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Peritoneal metastases (PM) are defined as the primary or secondary occurrence/progression of malignant tumor in peritoneum. PM were previously thought to be a terminal disease without effective treatment, with short survival and poor prognosis. With the change in the understanding of PM, the oncology communities regard it as a curable regional cancer metastasis, and create a comprehensive treatment technology system with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as the core, and establish professional PM treatment centers based on this. The professional PM treatment centers have significantly prolonged the survival of patients, and some patients can even achieve clinical cure. However, in China, there are very few professional PM treatment centers, but the number of PM patients is huge, and most of the patients can't receive professional treatment, resulting in poor survival and prognosis. Based on the cancer statistics in 2015 published by China National Cancer Center Registry and clinical outcome literature on peritoneal metastasis, this paper uses clinical epidemiology methodology to calculate the number of newly diagnosed patients with peritoneal metastasis, to estimate the number of specialized peritoneal cancer centers required, to provide data support for the promotion of professional treatment technology system for PM in our country, and to boost the development of peritoneal oncology.
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Objective:s To evaluate the impacts of prior surgical scores(PSS) on the clinical efficacy and perioperative safety of cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) for pseudomyxoma peritonei(PMP).Methods:From the comprehensive PMP database, we collect the cases treated for the first time by CRS+ HIPEC, to form this study cohort. The clinicopathological features, PSS, CRS+ HIPEC details, overall survival(OS), and serious adverse events(SAEs) are systematically analyzed, to study the correlations between PSS and OS or SAEs.Results:335 PMP cases received standardized CRS+ HIPEC in this study. The median OS is 58.2 months for PSS-0 patients, 63.7 months for PSS-1, and 55.4 months for PSS-2/3, with no statistically significant differences in OS among the different PSS groups(χ 2=0.499, P=0.779). Subgroup analysis by pathologic types also found no statistically significant differences among the different PSS groups. Moreover, no significantly statistical differences are observed in overall SAEs(χ 2=0.625, P=0.722), CRS-related SAEs(χ 2=0.267, P=0.901), and non-CRS-related SAEs(χ 2=0.677, P=0.715), among the different PSS groups. Conclusions:PSS does not pose significant impacts on the efficacy and safety of CRS+ HIPEC for PMP patients at experienced treatment center.
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Objective To study the clinical features,pathological characters,treatment and prognosis of patients with malignant solitary fibrous tumor (MSFT).Methods Retrospective analysis was made on the clinical data of 11 MSFT patients undergoing surgical resection in Beijing Shijitan Hospital from Jan 2010 to Dec 2017.Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier methods.Results One patient died of duodenal fistula within a month after surgery,and the other 10 patients recovered with no severe complications.Immunohistochemically,the tumor cells are all positive for CD34 (11/11) and vimentin (10/10) in a different degree.The median OS and DFS for the 10 patients were 49 and 26 months respectively.The 1-,3-,and 5-year OS rates were 89％,56％,42％ respectively.The 1-,3-,and 5-year DFS rates were 79％,34％,23％ respectively.Conclusion MSFT is a malignancy with high recurrence rate.Tumor recurrence was the main cause of death for patients with MSFT.
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Objectives@#To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.@*Methods@#The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis. A prognostic predictive nomogram was constructed and internally validated.@*Results@#115 patients were included. The median overall survival was 13.1 months, and 1-, 2-, 3-, and 5-year survival rates being 56.5%, 25.3%, 12.6%, and 8.1% respectively. Univariate and the following multivariate analysis identified completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival. The nomogram using these three factors showed a concordance index of 0.721 (95% CI: 0.669-0.773). The calibration curves for 1-, 2- and 3 -year survival probability showed a good consistency between actual observation and prediction.@*Conclusions@#The nomogram based on completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
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Objectives To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.Methods The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis.A prognostic predictive nomogram was constructed and internally validated.Results 115 patients were included.The median overall survival was 13.1 months,and 1-,2-,3-,and 5-year survival rates being 56.5％,25.3％,12.6％,and 8.1％ respectively.Univariate and the following multivariate analysis identified completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival.The nomogram using these three factors showed a concordance index of 0.721 (95％ CI:0.669-0.773).The calibration curves for 1-,2-and 3-year survival probability showed a good consistency between actual observation and prediction.Conclusions The nomogram based on completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
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Objective To investigate the possibility of perform depression screening with the patient health questionnaire (PHQ-9) in hepatocellular carcinoma patients,and to evaluate the prevalence of depression among these patients.Methods 186 hepatocellular carcinoma patients completed PHQ-9 and Hamilton depression scale (HAMD) from January 2015 to April 2015.60 patients randomly selected from these 186 patients received depression screening again with PHQ-9 in 7 to 14 days after the first survey.Results Cronbach's α coefficient of PHQ-9 was 0.869,the test-retest reliability 0.963,and the range of correlation coefficient of the nine items with the total score of the scale was 0.546-0.752 (P＜0.01).The sensitivity and specificity of PHQ-9 were 84.4％ and 95.7％ respectively.69(37.1％) cases of the 186 patients were detected with depression with PHQ-9,and mild,moderate and major depression were 41 (22.0％),21 (11.3％) and 7(3.8％) respectively.Conclusion PHQ-9 has been shown to have good reliability and validity for screening of depression in hepatocellular carcinoma patients.
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<p><b>OBJECTIVE</b>To explore the clinical and pathological factors influencing the prognosis of patients with hepatocellular carcinoma (HCC)(≤5 cm) after hepatectomy.</p><p><b>METHODS</b>Two hundreds and nineteen cases with HCC(≤5 cm) undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 and July 2013 were collected. The alpha fetoprotein (AFP) level, tumor number, tumor size (diameter), liver cirrhosis, vascular invasion, capsular invasion, differentiation, surgical methods, resection margin, the way of treatments, the situation of recurrence and time to recurrence were analyzed. Log-rank test and the stepwise Cox proportional-hazards models were used to compare the prognosis, respectively.</p><p><b>RESULTS</b>The 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3% respectively in all patients.Single factor analysis indicated that vascular invasion, capsular invasion, tumor size, hepatic vascular occult, liver cirrhosis, tumor differentiation, AFP, the way of treatments, the situation of recurrence and time to recurrence can affect the prognosis significantly (all P<0.05). The multifactor analysis showed that AFP, tumor differentiation, liver cirrhosis, capsular invasion, tumor size and the situation of recurrence and time to recurrence were independent prognostic factors (all P<0.05).</p><p><b>CONCLUSION</b>The prognosis of patients with HCC(≤5 cm) underwent hepatectomy are affected by multi-factors, such as AFP, tumor differentiation, liver cirrhosis, capsular invasion, tumor size and the situation of recurrence and time to recurrence.</p>
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Humans , Carcinoma, Hepatocellular , Diagnosis , General Surgery , Hepatectomy , Liver Cirrhosis , Diagnosis , Pathology , Liver Neoplasms , Diagnosis , General Surgery , Neoplasm Recurrence, Local , Prognosis , Proportional Hazards Models , Retrospective Studies , Survival Rate , alpha-FetoproteinsABSTRACT
<p><b>OBJECTIVE</b>To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>A total of 54 patients with HCC who underwent hepatectomy were divided into two groups: RIP group (regional ischemic preconditioning with continuous clamping, n=15) and HHV group (hemi-hepatic vascular inflow occlusion, n=39). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared.</p><p><b>RESULTS</b>The volume of intraoperative blood loss had significant difference between the two groups (P=0.039). One case (6.7%) in the RIP group and 17 cases (43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time (P>0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P>0.05) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006).</p><p><b>CONCLUSION</b>The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.</p>
Subject(s)
Humans , Ascites , Bilirubin , Blood Loss, Surgical , Blood Transfusion , Carcinoma, Hepatocellular , General Surgery , Constriction , Hepatectomy , Hepatic Artery , Ischemic Preconditioning , Length of Stay , Liver Neoplasms , General Surgery , Portal Vein , Postoperative PeriodABSTRACT
<p><b>OBJECTIVE</b>To explore the significance of resection margin and tumor number on survival of patients with small liver cancer after hepatectomy.</p><p><b>METHODS</b>We collected 219 cases with small liver cancer undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 to July 2013. The survival rates were compared by log-rank test between two resection margin groups (≥ 1 cm vs. <1 cm), different tumor number groups (single tumor vs. multiple tumors). We also performed a multifactor analysis by Cox model.</p><p><b>RESULTS</b>The 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3%, respectively, in all patients. The median survival time was 28 months in the group of <1 cm resection margin and 36 months in the group of ≥ 1 cm resection margin (P=0.249). The median survival time was 36 months in the group of single tumor and 26 months in the group of multiple tumors (P=0.448). The multifactor analysis also did not show significant effect of resection margin and tumor number on the patients' survival.</p><p><b>CONCLUSIONS</b>For small liver cancer, the resection margin of 1 cm might be advised. Increasing resection margin in further could probably not improve therapeutic effect. Standardized operation and combined treatment will decrease the negative influence of multiple tumors on overall survival.</p>
Subject(s)
Humans , Combined Modality Therapy , Hepatectomy , Liver Neoplasms , Mortality , Pathology , General Surgery , Survival Rate , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma (HCC) after preoperative transcatheter arterial chemoembolization (TACE).</p><p><b>METHODS</b>A retrospective case-matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients (82 patients with selective and dynamic region-specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma) was included in this study, in which 35 patients underwent TACE therapy, and a 1:2 matched control group of 70 subjects.</p><p><b>RESULTS</b>The patients of preoperative TACE therapy group had a higher level of γ-glutamyl transpeptidase before operation (119.52±98.83) U/L vs. (67.39±61.25) U/L (P=0.040). The operation time was longer in the TACE group than that in the control group but with a non-significant difference (232.60±95.43) min vs. (218.70±75.13) min (P=0.052). The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group (P>0.05). There were no massive hemorrhage, biliary fistula and 30-d death neither in the treatment group and matched control group.</p><p><b>CONCLUSIONS</b>Preoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region-specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.</p>
Subject(s)
Humans , Carcinoma, Hepatocellular , Therapeutics , Case-Control Studies , Chemoembolization, Therapeutic , Methods , Hepatectomy , Methods , Liver , Liver Neoplasms , Therapeutics , Operative Time , Preoperative Period , Recovery of Function , Retrospective Studies , gamma-GlutamyltransferaseABSTRACT
<p><b>OBJECTIVE</b>Hepatocellular carcinoma (HCC) is sexually dimorphic, with a significantly higher incidence in male. But it is not clear whether the women have a better prognosis than the men. The present study aimed to compare the short and long-term outcomes, postoperative recurrence and survival in female and male patients with HCC after hepatectomy.</p><p><b>METHODS</b>Clinicopathological data of retrospective analysis was performed on 40 female and matched 40 male HCC patients treated by hepatectomy in Cancer Hospital of Chinese Academy of Medical Sciences between May 2006 and May 2012 were retrospectively reviewed in this study. Patients were paired in terms of age, chronic hepatitis, Child-Pugh class, tumor size, histological differentiation, presence of satellite nodules and resection margin.</p><p><b>RESULTS</b>Hepatectomy was successfully performed in all 80 cases. There was no significant difference in intraoperative variables and postoperative outcomes between the female and male groups except the level of total bilirubin. The 1-, 3- and 5-year recurrence-free survival rates were 76.7%, 47.4% and 29.7% in the female group and 63.8%, 30.0% and 25.0% in the male group (P = 0.12). Corresponding overall survival rates were 92.2%, 81.5% and 55.4% in the female group and 97.4%, 55.2% and 39.0% in the male group (P = 0.04).</p><p><b>CONCLUSION</b>Certain gender differences might exist in HCC patients after hepatecomy, favoring females in the overall survival and the tolerance for liver injury.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Diagnosis , Pathology , General Surgery , Follow-Up Studies , Hepatectomy , Liver Neoplasms , Diagnosis , Pathology , General Surgery , Neoplasm Recurrence, Local , Prognosis , Retrospective Studies , Sex Factors , Survival RateABSTRACT
<p><b>OBJECTIVE</b>R0 resection, Pringle maneuver, intraoperative massive blood loss and perioperative blood transfusion have been definitely recognized to be surgery-related risk factors of recurrence of hepatocellular carcinoma (HCC) in recent years. The aim of this study was to investigate the post-operative risk factors of recurrence of HCC after control of the above mentioned risk factors.</p><p><b>METHODS</b>288 consecutive HCC patients underwent hepatectomy with selective regional vascular occlusion by the same surgical team. All patients had R0 resection, less than 800 ml blood loss and had no perioperative blood transfusion. The clinical and pathological factors were retrospectively analyzed.</p><p><b>RESULTS</b>The total 1-year, 3-year and 5-year disease-free survival rate (DFS) was 74.9%, 49.3% and 34.3%, respectively. Univariate analysis showed that serum gamma-glutamyl-transferase rise >55 U/L, AFP > 400 ng/ml, tumor diameter >5 cm, multi-focal lesions, satellite nodules, poor differentiation, microvascular invasion, envelope invasion, postoperative liver insufficiency, preoperative TACE and postoperative TACE were significantly associated with poor DFS. Multivariate Cox analyses revealed that tumor size, satellite nodules, poor differentiation, microvascular invasion and postoperative liver insufficiency were independent prognostic predictors associated with shorter DFS. According to the results of multivariate Cox analysis of 158 cases with at least one risk factor selected from the whole group, further analysis demonstrated that perioperative TACE was not significantly associated with the median DFS (P > 0.05 for all).</p><p><b>CONCLUSIONS</b>Selective regional vascular occlusion may effectively control the surgiury-related risk factors of recurrence of HCC. Tumor features are the main affecting factors of DFS. Preoperative or postoperative TACE do not benefit patients who received curative resection.</p>