ABSTRACT
Objective:To evaluate the risk of HBV recurrence after liver transplantation in patients with end-stage hepatitis B related liver disease, and to explore the indications for antiviral therapy withdrawal.Methods:The data of HBV DNA, cccDNA in liver puncture tissues and peripheral blood in 31 patients after liver transplantation was retrospectively analyzed.Results:Among the 31 patients, 15 (48%) had detectable and quantified HBV DNA in liver biopsy tissue, while their HBV related serological indicators were negative, suggesting an occult HBV infection in some patients. The study found 15 out of 19 cases who were taking Entecavir were cccDNA negative (78.9%), compared to 5 out of 12 cases (41.6%) in Lamivudine regiment ( P=0.03). Conclusions:Hidden HBV infection can be detected by amplifying cccDNA and HBV DNA in liver puncture tissue by using ddPCR. Entecavir is superior to lamivudine in the clearance of cccDNA.
ABSTRACT
Objective@#To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer, and make a brief summary combining with the present study.@*Methods@#Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed, Cochrane Library, China National Knowledge Infrastructure(CNKI), Wan Fang Data, and VIP. Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale, then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3 software. Publication bias was analyzed by Stata 12.1 software.@*Results@#A total of 28 articles were finally included in the systematic review, including 23 case-control studies and 5 cohort studies. The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer(OR=1.70, 95%CI: 1.39~2.08, P<0.05)、colon cancer(OR=1.74, 95%CI: 1.36~2.23, P<0.05)、rectal cancer (OR=1.35, 95%CI: 1.02~1.80, P<0.05). The results showed a risk of colorectal cancer(OR=1.31, 95%CI: 1.14~1.51, P<0.05) and colon cancer (OR=1.20, 95%CI: 1.05~1.36, P<0.05) after cholecystectomy, but the risk is significantly less than the risk in patients with gallstone. And there is no relevance between cholecystectomy and the risk of rectal cancer(OR=0.89, 95%CI: 0.73~1.08, P>0.05).@*Conclusion@#There is a positive association between cholecystolithiasis and colorectal cancer, but cholecystectomy itself may be not the risk of rectal cancer.
ABSTRACT
Objective To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer,and make a brief summary combining with the present study.Methods Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wan Fang Data,and VIP.Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale,then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3software.Publication bias was analyzed by Stata 12.1 software.Results A total of 28 articles were finally included in the systematic review,including 23 case-control studies and 5 cohort studies.The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer (OR =1.70,95 ％ CI:1.39 ～ 2.08,P ＜ 0.05)、colon cancer (OR =1.74,95 ％ CI:1.36 ～ 2.23,P ＜ 0.05)、rectal cancer (OR =1.35,95 ％ CI:1.02 ～ 1.80,P ＜ 0.05).The results showed a risk of colorectal cancer (OR =1.31,95 ％ CI:1.14 ～ 1.51,P ＜ 0.05) and colon cancer (OR =1.20,95％ CI:1.05 ～ 1.36,P ＜ 0.05)after cholecystectomy,but the risk is significantly less than the risk in patients with gallstone.And there is no relevance between cholecystectomy and the risk of rectal cancer(OR =0.89,95％ CI:0.73 ～ 1.08,P ＞0.05).Conclusion There is a positive association between cholecystolithiasis and colorectal cancer,but cholecystectomy itself may be not the risk of rectal cancer.
ABSTRACT
Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.