
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Abhinav Seth
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Yong K Kwon
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Liu S, Zhou P, Shen Q, Qian G. Efficacy of microwave ablation with parallel acupuncture guided by ultrasound in treating single hepatocellular carcinoma in high-risk areas: A retrospective analysis of 155 patients. J Cancer Res Ther 2024; 20:547-554. [PMID: 38687924 DOI: 10.4103/jcrt.jcrt_1246_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To investigate the safety and short- and long-term efficacy of ultrasound-guided microwave ablation (MWA) with parallel acupuncture for treating single hepatocellular carcinoma (HCC) in high-risk areas. METHODS Retrospective analysis was performed on 155 patients with single hepatocellular carcinoma who underwent microwave ablation in our hospital between December 2015 and September 2016. Patients with a tumor distance of ≤5 mm from the risk area were included in the observation group. Patients with a tumor distance of >5 mm from the risk area were placed in the control group. The patients' preoperative general health status, tumor site, tumor size, follow-up data, disease-free survival rate, overall survival rates, local tumor progression, and intrahepatic distant recurrence rate were collected and analyzed. RESULTS The 1-, 3-, and 5-year overall survival rates for the observation group were 91.8%, 75.5%, and 59.2%, respectively. The 1-, 3-, and 5-year overall survival rates for the control group were 97.2%, 84.0%, and 66.0%, respectively. There were no significant differences between the two groups (P = 0.522). A tumor size of ≤20 mm (HR = 0.488, 95% CI = 0.254-0.940, P = 0.032) was an independent risk factor affecting the overall survival of patients with solitary HCC treated with MWA. The 1-, 3-, and 5-year recurrence-free survival rates for the observation group were 59.2%, 28.6%, and 18.4%, respectively, and those for the control group were 79.2%, 43.4%, and 31.1%, respectively. There was a statistical difference between the two groups (P = 0.007). Tumor size ≤20 mm (HR = 0.468, 95% CI = 0.303-0.723, P = 0.001), tumor location in a risk area (HR = 1.662, 95% CI = 1.121-2.465, P = 0.011), and an α-fetoprotein (AFP) level of <200 ug/L (HR = 0.612, 95% CI = 0.386-0.970, P = 0.036) are independent factors affecting the recurrence-free survival of MWA treatment for HCC. CONCLUSION Microwave ablation with parallel acupuncture guided by ultrasound is a safe and effective treatment for single hepatocellular carcinoma in high-risk areas.
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Affiliation(s)
- Sheng Liu
- Department of Interventional Ultrasound, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of China Naval Medical University, Shanghai, China
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Yang J, Cui L, Zhang W, Yin Z, Bao S, Liu L. Risk Models for Predicting the Recurrence and Survival in Patients With Hepatocellular Carcinoma Undergoing Radio-Frequency Ablation. Clin Med Insights Oncol 2024; 18:11795549231225409. [PMID: 38332774 PMCID: PMC10851722 DOI: 10.1177/11795549231225409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024] Open
Abstract
Background Hepatocellular carcinoma (HCC) patients have a poor prognosis after radio-frequency ablation (RFA), and investigating the risk factors affecting RFA and establishing predictive models are important for improving the prognosis of HCC patients. Methods Patients with HCC undergoing RFA in Shenzhen People's Hospital between January 2011 and December 2021 were included in this study. Using the screened independent influences on recurrence and survival, predictive models were constructed and validated, and the predictive models were then used to classify patients into different risk categories and assess the prognosis of different categories. Results Cox regression model indicated that cirrhosis (hazard ratio [HR] = 1.65), alpha-fetoprotein (AFP) ⩾400 ng/mL (HR = 2.03), tumor number (multiple) (HR = 2.11), tumor diameter ⩾20 mm (HR = 2.30), and platelets (PLT) ⩾ 244 (109/L) (HR = 2.37) were independent influences for recurrence of patients after RFA. On the contrary, AFP ⩾400 ng/mL (HR = 2.48), tumor number (multiple) (HR = 2.52), tumor diameter ⩾20 mm (HR = 2.25), PLT ⩾244 (109/L) (HR = 2.36), and hemoglobin (HGB) ⩾120 (g/L) (HR = 0.34) were regarded as independent influences for survival. The concordance index (C-index) of the nomograms for predicting disease-free survival (DFS) and overall survival (OS) was 0.727 (95% confidence interval [CI] = 0.770-0.684) and 0.770 (95% CI = 0.821-7.190), respectively. The prognostic performance of the nomograms was significantly better than other staging systems by analysis of the time-dependent C-index and decision curves. Each patient was scored using nomograms and influencing factors, and patients were categorized into low-, intermediate-, and high-risk groups based on their scores. In the Kaplan-Meier survival curve, DFS and OS were significantly better in the low-risk group than in the intermediate- and high-risk groups. Conclusions The 2 prediction models created in this work can effectively predict the recurrence and survival rates of HCC patients following RFA.
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Affiliation(s)
- Jilin Yang
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Lifeng Cui
- Department of Thoracic Surgery, Maoming People’s Hospital, Maoming, China
| | - Wenjian Zhang
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Zexin Yin
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Shiyun Bao
- The Second Clinical Medical College, Jinan University, Shenzhen, China
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China
| | - Liping Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, China
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China
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Preoperative Predictors of Early Recurrence After Liver Resection for Multifocal Hepatocellular Carcinoma. J Gastrointest Surg 2023:10.1007/s11605-023-05592-1. [PMID: 36857014 DOI: 10.1007/s11605-023-05592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/07/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Liver transplantation remains the optimal treatment for multifocal hepatocellular carcinoma (HCC). However, due to resource constrains, other therapeutic modalities such as liver resection (LR), are frequently utilized. LR, however, has to be balanced against potential morbidity and mortality along with the risks of early recurrence leading to futile surgery. In this study, we evaluated preoperative factors, including inflammatory indices, in predicting early (< 1 year) recurrence in patients who underwent LR for multifocal HCC. METHODS This was a post hoc analysis of 250 consecutive patients with multifocal HCC who underwent LR. RESULTS After exclusion of 10 patients with 30-day/in-hospital mortality, 240 were included of which 134 (55.8%) developed early recurrence. Hepatitis B/C aetiology, 3/ > more hepatic nodules and elevated alpha-fetoprotein (AFP) ≥ 200 ng/ml were significant independent preoperative predictors of early recurrence. The early recurrence rate was 72.1% when 2 out of 3 significant predictive factors were present. The conglomerate of all 3 factors predicted early recurrence of 100% with a statistically significant association between number of predictive factors and early recurrence (p < 0.001). CONCLUSION Better patient selection via the use of preoperative predictive factors of early recurrence such as hepatitis B/C aetiology, ≥ 3 nodules and elevated AFP ≥ 200 ng/ml may assist in identifying patients in whom LR is deemed futile and improve resource allocation.
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Lv S, Li S, Yu Z, Wang K, Qiao X, Gong D, Wu C. Application of the Preoperative Assistant System Based on Machine Learning in Hepatocellular Carcinoma Resection. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4757668. [PMID: 34608411 PMCID: PMC8487386 DOI: 10.1155/2021/4757668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
To conduct better research in hepatocellular carcinoma resection, this paper used 3D machine learning and logistic regression algorithm to study the preoperative assistance of patients undergoing hepatectomy. In this study, the logistic regression model was analyzed to find the influencing factors for the survival and recurrence of patients. The clinical data of 50 HCC patients who underwent extensive hepatectomy (≥4 segments of the liver) admitted to our hospital from June 2020 to December 2020 were selected to calculate the liver volume, simulated surgical resection volume, residual liver volume, surgical margin, etc. The results showed that the simulated liver volume of 50 patients was 845.2 + 285.5 mL, and the actual liver volume of 50 patients was 826.3 ± 268.1 mL, and there was no significant difference between the two groups (t = 0.425; P > 0.05). Compared with the logistic regression model, the machine learning method has a better prediction effect, but the logistic regression model has better interpretability. The analysis of the relationship between the liver tumour and hepatic vessels in practical problems has specific clinical application value for accurately evaluating the volume of liver resection and surgical margin.
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Affiliation(s)
- Shouyun Lv
- Occupational Health Department, Haikou Center for Disease Control & Prevention, Haikou 571101, China
| | - Shizong Li
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
| | - Zhiwei Yu
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
| | - Kaiqiong Wang
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
| | - Xin Qiao
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
| | - Dongwei Gong
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
| | - Changxiong Wu
- Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Haikou 570311, China
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Sulaiman AS, Gani RA, Hasan I, Lesmana CRA, Kurniawan J, Jasirwan COM, Kalista KF, Nababan SHH, Aprilicia G, Lesmana LA. Overall Survival of Hepatocellular Carcinoma Patients Underwent Radiofrequency Ablation (RFA) Treatment: a Retrospective Cohort Study from Two Referral Hospitals in Indonesia. J Gastrointest Cancer 2021; 53:632-640. [PMID: 34379264 DOI: 10.1007/s12029-021-00676-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the curative modality therapies commonly used for the early stage of HCC management. Although numerous studies have reported the outcome of RFA around the world, the data regarding the usage of RFA for the early and intermediate stage of HCC remains limited. Hence, the study aimed to report the survival rate of the early and intermediate stage HCC patients who underwent RFA in two tertiary referral hospitals in Jakarta, Indonesia. METHODS A retrospective cohort study was conducted in Cipto Mangunkusumo and Medistra multicenter hospital in Jakarta, Indonesia. The patients with HCC BCLC A and B who underwent RFA treatments between January 2015 to December 2017 were recruited for the study. Baseline characteristics of patients were collected from the medical record. Survival analysis was calculated using the Kaplan Meier. p value result was obtained from the log-rank test. Sub-analysis of factors associated with the survival was also included in this study. RESULTS There were 62 patients enrolled in this study (32.3% were BCLC A and 67.7% were BCLC B). Forty-six out of 62 patients (74.2%) were reported to have RFA as their first line of treatment, while 12 (25.8%) were reported to have a combination of RFA and other therapy modalities. All these patients were follow-up with an average duration of 27 months. The survival rate of liver cancer due to HCC for 12 and 36 months in patients who received RFA was 82.3% and 57.8%, respectively. Moreover, BCLC staging of liver cancer and response after RFA was significantly associated with survival. CONCLUSION RFA still can be used as initial modality therapy nor combination with another therapy for the early and intermediate stage of HCC. BCLC staging and response after RFA had shown to be the independent factors related to survival.
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Affiliation(s)
- Andri Sanityoso Sulaiman
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Rino Alvani Gani
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Irsan Hasan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Cosmas Rinaldi A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Chyntia Olivia Maurine Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Kemal Fariz Kalista
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Saut Horas Hotaguan Nababan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Gita Aprilicia
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Li Y, Xiao W, Gao Z. A systematic review and meta-analysis of radio frequency ablation and routine resection in the treatment of small hepatocellular carcinoma. J Gastrointest Oncol 2021; 12:770-780. [PMID: 34012665 DOI: 10.21037/jgo-21-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background This study sought to conduct a meta-analysis of the relevant literature on radiofrequency ablation (RFA) and routine resection in the treatment of small hepatocellular carcinoma (SHCC) in recent years, and to examine the clinical efficacy and safety of different schemes. Methods PubMed, The Cochrane Library, Embase, CNKI, Chinese biomedical literature, VIP Chinese journal and the Wanfang Database were used to comprehensively search for relevant papers on clinical control studies of RFA and the routine resection SHCC published between January 2008 and December 2019. The clinical efficacy and safety of different schemes in the treatment of SHCC were compared, including the overall survival rate within 1, 3, and 5 years, and the incidence of complications during treatment. A meta-analysis was undertaken using methods provided by the Cochrane Collaboration and RevMan 5.3 software. Results A total of 13 publications of studies were retrieved in which 2,384 patients participated. Of these patients, 1,256 (52.68%) were allocated to the RFA group and 1,128 patients (47.32%) to the conventional resection group. The effect size of the 1-year overall survival rate for the two groups was odds ratio (OR): 0.78 [95% confidence interval (CI), 0.43-1.38]; Z test: P=0.32. The effect size of the overall survival rate within 3 years was OR: 0.71 (95% CI, 0.48-1.05); Z test: P=0.07. The difference was not statistically significant. The 5-year overall survival rate of the RFA group and conventional resection group was OR: 0.55 (95% CI, 0.40-0.72). The OR value fell within the CI, excluding 1; Z test: P<0.0001. The difference was statistically significant. The incidence of complications in the RFA group during treatment was lower than that in the conventional resection group (OR: 0.45; 95% CI, 0.32-0.69). The OR value was within the CI, excluding 1; Z test: P=0.0002. The difference was statistically significant. Conclusions The short-term effect of RFA in the treatment of SHCC is basically the same as that of routine resection; however, the long-term effect is significantly lower than that of routine resection. RFA has a lower incidence of complications during treatment, and thus better clinical safety.
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Affiliation(s)
- Yu Li
- Department of General Surgery, PLA 942 Hospital, Yinchuan, China
| | - Weike Xiao
- Department of General Surgery, PLA 942 Hospital, Yinchuan, China
| | - Zhenrong Gao
- Department of General Surgery, PLA 942 Hospital, Yinchuan, China
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Zhou Y, Ding J, Qin Z, Wang Y, Zhang J, Jia K, Wang Y, Zhou H, Wang F, Jing X. Predicting the survival rate of patients with hepatocellular carcinoma after thermal ablation by nomograms. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1159. [PMID: 33241008 PMCID: PMC7576088 DOI: 10.21037/atm-20-6116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background To accurately predict the survival rate of patients with hepatocellular carcinoma (HCC) undergoing thermal ablation using nomograms taking early recurrence into account as a risk factor. Methods A total of 591 patients receiving percutaneous thermal ablation were included in this study. The overall survival (OS) and recurrence-free survival (RFS) rate was analyzed. Two prognostic nomograms with or without taking early recurrence into account as a risk factor were constructed using the independent predictors assessed by the multivariate Cox proportional hazard model. The performance of the nomograms, in terms of discrimination and calibration, was evaluated. Results The cumulative RFS and OS rates at 1-, 3- and 5-year are 82.2%, 52.5%and 38.4%, 96.6%, 83.6% and 65.5%, respectively. Multivariate analysis without considering the early recurrence shows that tumor number, α-fetoprotein (AFP) level, liver function, and GGT level are associated with OS. The early recurrence, tumor number, AFP level, and liver function are considered associated with the OS when considering early recurrence. Two different nomograms were developed from the above two results. Internal validation with 1,000 bootstrapped sample sets of the two nomograms shows the concordance indexes of 0.69 (95% CI: 0.624-0.748) for the baseline nomogram and 0.81 (95% CI: 0.754-0.857) for the early recurrence-based nomogram, with the latter significantly better in discriminating performance (Z statistics =92.19, P<0.0001). Conclusions The survival rate of patients with HCC undergoing radical thermal ablation can be reliably predicted by the nomogram presented in this study, which was developed by taking early recurrence into account.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Zhengyi Qin
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Yijun Wang
- Department of Hepatobiliary Surgery, Tianjin Third Central Hospital, Tianjin, China
| | - Jiayi Zhang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Kefeng Jia
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Fengmei Wang
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
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