ABSTRACT
Hepatocellular carcinoma(HCC) is one of the most common malignancies in the world. Liver resection and transplantation are currently the most important treatments,but the high recurrence rate of postoperative tumors significantly reduces long-term survival. Microvascular invasion(MVI) predicts the risk of postoperative tumor recurrence and is an independent risk factor for recurrence after resection. Furthermore,focusing on how the postoperative management can be improved on histopathologically confirmed patients with HCC with MVI,and the potential roles of using predictive tests to estimate the risk of presence of MVI,help in preoperative therapeutic decision-making in patients with HCC.
ABSTRACT
Objective To investigate the effect of preoperative carbohydrate antigen 19-9 (CA19-9) levels on the prognosis of hepatocellular carcinoma (HCC) patients with different α-fetoprotein (AFP) levels. Methods The medical records and follow-up data of 3 791 HCC patients undergoing hepatectomy in our hospital from Jan. 4, 2008 to Dec. 31, 2010 were prospectively collected. When 400 ng/mL was taken as the cut-off value of preoperative AFP level and 32 U/mL as the cut-off value of preoperative CA19-9 level, the patients were divided into four groups: double positive group (DP group), CA19-9 single positive group [SP (CA19-9) group], AFP single positive group [SP (AFP) group] and double negative group (DN group). The tumor characteristics of the patients in the four groups were compared. Kaplan-Meier analysis and log-rank test were used to analyze the overall survival (OS) and disease-free survival (DFS) of each group. Univariate and multivariate analyses were performed using Cox proportional hazards model to screen the independent factors influencing the prognosis of HCC patients. Results Patients in the four groups had different tumor characteristics. Compared with the DN group, the tumor maximal diameters of patients in the SP (AFP) and DP groups were significantly larger, the percentages of patients with Edmondson-Steiner grade III- were significantly higher and the positive rates of microvascular invasion (MVI) were significantly higher (P<0.01), and the proportion of multiple tumor in the DP group was significantly higher (P<0.05); while the tumor maximal diameter in the SP (CA19-9) group was significantly smaller (P<0.05), and the proportion of multiple tumor was significantly higher (P<0.01). The 1-, 3- and 5-year OS rates of patients in the DN group, SP (CA19-9) group, SP (AFP) group and DP group were decreased successively (P<0.01). The 1-, 3- and 5-year DFS rates of patients in the DN group were the highest (P<0.01), while those in the DP group were the lowest (P<0.01); there were no significant differences in the 1-, 3- or 5-year DFS rates between the SP (CA19-9) and SP (AFP) groups. The stratified analysis of preoperative AFP levels showed that the 1-, 3- and 5-year OS rates and DFS rates in the CA19-9<32 U/mL group were significantly higher than those in the CA19-9≥32 U/mL group. Multivariable analysis showed that AFP≥400 ng/mL, CA19-9≥32 U/mL, intraoperative bleeding≥600 mL, tumor maximal diameter≥5 cm, multiple tumor, absence of tumor capsule, MVI, and Edmondson-Steiner grade III- were independent risk factors of OS (P<0.05); hepatitis B surface antigen (＋), AFP≥400 ng/mL, CA19-9≥32 U/mL, tumor maximal diameter≥5 cm, multiple tumor, absence of tumor capsule, and MVI were independent risk factors of DFS (P<0.05). Conclusion Preoperative serum AFP≥400 ng/mL and CA19-9≥32 U/mL are independent risk factors of OS and DFS in HCC patients. Preoperative CA19-9 level is an important indicator to further assess the prognosis of HCC patients with different AFP levels.
ABSTRACT
<p><b>BACKGROUND</b>The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome (SVCS). The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA).</p><p><b>METHODS</b>The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed. Of these, there were 14 males and 6 females (mean age of 59.1 years) with SVCS who received EBUS-TBNA that were included in the analysis.</p><p><b>RESULTS</b>The mean short axis diameter of the paratracheal lesions was (3.32 ± 1.79) cm (range, 1.69 to 9.50 cm) and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of (2.14 ± 0.49) cm (range, 1.73 to 3.01 cm). An average of 4.3 punctures was performed per lesion. Malignancy was confirmed in 16 cases (10 small cell carcinomas, 4 adenocarcinomas, 1 squamous cell carcinoma and 1 Hodgkin lymphoma). In two patients, pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up. One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC. One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin's lymphoma. The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.</p><p><b>CONCLUSION</b>EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.</p>